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Acne, Hair Loss, And The Microbiome
Can the trillions of bacteria living in our gut and skin influence our predisposition to acne and hair loss? Ten years ago, the answer was, “no.” But today researchers are changing their tune.
Evidence shows that the non-human bacteria living in (and on) us — known as our microbiome — helps regulate everything from our moods to our hormones… and maybe even our susceptibility to hair loss.
In fact, a study reveals that a bacterial strain known as propionibacterium acnes — a bacteria commonly associated with acne — may also contribute to a form of hair loss known as diffuse hair thinning.
This article reveals why.
First we’ll dive into the science behind the microbiome: why some bacteria cause infection while others don’t.
Then we’ll uncover the latest research on p. acnes — how this bacteria can trigger an inflammatory response, when p. acnes is associated with acne (and when it’s not), why p. acnes is also linked to hair loss, and whether p. acnes really causes hair loss… or is just an opportunistic invader of another symptom connected to hair thinning.
You might find this article helpful if you’re curious about…
- The connection between our microbiome, acne, and hair loss
- Why your acne blemishes always flare up in the same place, year after year
- Why most antibiotics fail to fight off p. acnes, and how they can increase acne severity in the long-run
- How to stop the over-colonization of p. acnes to reduce acne and keep your health (and hair) in check
Our Microbiome Affects Our Health (And Hair)
Our bodies are colonized by thousands of different microorganisms – bacteria, fungi, viruses, and even parasites. And these bugs are everywhere — from our gastrointestinal tracts to our skin and scalps.
In fact, our bodies are covered in at least as many non-human cells as we have human cells (don’t believe the old saying that we have ten times more bacterial cells than we do humans — those estimates are outdated!).
Many of these microorganisms are harmless. We call these “resident” bugs commensal microorganisms — and by definition, commensal microorganisms don’t cause infection.
Unfortunately, not all microorganisms are commensal. Some bacteria can hurt us — and even kill us.
Why Do Some Microorganisms Cause Infection, While Others Don’t?
It has to do with one thing: whether a bacteria triggers an inflammatory response from our bodies.
Some bacteria exist inside and around us — eating dead cells and partially digested foods. And as long as our bodies don’t perceive these bacteria as threats — we generally leave them alone.
But sometimes our bodies do find a bacteria threatening. This often isn’t the result of the bacteria… but rather, what the bacteria is doing (like eating our living tissues, or even releasing toxic byproducts).
And in order to understand how p. acnes is linked to acne and hair loss, we need to know exactly how “pathogenic” bacteria trigger our bodies into an inflammatory response.
So let’s illustrate this process with a familiar example: the bacteria that causes strep throat.
Example: Streptococcus Pyogenes, Inflammation, And Strep Throat
Strep throat is a bacterial infection in our throats that causes tonsil pain, fever, difficulty swallowing, and significantly swollen throat tissues. Here’s what happens:
Through food or fluid exchanges with an infected person, a bacteria known as streptococcus pyogenes enters our throats and begins competing against our commensal (safe) bacteria for resources — like dead cells and microorganisms. Eventually, streptococcus pyogenes beats out our commensal bacteria. Then it replicates. It rapidly colonizes our throats — reproducing quickly and in high numbers.
The problem: as streptoccocus progenes eats resources, it produces — as a byproduct — toxins. And as the colony grows, this bacteria produces higher levels of toxic byproducts.
By definition, toxins are poisonous. They can’t be easily digested. Some toxins even damage tissues. So in the presence of a toxin overload, our tissues sense cellular damage, and our bodies react by activating certain signaling proteins.
These proteins tell our bodies to begin a pro-inflammatory response — increasing blood flow to the damaged area — so that more blood floods the tissues (and inside that blood, more signaling proteins).
The result: tissue swelling. That painful, sore, difficult-to-swallow aching we get with strep throat.
But ironically, this “swelling” — which most doctors try to reduce — serves three critical purposes:
- The swelling is feedback that our signaling proteins are still at work, and that they’re still needed to repair injured cells, clear away cellular debris, and metabolize any tissues beyond saving. (Healing)
- The swelling clots our blood to prevent the infection from spreading. (Threat Localization)
- This swelling creates an environment where it’s harder for the infectious bacteria to survive. (Adaptive Immune Response)
That third point is important. These signaling proteins don’t just help us heal. They also attack the toxin-releasing bacteria. And if an infection is severe enough, these proteins will even tell our bodies to induce a fever — since many infectious bacteria can’t survive in climates hotter than our normal body temperature.
These “reactions” (which doctors call symptoms) persist until enough streptococcus pyogenes is eliminated and the toxin load reaches a safe level. Then our bodies begin an anti-inflammatory response — where new signaling proteins arrive to tell our tissues to stop swelling and clotting — and that the repairs are finished.
The end-result: the defeat of streptococcus pyogenes, and a resolution of all those painful symptoms.
And that’s how our bodies fight off pathogenic bacteria. We sense a toxin or tissue damage, signal a threat, send blood to the damaged area, clot and swell our tissues, fight the infection, repair the damages, and heal.
And that’s the major difference between pathogenic bacteria and commensal bacteria: pathogenic = inflammation; commensal = little to no inflammation.
Now that we know this, let’s dive into where the bacteria p. acnes comes into play — why it’s so invasive, how it’s linked to both acne and hair loss, and why our bodies have a hard time fighting off overgrowths.
P. Acnes: A Bacteria Linked To Acne & Hair Loss
The bacteria propionibacterium acnes (p. acnes) straddles the line between pathogenic (eliciting an inflammatory response) and commensal (harmless).
On one hand, p. acnes is one of the three major commensal genera that make up our skin microbiome (staphylococcus, corynebacterium, and propionibacterium). Propionibacterium (like p. acnes) are found on skin surfaces and deep within our hair shafts and sebaceous glands. In normal amounts, propionibacterium don’t elicit an inflammatory response.
On the other hand, p. acnes does elicit inflammation if it over-colonizes certain tissues. Specifically, our sebaceous glands (and hair follicles).
In fact, the over-colonization of p. acnes in sebaceous tissues is the connecting point between p. acnes, inflammation and acne (we’ll get to hair loss soon).
How P. Acnes Triggers Acne
Step #1: P. Acnes Colonizes Our Sebaceous Glands
Sebaceous glands are glands within our skin that secrete sebum — an oily bodily lubricant — into our hair follicles.
Sebum (the oil secreted by the sebaceous gland) lubricates our hair and skin. Sebum helps create a protective barrier between our skin and the rest of the world — specifically, pathogenic microorganisms.
Unfortunately, sebum can’t protect us from all microorganisms. Some microorganisms actually feed off of sebum… P. acnes is one of them.
P. acnes typically colonizes places where sebum production runs rampant — like our faces and hair. That’s why propionibacterium acnes is found in the ducts of our sebaceous glands. It’s as close to its food source (sebum) as it can get.
Unfortunately, this comes with consequences.
Step #2: P. Acnes Feeds Off Sebum And Cellular Debris
Once p. acnes enters the sebaceous gland, it has access to a plentiful supply of sebum and cellular debris. This allows p. acnes to thrive and reproduce freely.
This isn’t necessarily a problem… unless p. acnes grows too large. Why? Because when p. acnes grows, it also releases a number amount of metabolic byproducts, including…
- …more partially digested cellular debris
- …enzymes that break down more sebum (food for p. acnes) — which inadvertently damage the cells inside our sebaceous glands.
The end-result: increased sebum production (to replace the eaten sebum), increased cellular damage, increased cellular debris, and the rapid colonization of p. acnes as its food supply continuously replenishes.
At this point, we have a problem.
Step #3: Our Bodies React By Releasing Signaling Proteins
Similar to how our throats sense the toxic byproducts of streptococcus pyogenes, our sebaceous glands also sense the cellular damage created from p. acnes… and respond by releasing signaling proteins.
Here’s what happens: the skin cells surrounding our sebaceous tissues release pro-inflammatory signaling proteins — specifically, interleukins and tumor necrosis factor. And what do these proteins do?
Step #4: Those Proteins Kickstart An Inflammatory Response
A pro-inflammatory response begins… Our tissues near the sebaceous glands start to swell with blood.
This blood then carries more signaling proteins — which leads to more swelling. And just like the throat swelling with strep throat, sebaceous gland swelling helps us…
- Repair the tissues damaged by p. acnes,
- Kill off the invading bacteria, and…
- Clot our blood — so the “infection” doesn’t spread beyond the sebaceous gland
And what’s a consequence of this inflammatory response?
