The chronic skin disease acne vulgaris is today so common that it’s by many considered a natural part of human life. The vast majority of people in industrialized societies get acne sometime during their life. Whereas some only get the occasional blemish during their teenage years, others get severe cysts that leave deep, lifelong scars and ruin their quality of life.
I got quite a bit of pimples in my youth and know well how frustrating and depressing that can be. Back 5-10 years ago, I spent a lot of time trying to find out why and how acne vulgaris develops, and over time, I gradually started to put the pieces together.
The fact that something is normal doesn’t necessarily mean that it’s natural
Today, in many countries, including the U.S., more than 50% of the population is overweight; hence, it could be argued that being overweight is the norm. If you’re lean, you’re in the minority. However, if we look at things from an evolutionary perspective, a different picture emerges. Throughout the vast majority of our species’ evolutionary history, virtually all humans had a body mass index of below 25. This statement is supported by a large body of evidence, including body composition data derived from studies investigating the health and physical fitness condition of ancestral, non-westernized humans (1, 2). All animals that live in an environment for which they are genetically well-adapted are fairly lean. Humans are no exception.
A similar picture emerges for acne vulgaris. The fact that it’s today normal to get acne doesn’t mean that getting acne is a natural part of being human. Actually, the weight of the evidence clearly suggests that it