Step #5: The Inflammation Shows As Acne (Pimples)
That’s right. Acne (and pimples) are as simple as that: they’re a consequence of our body’s inflammatory response. And this inflammatory response is the result of the toxic byproducts produced by high numbers of p. acnes.
In other words, it’s not the p. acnes that causes the pimple… it’s our cells’ reaction to the byproducts of p. acnes that causes the pimple.
And that’s how p. acnes generates inflammation in the upper part of hair follicles — and is linked to acne.
This is also why we don’t get acne where there aren’t sebaceous ducts (and thereby hair follicles). For instance — we don’t get acne on our hands or the bottom of our feet — there are no sebaceous glands. If we do get acne here… it’s probably not acne — and we should go to a doctor.
So knowing this, where does the p. acnes-hair loss connection come into play?
How Is P. Acnes Connected To Hair Loss?
So far, p. acnes is associated with hair loss through…
- The release of molecules known as porphyrins, and…
- A case study analyzing thinning hair shafts and p. acnes infection
Let’s take these one-by-one.
P. Acnes, Porphyrins, Reactive Oxygen Species, & Hair Loss
Porphyrins are molecules produced by our bodies that help support aerobic (oxygen-dependent) life.
You’ve probably heard of the most well-known porphyrin — heme. Heme is responsible for the pigment in our red blood cells, and it’s a cofactor for hemoglobin — a protein that helps carry iron throughout our blood.
P. Acnes Releases Porphyrins
Interestingly, when p. acnes eats sebum inside the sebaceous gland, it also releases porphyrins. These porphyrin molecules are then activated by the sun (UV light) and produce something known as reactive oxygen species (ROS).
Porphyrins Make Reactive Oxygen Species (ROS)
Reactive oxygen species are oxygen-containing molecules that are so unstable, they need to immediately bind to nearby molecules. Unfortunately, when reactive oxygen species bind to these molecules, it often comes at a cost: the destabilization of enzymes and even cellular degradation. The end-result: inflammation.
Porphyrins & Reactive Oxygen Species (ROS) Are Linked To Pattern Hair Loss
Interestingly, porphyrins in the sebaceous canal are associated with pattern hair loss. In other words, this suggests pattern hair loss may be the result of long-standing inflammation.
But the more pertinent implication? Our bacteria inside the sebaceous canals — like p. acnes — increase porphyrins, ROS, and inflammation — which may contribute to the hair loss cascade.
So goes the p. acnes-porphyrin-hair loss connection… And now, two case studies may further solidify the case that p. acnes contributes to hair loss.
Case Study #1: P. Acnes In Thinning Hair Shafts
In 2012, A team of researchers evaluated four patients with non-scarring diffuse hair loss — with hair loss ranging from the typical “even” thinning in women… to the patchy hair loss in those with alopecia areata.
In addition to these patients’ thinning hair, each subject also suffered from “hair casts” — a condition characterized by dandruff-like casts encircling the hair shafts.
The investigators decided to take biopsies of the subjects’ hair follicles.
And what did they find?
Isolates of the bacteria p. acnes.
Or in other words, over-colonizations of the same bacteria that produce porphyrins, eat sebum, and cause an inflammatory cascade that results in acne.
Treatment Attempt #1: Anti-Dandruff Creams
The researchers attempted to treat the patients with standard anti-dandruff shampoos — but the hair casts (and hair loss) persisted.
Treatment Attempt #2: Antibiotics For P. Acnes
Then the subjects began a round of systemic antibiotics to target the p. acnes infection.
Within weeks, the hair casts disappeared. In addition, the patients reported either a slowing of hair loss, a stop in hair loss, or in one case — even hair regrowth (when combined with minoxidil).
Results: Hair Casts Disappear; Hair Loss Stops
Unfortunately, no hair count analyses were performed. Each patient’s hair growth was either self-reported or determined during a follow-up examination. So it’s tough to say just how much the removal of these hair casts (and thereby a reduction in p. acnes) helped with hair regrowth.
In any case, the clearance of hair casts are evident in the photos:
(a) and (b) show a patient with hair casts and diffuse hair loss; (c) shows a hair cast under a microscope; (d) shows clearance of the hair casts after treatment with antibiotics against p. acnes. (source)
The case study is interesting, but without more data, we can’t draw conclusions and say that p. acnes was the cause of hair loss for these patients…
…but the research implicating p. acnes in hair loss continues to grow — especially in the next case study.
Case Study #2: Calcification & P. Acnes
These researchers published a study of a patient with acne scars and a condition known as calcinosis cutis.
Calcinosis cutis is the abnormal deposition of insoluble calcium in and under the skin. And despite its brutal-sounding name, typically this calcification (and scarring) isn’t too visible on the skin surface.
Just look at this photo. Despite teenage (and adult) acne, the patient’s skin has relatively little scarring…
Unfortunately, this photo doesn’t show the full picture of soft tissue calcification. Because when researchers did a tomography scan for soft tissue calcification, here’s what they discovered:
Those white dots are all signs of soft tissue calcification. And that calcification is far more prevalent than what we see at the skin surface. In fact, this soft tissue calcification appears to have deposited in major acne sites — or in other words, places of inflammation likely triggered by p. acnes.
How Is Calcification Relevant To P. Acnes?
For one, p. acnes is a causative factor in acne. And this case study demonstrates that for some individuals, acne may result in soft tissue calcification deposits within our sebaceous glands.
That means we need to study the implication that p. acnes might also play some sort of role in this soft tissue calcification — and whether this soft tissue calcification is the difference between scarring and non-scarring acne.
Now, calcification might not be a widespread phenomenon for most acne sufferers… but we don’t yet know. To my knowledge, most acne sufferers aren’t lining up for facial tomography scans. And the reality is — soft tissue calcification might occur in a majority of those with acne… But we haven’t yet done the studies.
And without these studies, we can’t rule out that p. acnes might play some causal role in hair loss.
How Are Calcification, P. Acnes, And Hair Loss Connected?
Well, p. acnes doesn’t just live on our skin. P. acnes is also found in our arteries. And interestingly, p. acnes in our blood capillaries is associated with atherosclerosis (the hardening of arteries), which may lead to calcium deposits inside our arteries.
In balding men, calcification is also found in the blood capillaries supporting thinning hair follicles (but not in non-thinning hair follicles). In fact, this observation was first made in the 1920’s!
There’s also growing evidence that calcification precedes pattern hair loss, and that calcification might even be a consequence of elevated DHT (the hormone commonly associated with pattern hair loss).
The bottom line: we need to explore the relationship between p. acnes, inflammation, calcification, and hair loss further. But for now, all we know is that p. acnes can increase inflammation in the sebaceous gland, and that for some individuals, this inflammation may lead to soft tissue calcification.
Can We Reduce P. Acnes To Fight Acne (And Maybe Even Hair Loss)?
There are no easy answers here. But first, let’s start off with what not to do when suffering from p. acnes over-colonization (and thereby acne and potentially hair loss).
Conventional Treatments Fail To Reduce P. Acnes Effectively
Here’s how I define an “effective treatment”:
- The treatment must reduce p. acnes colonization (and thereby acne)
- The treatment must not lead to major unintended consequences to our health
Unfortunately, most conventional treatments fail on both categories. Here are two examples:
Failure #1: Antibiotics For P. Acnes
Systemic (oral) antibiotics are moderately effective at reducing p. acnes infection. In fact, this is why many doctors prescribe low-grade antibiotics like amoxycillin to fight off acne.
The good news is that during treatment, acne typically does reduce (and even go away completely).
But this comes with consequence. The problem is that p. acnes is everywhere. It recolonizes quickly after a round of antibiotics. And the p. acnes that survives antibiotic treatment typically builds a resistance to that antibiotic.
Problem #1: P. Acnes Becomes Antibiotic-Resistant
This is a bigger issue than most medical practitioners recognize. In fact, p. acnes resistance to antibiotics has grown from ~20% in the 1970’s to ~60% in the 1990’s — with new estimates suggesting as much as 80% of p. acnes are resistant to standard antibiotic treatment today!
Problem #2: This May Cause Recurring Acne Lesions From P. Acnes (Repeat Blemishes!)
The second issue is that once this antibiotic-resistant p. acnes recolonizes our sebaceous glands, it evokes the same inflammatory response: acne. Only this time, we can’t use antibiotics to treat it.
In fact, this is why so many people end up getting the same blemishes, in the same place, year after year. This type of acne recurrence is more typical in acne sufferers who have been treated with antiobiotics in the past! It’s the same p. acnes colony in the same sebaceous glands — overgrowing again and again.
Problem #3: Systemic Antibiotics Inadvertently Kill Other Bacteria — And Even Bacteria We May Need For Healthy Functionality
Research now reveals that certain microorganisms aren’t all bad. In fact, some bacteria even create symbiotic relationships with our bodies — increasing vitamin metabolism, dampening overactive immune responses, and even helping regulate hormone secretion, cognitive function, and even our responses to stress and anxiety.
Unfortunately, antibiotics don’t discriminate the bad from the good bacteria. They wipe out everything. And when it comes time to recolonize, you’re literally rolling the dice and hoping good bacteria will recolonize instead of bad bacteria.
Sadly, the dice often rolls against your favor. For instance, antibiotic abuse is now linked to the resurgence of a bacteria known as clostridium difficile, which killed 29,000 Americans in 2011. That’s over three times as many American deaths than the HIV/AIDS virus for the same year.
The bottom line: think twice about antibiotic use. It’s a short-term win with long-term consequences.
Failure #2: Accutane For P. Acnes
Accutane is the brandname of a drug known as isotretinoin — which is a synthetic derivative of a retinoid (or in other words, the animal form of vitamin A). Essentially, it’s similar to high oral doses of retinol (vitamin A).
Accutane (Isotretinoin) is extremely effective at reducing moderate-to-severe acne — even after treatment is stopped. Why? Because Accutane atrophies (and can even destroy) our skin’s sebaceous glands.
This reduces sebaceous gland functionality, which reduces sebum production. P. acnes eats sebum to survive. And with less sebum production, p. acnes has less food. That makes it more difficult for p. acnes to colonize (or over-colonize) a sebaceous gland — because there’s significantly less food for them.
The end-result: Accutane significantly reduces p. acnes colonization in the skin and in hair follicle ducts. And in doing so, it reduces sebaceous gland inflammation… and thereby reduces acne.
The good news: Accutane irreversibly atrophies our sebaceous glands, so that p. acnes colonization and acne lesions decrease for life.
The bad news: Accutane irreversibly atrophies our sebaceous glands, and is extremely toxic.
Side Effects Of Accutane Use: Depression, Autoimmune Disease, Liver Damage, And Pancreatitis
Properly diving into the dangers of Accutane would turn this 4,000 word article into a book. But the bottom line is this: Accutane is a synthetic derivative of retinol, and high dosages, retinol is extremely toxic.
Problem #1: Retinol Toxicity
In fact, retinol toxicity — or hypervitaminosis A — is why you should never eat polar bear liver. It’s extremely high in retinol, and our bodies can’t metabolize surging amounts of retinol all at once. If we try, our livers and pancreas will likely shut down.
Problem #2: Accutane Decreases Brain Activity In The Frontal Cortex
Accutane is synthetic — meaning it is a chemical derivative that mimics the look of natural-occurring retinoids. Our bodies don’t always read synthetic chemicals the same way they do their naturally-occurring molecular counterparts. And this “difference” tends to play out in Accutane’s effects on brain activity.
In fact, one study suggests that Accutane users experienced a 21% decrease in brain metabolism in the orbito-frontal cortex. This partly explains why Accutane users have to be monitored closely for depression and suicidal thoughts.
Problem #3: Accutane May Be A Trigger To Autoimmune Thyroid Disease
Accutane is also linked to increased incidences of irritable bowel syndrome and Crohn’s disease. With that said, the scientific consensus on association versus causation is still up for debate — and without a clear mechanism action, we can’t make any major claims.
However, Isotretinoin drugs (like Accutane) may also play a role in the development of autoimmune-based thyroid disease — at least according to this case study. But evidence here is still being explored.
Problem #4: Accutane Has Already Been Discontinued (But Not Really)
Since 2009, the brandname Accutane is no longer available as an acne treatment. This is the result of a series of class action lawsuits and litigation troubles for the drug maker, Roche USA.
But that doesn’t mean you still can’t get Accutane. In fact, Accutane is just one brand name for the drug isotretinoin. Isotretinoin is still available as a generic drug — and now comes packages as several other brand names.
So if you’re suffering from a p. acnes overgrowth and have acne (and maybe even hair loss), what should you do?
How To Fight P. Acnes Effectively (Without Drugs)
When it comes to fighting p. acnes — and fighting hair loss, too — there’s no “one size fits all” answer.
The causes of the p. acnes overgrowths are complex and multifaceted. As such, the treatments are complicated too. But if you’re suffering from acne (and maybe even hair loss), here are some good starting places.
Treatment #1: Eliminate Small Intestinal Bacterial Overgrowth
Our small intestines are used for nutrient absorption and are typically absent of large amounts of bacteria. However, psychological stress, a poor diet, and lacking sleep (among other triggers) can often lead to a condition known as Small Intestinal Bacterial Overgrowth (SIBO).
Small intestinal bacterial overgrowth (SIBO) is when bacterial colonies overgrow in the small intestine — which is typically devoid of significant amounts of bacteria and microorganisms. This leads to nutrient malabsorption and a host of other symptoms — from depression to acne and maybe even hair loss (expect an article on this soon).
Interestingly, people with acne rosacea are ten times more likely to suffer from SIBO than those without acne. In fact, practitioners who have successfully treated SIBO (like Chris Kresser) have stated that nearly 100% of the patients they treat for acne also test positive for SIBO.
Encouragingly, of the patients who are successfully treated for SIBO, their acne almost always disappears.
In fact, treating SIBO is my number one recommendation for reducing p. acnes overgrowths and eliminating acne (and possibly eliminating p. acnes as a hair loss trigger). If you prioritize any acne treatment, prioritize getting checked for SIBO, and then treating it effectively.
How To Test For (And Treat) Small Intestinal Bacterial Overgrowth
If you don’t have access to medical professionals who routinely treat complex cases of small intestinal bacterial overgrowth — like Chris Kresser or Dr. Amy Nett — I’d recommend you try following a protocol that’s proven successful (repeated times) for other individuals.
John Brisson of fixyourgut.com has had success treating many individuals with SIBO. In fact, I was referred to his work by a readers of this site who used John’s protocol to resolve his own SIBO symptoms. I respect John’s research and have no issues recommending him.
If you do attempt one of his protocols (which are published online for free), be sure you’ve properly diagnosed your type of SIBO. Testing information can also be found on his site.
Treatment #2: Reduce Sebum Production
Accutane is a drug that successfully reduces sebum production, but at the cost of unintended side effects. Is there a way to reduce excess sebum production without the use of isotretinoin drugs?
Yes. Let’s explore a few ways researchers are trying to do this.
#1: Topical Drugs That Reduce Sebum Production: Olumacostat Glasaretil
Olumacostat glasaretil (OG) is a drug that targets to reduce moderate-to-severe acne. It’s currently in human trials, and if approved, it’ll be the only acne-treatment drug that works exclusively by reducing sebum production.
OG is topically applied and works by inhibiting an enzyme called acetyl coenzyme-A carboxylase — which is needed to synthesize the fatty acids inside sebum. With less acetyl coenzyme-A carboxylase present, less sebum fatty acids are secreted to the skin, and thereby fewer p. acnes can colonize that skin.
Studies show that Olumacostat glasaretil significantly reduces sebum production and shows promise as an acne-treatment topical. The question remains: will it survive human trials without significant side effects? We won’t know for many months — but given acetyl coenzyme-A carboxylase’s importance in other organs of the body (like our livers) — the severity of side effects will probably depend on how much topically OG is systemically absorbed. For reference — I would never take this drug orally.
#2: Change Your Diet
Studies now demonstrate that sebum production is highly dependent on diet.
For instance, some studies show a strong correlation between excessive sebum production and carbohydrate-heavy westernized diets. Other studies speculate that high fat consumption — especially oxidized polyunsaturated fats — may also be linked to acne.
Which Diet Should You Try?
The reality is — I can’t tell you. Our microbiomes all vary. As such, each person’s system is going to respond differently to any particular diet. For reference, I had increased acne on a Standard American Diet, and persistent acne (and hair loss) while experimenting on a vegetarian (and then vegan) diet.
Ironically, I experienced increased sebum production on a low-carb paleo diet… but a significant reduction in acne. For the last few years I’ve been experimenting with a moderate carbohydrate paleo-based diet — which appears to be the best for me in terms of a cessation in hair loss, but I still get a little acne from time-to-time.
The bottom line is that you should start testing. A paleo-based model (with modifications) is currently what I’m following — and with success. But that doesn’t mean it will be the best solution for you.
Eat More (Unoxidized) Linoleic Acid
Sebum from acne-bearing skin appears to have less linoleic acid — a fatty acid from the omega 6 family. Linoleic acid is an essential fatty acid — which means our bodies can’t produce it on its own. So if you’re suffering from acne, you might want to consider getting more linoleic acid into your diet.
Sources include pumpkin seed oil and most nuts (though eat these sparingly and away from meals — as the lectin and phytate content in nuts can decrease total nutrient absorption). And above all, make sure any linoleic acid you consume is unoxidized.
Eat More Retinol (Vitamin A) — Just Not From Polar Bears
Accutane’s science was built off the fact that retinol (vitamin A from animal sources) modifies sebaceous gland structure and sebum secretion. A great way to reduce sebum production is simply to eat more retinol. Sources include ground beef, liver, and most organ meats.
Decrease Your Consumption Of Iron-Rich Foods (Or Donate Blood)
While it might seem at odds with the recommendation above (as liver is very iron-rich),
Studies show that p. acnes enzyme activity (the byproducts which p. acnes releases that damage our cells) increases in the presence of iron. In fact, this partially explains why p. acnes in our blood stream is so dangerous — because the availability of iron in our blood increases these p. acnes enzymes, which increases porphyrins, which increases ROS, which leads to inflammation, which leads to atherosclerosis.
To combat the proliferation of p. acnes in our blood, we should…
- Decrease our consumption of iron-heavy foods
- Pair our consumption of iron-heavy foods with iron binders (like calcium or caffeine)
- Donate blood
All three of these strategies should help with iron depletion, and in doing so, lower oxidative stress, decrease p. acnes in the blood, and prevent arterial plaque build-up. In fact, researchers think that isotretinoin’s effects on bacterial iron metabolism may be why the drug atrophies sebaceous glands and decreases sebum production. So it’s not too farfetched to suggest that decreasing iron in the blood might improve our skin quality overall.
Treatment #3: Probiotics (And Other Microorganisms)
While many studies suggest that probiotics can exacerbate acne (likely as a result of increased SIBO), new research demonstrates that certain microorganisms directly compete with p. acnes to keep any overgrowths at bay.
In fact, a commensal skin bacteria known as staphylococcus epidermidis directly inhibits the growth of p. acnes. This is a new discovery, and a very exciting one.
The implication is that a simple probiotic topical (of s. epidermidis) might resolve long-standing acne lesions… without disrupting the rest of our microbiome. That means a resolution in acne, and no side effects.
If more studies confirm these findings, it’s likely that a fermented s. epidermidis topical will make it to market as an acne treatment — and will be much safer versus drugs and antibiotics.
The bacteria p. acnes is directly implicated as a cause of acne… and is present in the hair shafts of some men and women with thinning hair. While p. acnes isn’t yet implicated as a cause of hair loss, it may contribute to pattern hair loss through the release of porphyrins and its potential connection to soft tissue calcification.
P. acnes isn’t necessarily a problem until the bacteria is 1) in our blood stream, or 2) overgrown in our sebaceous gland tissues. In my experience, the number one way to eliminate p. acnes overgrowth in either our skin or blood is to test for (and treat) small intestinal bacterial overgrowth.
Secondary measures to reducing p. acnes overgrowths include experimenting with our diets, reducing iron overload, and maybe even testing topical probiotics containing specific strands of s. epidermidis. All of these treatment options should help reduce p. acnes proliferation, inflammation, acne, and indirectly maybe even hair loss (though don’t get your hopes up on a hair recovery from eliminating p. acnes only).
Above all, don’t resort to antibiotic treatments or isotretinoin drugs to reduce acne. The long-term consequences far outweigh the short-term benefits.
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published five peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.
72 thoughts on “P. Acnes (Bacteria That Causes Acne) Linked To Hair Loss: What To Do About It”
Great research as always, Rob. I might have been in the minority by having long-term success with antibiotics to treat acne– it may have been even 5 years of dosing 100mg of minocycline/day back in high school and even into college, but wow let me tell you, it was the only thing to work wonders. Looking back, however, I realize how dangerous that could have been and I’m glad I’m off of it now.
Back then I had tried everything before going on antibiotics. Since puberty, I was always a naturally oily person. It leads me to wonder if there is any connection to hair loss for those with overly-active sebaceous glands in general. Diving deeper, it might have very well just been my diet that I didn’t care about. Thanks again for the thorough research!
Great points Matt! I can relate. I went on/off amoxycillin in high school for acne — for most of my senior year. I’d go through periods of completely clear skin, and when cycling off, the acne would resurface.
As far as hair loss, acne, and sebum production — studies show that sebum production is influenced by androgens (like testosterone and DHT). In fact, studies show that men who were castrated before puberty (and thereby never produced significant amounts of androgens) developed significantly less oily skin than non-castrated counterparts. And interestingly, for men who weren’t castrated before puberty (and thereby developed alongside androgens, and thus had relatively more oily skin), but instead were castrated after puberty — these men did not experience a decrease in sebum production post-castration.
So there’s some connection between pubertal androgen production and sebaceous gland development that creates lasting effects on sebum output for the rest of life — even if we eliminate DHT entirely.
I’m curious what you take is on oil pulling and how it may relate to hair loss and acne along with other aspects of health. I wrote a blog post about it, but it got me to thinking about all the veins and arteries and how some of the surface blood vessels may allow for easier diffusion of substances, most notably toxins.
Then I got to thinking about all the toxins in hair products and what affect, if any, this may play on the condition. Food for thought.
Hi Bo — oil pulling isn’t likely going to move the needle in terms of hair loss. I’ve also never found a study demonstrating its toxin-pulling capabilities beyond a theoretical level. In general, I encourage people to experiment with anything and everything, but when it comes to setting expectations, I don’t see oil pulling as a major lever toward fighting acne, improving detoxification, or reversing pattern hair loss.
I bought your book and have been trying to follow your protocol, including massage and diet. Recently, I read a book entitled The Plant Paradox by Dr. Gundy. A lot of his thoughts about lectins seem to be in line with yours, but there are some big differences such as your recommendation to consume more protein then what he recommends, and eating almost all fruits and vegetables. He considers fruit to be little more than pure sugar, and eliminates many vegetables which he claims are high in lectins such as tomatoes, cucumbers, etc….which I find hard to believe. My son is currently following his diet and has noticed an increase in loose bowel movements and some acne, which he didn’t have before. I am trying to get him to buy your book, but he hasn’t so far….he is using propecia and minoxidil. I would like to get him off of both of these by demonstrating the value of your protocol by my own improvement….5 months will be mid September. I would like to know your thoughts….thank you, Norm
Thanks for your support, Norm. I’m happy to help however I can. At the foundation of all hair regrowth plans is self-experimentation. One of the pillars of this site is to share what didn’t work for me (and what did) — so that others can fast-track their results and not have to go through a decade of self-experimentation like I did.
I’d encourage your son to continue trying different diets, and to be honest about his progress on them. If he eventually decides to try a diet similar to mine — that’d be great. If not, that’s okay too. There are readers out there who’ve succeeded in regrowing their hair without strict adherence to the diet for which I advocate.
As far as your son’s use of Minoxidil and Propecia — I hope he is fully aware of the potential side effects:
But if he’s going to go the conventional route, he should absolutely include dermarolling into his regimen. As mentioned in the book, dermarolling has been shown to enhance the efficacy of these conventional treatments — and sometimes by four-fold.
I look forward to your progress! Please keep me posted with everything.
All my best,
I have been fighting with acne on my scalp for may last two years. I tried almost every product on the market with no luck. My hair is diffusing and is falling out like crazy. I also take propecia for the last year but i dont see any improvements.
But, for the last seven days, i went on plant based diet so no dairy products and no meat and you wont belive, after three days all my scal acne were gone. Like GONE! I still cant belive it. I always thought that carbohydrates cause acne, so i ate low diet but it seems carbohydrates are not the problems. Now i eat all day mostly rice, pasta, bread and my scalp is improving very quickly. I dont know what that mean for my hair loss but, i will see in few months but I definitely feel better cause there is no inflammation.
So if you suffer from scalp acne try to avoid eating dairy products, i think this is the main cause in my case. But everyone is different.
Thanks Luka! A lot of people have reported success treating acne by cutting out dairy. It’s absolutely a factor for certain individuals.
As far as going completely plant-based — there’s been an interesting debate in the comments section here:
I never had acne in my life. But still hairloss. Though I have loads of dandruff.
Great article, as always. Thank you.
I was wondering if there was a way of sponsoring you. Your work is so important, I wish there was a way of supporting you on a rolling basis. I know Danny Roddy does it through Patreon.
What do you think? I’m sure I’m not alone in this.
All the best.
Thank you Mori.
I’ve been thinking about trying a sponsorship plan for a while. I hate putting a price tag on my book + video(s), and a sponsorship program would allow me to eliminate that model and make everything free. With that said, I’m worried that it wouldn’t be sustainable.
Danny Roddy’s following is large — and even still, the amount he earns monthly through Patreon probably doesn’t equate to how hard he works on his research / videos. In the US, we have to assume everything gets cut in half by taxes. And I have to believe that far fewer people read my work versus Danny Roddy’s. If I switched to Patreon, I’m worried I wouldn’t even cover my costs of the medical professionals that help me with my research articles.
I might be wrong, but I think part of the rationale behind Danny Roddy’s move to Mexico was so that he could make the Patreon model sustainable. I work a full-time job in addition to this site. I love it, and I’m not ready to give it up or move. I also live in the Bay Area (California) — so my cost of living is significantly higher.
All of these factors make me worried about a sponsorship model — though I’m not yet ready to rule it out. In the future, I’ll email readers to try and gauge interest in a Patreon model — because I think it’s an honest and earnest plan, and I think it keeps research as objective as possible. I’d love to at least attempt to switch to it one day. And if it fails, I can go back to the current model.
Hi Rob great article.
Is it worth mentioning about certain lifestyle changes ? Such as cold water rinses in the shower on the scalp ? ,And no shampoo?
My over sebum production stopped when I implemented cold water, stress reduction , and a more healthy diet. But I somehow believe that cold water had a bigger role to play than I think.
That’s absolutely a factor. In fact, evidence shows that prolonged psychological stress can increase bacterial migration into the small intestine, thereby contributing the small intestinal bacterial overgrowth (and therefore increased sebum production, p. acnes colonization, and finally acne).
Thank you Rob for the article. I believe I now know why I’m prone to post-inflammatory hyper-pigmentation. On another note, vitamin B-12 supplementation caused my acne breakouts. My acne started when I was 16. There were times it would clear up, but I couldn’t figure out the reason. It wasn’t until I made the connection during my mid-40’s that I realized my acne only cleared after stopping vitamin supplements. I started taking vitamins when I was 16. Now I take vitamins without B-12, and no longer have issues with acne.
Jazz – very interesting. A lot of readers have reported methylation issues with certain B-12 vitamins — since after doing genetic testing through 23andMe and running their data through Promethease, they discovered that they’re missing certain genes that help code for all the step processes of metabolizing B-12. There are a different kinds of B-12 — folate, methyl-B12, etc. — and I’m wondering if this might’ve been part of the issue.
Have you looked into the “enrichment theory” of inflammatory disease? It’s the idea that maybe grains aren’t that inflammatory, but that it’s rather the nutrient additives that are required to be added back into white grains (iron, folate (B12), etc.) that evoke an inflammatory response. Nutrient enrichment is actually required in the US (and many other countries) when a grain is turned from whole to white (like whole wheat to white wheat pastas or breads).
The enrichment theory actually seems to make a lot of sense. I only eat organic whole grains and don’t get an inflammatory response at all…
Wow… information overload! Rob, thank you for doing the research and connecting the dots.
I’ve noticed too that my shedding ramps up after significant sun exposure. I figured it was inflammation but it makes sense that the sunlight is interacting with p.acne on the scalp.
I’m also sure small intestine bacterial overgrowth is related. I personally was on many rounds of antibiotics as a baby for ear infections and l believe it set me up for all sorts of issues stemming from poor gut heath and resulting nutritional deficiencies (I’m significantly smaller than my siblings).
I had acne as a teen though my skin had been clear for years it is still oily.
I wonder if the application of coconut oil on the scalp may help fight the p.acne bacteria?
Anyways, thanks for the tips and food for thought. -Sierra
Thanks for reading, Sierra. Lauric acid (which makes up ~50% of coconut oil’s fatty acids) has anti-microbial properties, especially against p. acnes:
With that said, lauric acid reduces p. acnes through its anti-microbial constituents — and not directly through sebum reduction. I wonder if sebum reduction is the better route — since p. acnes appears to develop resistance to antibiotics, and if coconut oil’s mechanisms of action are any similar to a topical antibiotic, I’d be concerned the anti-acne effects of coconut oil might be short-lived.
I’m testing for SIBO tomorrow and will post my results (and my planned protocol for eliminating SIBO) if I have it. You might want to consider one of these tests here — since SIBO is more likely at the route of the issue:
The info on lauric acid looks really promising! I’m going to do coconut hair masks and I’ll let you know the results.
I’ll also look into treating sibo.
Thank you very much for another great post, Rob!
I’d like to share my own personal experience with acne and hair loss. I got what I would call medium severe acne in my early teens. I would continuously get really painful, inflamed spots. I also had pretty oily skin, especially on and around the nose. I had hoped that the acne would go away with the end of puberty, but unfortunately it persisted. In my early twenties, my hairline started receding (slowly).
I’m now well in my mid-twenties, and until about half a year ago, I still struggled with acne. Today, I’m practically acne-free. I do get the occasional pimple, but nothing major. My skin is slowly recovering. What did I do? I started following a whole food, plant based diet. Moreover, I try to avoid anything that triggers inflammation. For me, that means avoiding oil, sugar, gluten and caffeine. Additionally, I take an omega-3 supplement daily and maintain an anti-inflammatory omega 3:6 ratio. Drinking lots of water and avoiding stress also helps. I wash my face with water only and use organic aloe vera gel as a moisturizer.
Now that I’ve finally gotten rid of acne and treated the apparent inflammatory state that my body was in, I’m hoping to eventually restore my hairline completely.
Time will tell. If I learned anything through all kinds of experiments is that these processes take time. Especially skin takes a long time to heal…
Manuel — a huge thank you for always sharing information and commenting on these articles. I really appreciate it and know that a lot of other people do too. I’m doing an SIBO test tomorrow and plan on posting the results when they’re available, and if I have it, explaining the protocol I’ll be following in attempts to resolving it. While I didn’t have as much success as others with a plant-based diet, it’s clear that veganism definitely works for some people. Keep us posted on your progress!
hey rob, great article, thanks for writing it.
Ive always had an incling that my hair loss is connected to acne. When i was 16 I started getting the diffuse hair loss that youre talking about, all of my hair shafts getting thinner and thinner but all over the scalp, and my brother got really bad acne at the same time. Im convinced we both had the same problem but different manifestations. i.e. something bacteria related or fungal. (i also noticed the hair loss started straight after i started drinking beer and wine which are high in yeast and bacteria etc.)
I was wondering, because ive noticed that Caprylic acid stops my hair shedding completely for about 2 hours, and its known to be a strong anti fungal. but ive researched it and apparantly caprylic acid (octanoic acid) which is c8 mct oil, doesnt kill p.acnes strain. maybe theres another strain that causes hair loss
would be great to get your thoughts
What complicates things with p. acnes is that once a follicle is infected, it’s significantly easier for other opportunistic bacteria to enter and colonize as well. This creates an interesting challenge in research — are we sure that it’s the p. acnes causing the acne (or in your case, hair shedding)… or could it be another opportunistic bacteria, parasite, or fungus that only colonizes the follicle in the presence of p. acnes? Unfortunately, research here is scarce (but there are some studies exploring this that I know of, and if they make it through peer-review, they could give us the answers).
There are a host of other microorganisms that might be contributing to your hair fall — and might also be sensitive to caprylic acid. I’m planning on writing more about the microbiome and pathogenic microorganisms for future posts — and I’ll be sure to touch on this!
Off the article topic but still related, can you re-share the Henry Choy research video presentation again?
I believe you mentioned somewhere but can’t remember. Was looking through the emails you sent so far but couldn’t find it.
The video was the actual case study.
Nice info btw.
Hey Goran — Henry Choy didn’t do a video presentation. I think you’re referring to Dr. Rei Ogawa — who studies skin stretching and mechanical stimulation (here’s the link to his video):
I just wanted to say thanks. I have your book and video and I admire your work and in depth research. I’m 80 and used to scientific research and I must say that your work ( book + articles )is holistic and serious. Keep up the good work and, again, thanks.
Kind regards / Bernard
Thank you Bernard. I appreciate your kinds words and your support to keep the website running. Please let me know if there’s anything you’d like me to research — I’d love to help however I can!
Please address the efficacy of topical castor oil against P. Acnes. I suspect it works very well, and some poorly understood anti-microbial effect is in fact its mechanism of action.
It’s certainly possible that topical castor oil can help. But as is the case with antibiotics for acne treatment, I wonder if resistance can also occur with castor oil. If you’re going to fight a p. acnes overgrowth, I think the key is to first look internally (and get tested for SIBO), then proceed from there. In terms of castor oil having anti-microbial properties — you’re absolutely right (most fat-based topicals have some sort of anti-microbial agents). In terms of that being the main mechanism of action for castor oil helping to reduce / reverse hair loss… I’m not sure we can yet make that claim given the research done on castor oil. But it’s certainly a potential mechanism of action.
I’ll write an article on this in the future.
I’m also aware of the PGE2 effects, at least on a superficial level considering I am not a biochemist. Whether it was anti-microbial effects or the anti-inflammatory properties, topical castor oil had a profound impact on my acne and scalp inflammation. I do not have SIBO or bad digestion. I could *feel* it working day to day in the skin itself, on the scalp in exactly the M-shaped area that was showing some recession, and also in the places on my arms and face that were plagued with acne. All my inflammation was in my skin.
By the way, scalp pinching over five months also clearly broke up some areas of fibrosis/calcification in my case. But the side effect was not “adult cradle cap” or somewhat more dandruff, as I’ve seen it described. I very distinctly developed lesions that scabbed over. Eventually the lesions had just hardened skin that peeled off in whole dime sized chunks. The skin would at first be slightly indented in the lesion area, but after a month would heal up with pliable healthy skin and thickening hair.
I believe between castor oil and scalp pinching I have arrested and almost fully reversed some mild hairline recession. But the impacts of castor oil on a chronic acne problem were probably a bigger win in my case. Many other topical and supplement and diet experiments did absolutely nothing. I suspect a few courses of antibiotics for sinusitis may have created the whole skin problem in the first place. I will probably never take antibiotics again unless it’s a truly critical matter.
Thanks for sharing your progress! There are several readers right now combining a fat-based oil + the massages, and with success. It’s an interesting note about the lesions. Some others have reported this, but typically, they’ve likened it to too high of a massage intensity. It sounds like you pushed through that same period without letting up, and ended up seeing some hair thickening after those lesions healed. If you’ve been taking photos, readers and I would love to see what your progress looks like! Otherwise, keep up the great work.
You can see the vellus hairs coming in around the scarred lesioned areas. You can see the healing scars from multiple past lesions. The lower limit is my youthful hairline. I believe I will have my full youthful hairline in under a year.
I believe the ~1.5cm of my hairline that had receded did so on account of job stress and very foolish under-eating. That’s fixed now. I eat much more and have my job under control. So the question about pinching efficacy and other measures is a little tricky, because I know stupid diet and lifestyle decisions played into the problem.
I don’t see the point in holding back from painful pinching. Get it over with. Power through. Let the lesions form and deal with it. Why not? You can see vellus hairs forming around the fresher lesion in the picture.
as soon as I found your book and results and stuff I bought the book and read it in 2 days. amazing stuff I have to say.
I have been doing the massages regularly for around 4 months ago, (I started 6 months ago but then I got pneumothorax and had to stay in the hospital for 10 days and then wasn’t able to do the massages for the next month or so). I’ve cut grains and bread out of my diet too.
I’m suffering from a lot of dandruff, I mean its not stopping at all. when I do the massages a lot of big pieces of dandruff are stuck between my hair. I stopped using any type of shampoos since 6 months ago.
on a good note im seeing new hairs on the temples and when massaging not much hair falls off.
but on the sides and the crown, combing after the massages a lot of hair falls off (70 to 80)
is it the dandruff caused by the thus bacteria that is still causing it. should I go back to using shampoos or should I just keep going on with the regiment. I know you don’t have all the answers, but any advice from experience would help. feeling a bit demotivated lol.
It’s great that you’re seeing new hairs on the temples!
Regarding the dandruff: I’ve now been doing the massages for almost 6 months. I still get quite a bit of dandruff, but in the first 4-5 months it was definitely a lot more. I think the dandruff is caused by the massages and not any bacteria. Just hang in there, it will get better eventually. Using a boar bristle brush really helps me personally to get rid of any dandruff.
Losing 70-80 hairs while combing seems a lot to me though…
Have you always experienced dandruff, or is this a new problem since starting the massages? If the former — it’s possibly bacterially-related. If the latter — you might be massaging too aggressively in those regions. If so, I’d reduce your intensity (or take a few days off) and see if the shedding + dandruff subsides. To gauge a proper intensity, try shooting for 15-25 hairs shed per massage (even fewer if you can).
Congrats on the temple hair regrowth! Please keep us posted.
Any updates on your SIBO test?
Hey Dante — the test has been processed. Now I’m just waiting for my release form to process so I can see my results. If I do have SIBO, I have an action plan that I’ll start to implement in late August that I’ll be sure to share with everyone.
You can do whatever you want with the pic, assuming it’s properly stripped of meta-info. I didn’t bother checking.
I have started to take coffee with gelatin powder dissolved into it, is this a better alternative than black coffee on its own ? Thanks in advance
Hey Michael — it depends. There are a few things that might make this problematic:
1) Digestive distress from combining coffee + protein.
2) I’ve found that many diffuse thinners tend to be caffeine sensitive (and that removing caffeine can significantly slow their hair shedding rates).
Gelatin is great, and you can combine it with coffee if you’d like — so long as you think you’re clear of those issues above.
Gelatin is a waste product. I highly doubt it’s gonna be good for one’s body – especially the digestive tract.
Regarding coffee: While I can’t always refrain from drinking it, keep in mind that it increases your cortisol levels, leading to more stress and potentially worsening skin conditions. I often get some zits after having had coffee.
From my experience, I can recommend the following drinks: LOTS of water, green tea, (green) smoothies. The latter also contain lots of fiber, which is fantastic for your digestive tract.
Hi Rob, you are on to great things!
Though i would chime in on the accutane topic.
I certainly think there is some kind of connection with acne and hair loss too but i guess the whole thing is all connected in some way.
To accutane or not to accutane…….hahaha
I had chronic acne from my teens that never went away and skin so oily I was worried that Bush was going to invade my face (hahaha).
I was a disaster, my face, back, scalp. Oh man.
As a child and teen, my diet was fairly good with not too much sugar either.
My father had severe acne as an adult too and a good diet and lifestyle.
When i was 39 (thats right, 39) and fed up with disastrous skin, i went on accutane and it worked like a miracle.
It really did.
In a word………life changing.
I was worried about it as i had heard how bad it was, rectal bleeding, hemorrhaging, suicidal thoughts, all sorts of stuff, but i figured none of that was worse than what i was already living with and as an adult having tryed it out, i am very glad i did.
So what can i offer from my experience, well, a more balanced insight than a roller coaster teen might have.
I have always been depressed as hell but a certain weight was certainly lifted by being able to wear a white t shirt without worrying whether Mount Back-atoha was going to erupt or being tank top in summer or hell, just that i could feel confident around my girl with out a shirt on was bliss.
Just that i could somewhat more confidently show my face in public as an adult was amazing.
That is worth a lot to me man, maybe even a health tradeoff, if there is one.
A short happy life trumps a long miserable, futile one.
Over all i was less depressed as i could see great things happening.
In addition, there were no weird or unexpected mood swings or strange health problems. My cholesterol was up as expected though. Not too bad though for the gains.
Again, despite what ever health trade off there might be, i am happy i went that path and would always recommend it to anyone truly being wrecked by severe acne.
I am only me though and its very important to state that.
Others may experience terrible things from it, so weigh it up first.
Regardless of any research, genes do play a part. Period.
My dad looked dreadful and i followed the same way.
I dont believe diet really plays much part other than to make things worse than they already are.
As an example, a friend of mine also had the great fortune of their father handing down some acne genes even worse than mine.
Now, this person has grown up in an excellent situation with very very health focused lifestyle. Very fit and athletic and excellent, varied diet.
Skin even worse than mine despite anti biotics and other meds.
So when i recommended accutane, he was apprehensive but went ahead with it.
Again great results with no visible problems or weird depression and still very high functioning intelligence.
I believe they would also accept health probs rather than humiliation, shame and depression over crappy skin.
They are very happy now.
I dont believe that this was a coincidence.
While gene expression plays a part, genetics really do come in to it in a huge way.
Accutane is not the devil, as far as we know and in certain circumstances, its the best we can do right now with what we have.
The alternatives such as diet or anti biotics just aren’t up to the same standard yet.
Having lived through the humiliation and shame of chronic teen and adult acne, am very glad i made the choice i did.
Just thought it best to tip the scales back to balance a bit on this topic.
All that said, Rob, you are truly a legend and I will be buying your book very soon.
You might want to check out Brian Turner on YouTube. Ultimately, he completely healed his (severe) acne through diet. He was on Accutane for a long time but once he stopped using it, the acne returned. It’s quite amazing what diet can achieve.
Speaking from personal experience, I’d also have to disagree: diet does not only have the power to make things worse, it can also improve them considerably.
Having suffered from acne for a long time myself and having tried many treatments, I can totally see your argumentation though and it’s great that you’re feeling so much better. 🙂
Quick question about minoxodil.slightly
When did you stop using minoxodil ? And did you see a shed ?
I’ve recently stopped aswell just this week.
Do you have any idea on scalp itch and hair loss? I’ve never complained about my hairline but I have a silly diffuse thinning. I constantly find myself scratching my scalp, it’s not very harsh scratching but I have a constant need to do so. I don’t have big flakes like dandruff but when I wear dark clothes and stratch my scalp there are tons of small flakes fallen on my tshirt. What do you think, can it be because of a fungal infection or smth?
There’s a good chance this is related to hyperkeratosis (the thickening of the outer layers of the skin) — which could be the result of p. acnes colonization, a fungal infection, or any of the other myriad symptoms that precede pattern hair thinning. The itching is commonly reported though. Have the massages not helped reduce the itching?
For a while, I stopped massages as I think touching my scalp may feed the bacteria and fungi. But when I used to do the massages I remember that my itching was less. How do you think I should combat with the bacteria and all? Should I continue massages and use ketoconazol 2% shampoo, if yes what else should I do?
Hey Mert — typically, a bacterial overgrowth in the scalp would be caused more from the internal environment of the intestinal mucosa or the environment of the scalp itself, and less so touching the scalp with your hands. For reference — p. acnes is literally everywhere — crawling almost all parts of our skin and most surfaces of the world in which we interact. But it’s only in certain environments that it over-colonizes.
Keto shampoo should help — at least for now. But the real fix is in addressing your intestinal and scalp environments.
Nowadays I’ve been trying to not touch my scalp and use 2-3 times a week ketoconazole 2% shampoo. Today I scratched my scalp a bit on a black surface, it’s like flakes on my scalp rains with also hair. Then I just combed a bit my hair with my hands, and it was soo much. So much flakes coming with hair. What is this? What should I do?
Have you tried Rob’s lifestyle and diet recommendation from the book ?
Maybe the cold water shower and no shampoo could help.
I noticed very small flakes after massages early on. But using lukewarm water and then cold water rinses helped.
But I think your issue sounds more complicated and problematic than mine.
Hi rob.l’m from china.My question is if chinese can be provided in your book ?
Hey Roy – I got back to you through email, but to reiterate, I currently don’t have a Standard Mandarin / Mandarin Chinese translation of the book. I’ll look into doing this and when a translated version is ready, I’ll be sure reach out.
Any thoughts on metabolic-type diets?
It’s a great question, and I think one that deserves a longer form response than this comment alone. The gist is that as someone’s body structure changes, so does their metabolic needs. For instance, men with relatively higher body fat, on average, do better on ketogenic diets; whereas men with low body fat percentages typically demand higher amounts of carbohydrates to maintain muscularity and testosterone levels.
It’s certainly true that not everyone thrives on the exact same diet. My sister does better on a vegan diet than I did. But for me personally, I do better on a moderate carbohydrate paleo-based diet than any other dietary iteration I’ve tried. At the end of the day, what matters most is eating a nutrient-dense + bioavailable diet — meaning of the nutrient-dense foods you can ingest, your body can actually metabolize the nutrients. That latter part varies for everyone, hence the variation. For instance, I’m missing methylation steps (according to my 23andMe data) that allow me fully process some B-vitamins, and that lead to a decrease in my body’s ability to regulate the citric acid cycle. As a result, I don’t do well with certain foods… but I do great breaking down meats / seafoods. And I’m leaner, so I eat more carb-heavy than other paleo-based dieters.
So in short — an optimal diet will vary wildly from person to person. But we should all start at a nutrient-dense, bioavailable diet. This will trump all blood-type diets, metabolic-type diets, or dietary fads. Then we can use individual data to make tweaks from there.
I can’t thank you enough for this amazing article. I’m a 21 yr old male with diffuse thinning and minimal temple recession. I also have moderate acne that flares up time to time.
My hairloss is EXACTLY similar to the one in the case study you posted here. Even the hair casts look similar. I’ve been to many derms over the past 3 yrs and they’ve all prescribed minoxidil and stupid antifungal shampoos and pills (they didn’t work! Surprise!)
I want to fight this condition but I’m not too keen on taking systemic antibiotics. The possibility of developing Antibiotic resistance is too real. I want to try alternative options first. I did some research and found that lauric acid (found in coconut oil) is extremely effective at combating P. Acnes bacteria.
I’m thinking of applying a topical solution of coconut oil and onion juice (because of its antimicrobial, anti-inflammatory and hair promoting features). Do you think this will be as effective as systemic antibiotics?
Also, I drink a lot of milk. Should I try cutting milk products for a week or something?
Thanks in advance!
Thanks for your kind words, and for taking the time to read the article. I’ve looked into lauric acid and think it’s a viable short-term solution. While lauric acid likely won’t resolve the underlying issues of chronic p. acnes infection, it should help stave off over-colonization locally (wherever you decide to apply it).
You should absolutely try cutting out dairy! It made a huge difference for my skin, and has for many others. I’m curious what the rest of your diet looks like, and if you’ve tried experimenting with different diets to help resolve your acne. In many cases, dietary changes alone are enough to move the needle.
Keep me posted!
I have mild acne on my face and mild to severe acne on my chest, shoulders and upper arms and also frontal diffuse hair thinning.
This article made me suspect if the source of the problem is my gut. While reading this, I immediately recalled having digestive disorder after a cheese pizza recently. It has been two days since I read this and I’ve cut out dairy. I will report the changes here. I have a strong feeling that there will be improvements.
Thank you Rob as always you have added another dimension to my outlook on the problem.
Thank you Safiye! Eliminating dairy is a great first step toward troubleshooting acne, as it’s often a significant and under-appreciated contributor of many skin conditions (though at the same time, many people can consume dairy without issue). Keep us posted!
I quit dairy like you advised. I’ll report back after a couple of months. I’m convinced I’m in the right track. My hair loss is most certainly due to hyperseborrhea.
I have hair casts and If I scratch the parts of the scalp where I’m losing hair, I get white flakes on my nails. Is this built up sebum? I think it’s causing my follicles to miniaturise.
Will your scalp massage help with this or will it make things worse? And do you know any other ways through which I can reduce sebum production? Also, do you think Minoxidil will be effective in my condition?
Thanks in advance!
These questions are difficult to answer, mainly because I’m not sure what kind of hair loss to which you’re suffering. For instance, shedding can be induced by prolonged hyperseborrhea, but in general, hyperseborrhea is mostly associated with pattern hair loss, rather than causative. With that said, cutting out dairy / gluten tends to improve this hyperseborrhea in most cases, and substantially.
The massages often help with dandruff / sebum production in the long-run, but in the short-run can end up leading to excess dandruff as the skin adjusts to the stimulation, or if someone is massaging too hard. In your case, the benefits of massaging depends on what kind of hair loss you have (for instance: fungal-related hair loss which coincides with hyperseborrhea and shedding, or pattern hair loss — of which the massages should help).
Minoxidil would help if you’re experiencing the latter, but most likely not if your hair loss is due to the former.
I am probably the best example of what is being discussed in this article.
11 years ago I was misdiagnosed with Crohn´s, back in those days I had some acne but nothing special. I used a topical Erythromycin and it worked out. While treating Crohn´s I had a flare up in my acne, as a result of Corticosteroid treatment. It was nothing special, as it was more stressful while pilled up with dealing with this disease. It lasted for 6 months to a year, then it went away.
Fastforward 6 years and I was diagnosed with Ulcerative Colitis . The treatment was less harsh and I was thankful for it.
In 2012 I had my first case of dermatitis. I cannot remember the treatment I did for it but it worked, although temporarily. The next 5 years have been a battle of dealing with dermatitis and Foliculitis Decalvans. Part of it was my fault, as I struggled with depression and with the uncertainty of this diseases, I just kinda lived with it, in pain. I have tried several medication, from natural to artificial, it never really worked out for me. It was extremely painful and not really worth it, as it would come back, just months after the treatment.
With all of this, I have diffuse thinning all over my scalp. Maybe it was a result of using things like Apple Cider Vinegar or maybe a result of FC treatment, but I do not know and quite frankly do not care. I just want to have a healthy scalp, for once.
This year I decided that enough is enough, took a final plunge and consulted a dermatologist and nutritionist to devise a plan to deal with my inflammation. I have removed gluten and diary from my diet and made an effort to reduce carbon hidrates. I was prescribed 10mg Accutane, daily. I know it is a scary drug, but the dosage is low and I am taking blood and urine tests to see how I react to it.
My goal is to reach a point where I have taken control of my inflammation, which is severe, and then move forward with natural treatment. I do not want to be hostage of antibiotics.
I have read about things like Perilla leaves, that have an effect on inflammation. Things like brocolli sprouts, but I ask you, is there any evidence behind this or not? What is your opinion?
Now, the discussion about the microbiome and gut flora always interested me as I suffer from UC, but never once was it mentioned by my gastroenterologist. It is something that I have noticed about convencional medicine, is that very rarely do they try approach unconventional methods. It is a conundrum, as they have no problem prescribing antibiotics that might ruin your life on the long term. Go figure.
A big problem of mine is having too much sebum. Since I remember, I have always had extremely oily hair. I have searched and googled and washing your hair daily only makes it worse, but it is a paradox, has having oily hair is extremely uncomfortable. Is there anything backing this up? When I talked to my dermatologist, he said there is not much I can do about it and I should just resort to use Nizoral and Accutane for now.
At the end of the day, this is extremely frustrating as it feels like I am playing Whack-the-Mole with my body and when I hammer one Mole down, another one pops up.
So even though I appreciate your work, my anxiety flares up just thinking about all of the possibilities that might work or not.
Oh well, great job, either way.
Autoimmunity manifests for a variety of different reasons, and the biggest problem I have with conventional medicine is that the focus is always on symptom management, rather than disease resolution. I’m curious if you’ve gotten tests done for SIBO, GI Stool (Genova), a hormone panel inclusive of HPA-axis, an iron panel, a complete blood count, and a urine organic acids test to determine nutrient metabolism.
This type of things would give us a better idea of where your autoimmunity is manifesting: ie, a nutrient deficiency, a bacterial overgrowth in the small intestine, a yeast problem in the colon, an iron deficiency, or an iron deficiency of chronic inflammation / infection. In all of these cases, the treatments vary wildly. But interestingly enough, all of these things can express themselves as UC.
Depending on the condition, botanicals and nutraceuticals can be more effective than pharmaceuticals — as is typically the case with SIBO infections (where botanical treatments test as effective, or better, than drugs — and with little or no side effects). With other treatments, sometimes drugs are great. But it’s really a case-by-case basis.
Where are you located? The reason I ask is that if you’re in California (or the US), there are some doctors that can refer you to more diagnostic testing to better understand your autoimmunity, and in doing so, better treat it. In my experience, functional medicine practitioners are 20+ years ahead of conventional specialists (like a urologist) — who struggle to see a condition as larger than the body part it affects.
Thanks for the quick reply, Rob
I have done blood and urine, but I honestly cannot tell if those parameters were analyzed. I do know that I do not suffer from anemia, so iron deficiency seems to be out of question. I could try to scan the tests and post it here, but they are in Portuguese, so maybe I could translate them for you and see what you find. Although I have to say that 99% of these tests that I have done (and they are over a dozen) were always in good shape. Which is a good thing, but also frustrating.
My mother and sister suffer from thyroid problems, so who knows, maybe I have something going on there that might be upsetting my body. I plan to talk with my gastroenterologist and see if something can be done, regarding blood and urine work.
I am from Portugal, so I am far away from being in the US, sadly. I did find this Lab:
Is this what I should be looking for?
Hi rob ,
I gone through your website recently and found you are doing great research .
My struggle to fight hair loss is very long but I haven’t succeeded in it .
It’s now 10 years , I used to have long and thick hairs , I feel now they are left 1/4th
2 yeas back I was diagonised with severe vitamin d deficiency , I don’t know from how long I was suffering , I thought that’s the reason for my hair fall but after it recovered I don’t gain any hairs . Now
I have done all the blood test but nothing came in them , thyroid , iron bit b12 , hormonal levels all good ( I was also taking a complete multivitamin though )
About family history me and my father has same thin hairs which started thinning at same age . To him it seems because of acute dandruff, to me it seems highly oily scalp and pimples that hurt when I press that area .also he never much about his dandruff as much I did in my life . I too have mild dandruff . I have always used antidandruff shampoos , tried lemon juice and many other natural things . So that’s how our scalp is
I recently noticed that my scalp is tight really and when I tried to do deutesmence therapy it hurts when I do pressing n all . I started believing now that pimples n oily scalp is the reason since nothing came in my blood test .
I don’t have any food allergies , I was always drinking milk in my life , but I get sick if eat unhygienic foods easily , also when I get my monthly periods my stomach gets upset initially . But when I see the diet changes comments by other people I don’t understand what I will eat if I quit grains n dairy , that means only fruits n veggies? ?
Now I started applying clove oil , I’m finding it quite helpful .
Please put some light on my hair loss , and how to treat the p.acne if that’s the case , and what can I eat
Hey Harpreet — we’ve communicated over email since this comment, but I’d recommend looking into doing testing for gut dysbiosis. Your lab results didn’t show any signs of nutrient deficiencies — which would often indicate small intestinal bacterial overgrowth — and yet your case still presents with forms of digestive distress (i.e., symptoms of acne / skin sensitivity). As a result, I’d guess your gut problems are likely focused in the large intestine.
Stool testing is a good place to start. While it’s likely that addressing these non-hair related health issues will have only a marginal impact on your pattern hair loss (at best, the right diet slows or stops hair loss, but doesn’t reverse it), you’ll likely feel so much better.
But the sides of my scalp are not thick and hard but still I have thin areas too …can you explain me this
If the sides of your scalp are thinning, and you’ve presented previously with low vitamin D (as you mentioned in your email), I’d recommend getting checked for hyperparathyroidism. That usually results in overall hair thinning across the entire scalp.
I have oily facial skin and scalp, but I don’t suffer from acne. For the past two years I’ve been getting a pimple several times a week in random areas on my vertex and hairline, which I put down to high DHT influenced sebum protection in MPB. I have MPB with norwood 3 progression and very noticable diffuse thinning on vertex. I am a month into your massage therapy exercises. I wanted to ask in light of this article, how do you feel about GLA supplementation? In my diet (which aligns with your book) I consume very little vegetable oils – the only source being extra virgin olive oil drizzled on salad. Your article made me think I could lessen the sebum, thwart P. Acnes if it’s feeding on my scalp, and improve the scalp environment with a little more Omega6 – of which it seems GLA is perhaps the best.
Thanks for your thoughts!
You can certainly try GLA orally or topically as a test. Readers tend to respond to it differently (some report improvements to skin health, others more acne). Sourcing likely matters. If going with an oil — make sure it’s cold-pressed and in a dark bottle to prevent oxidation. And let us know how things go! I’d love to hear if you see improvements after a couple months.
Congratulations for your work! I want to ask your opinion if benzoyl peroxide is going to be effective for P.Acnes. How do you recommend that it should be applied?
I am having heavy hair thinning,and hair loss and dandruff.Previously I had problem of anal fissure,diarrhea and also had a heavy fall in blood count after a fever 2 years before.I am also heavily sweating.What tests should i take and treat?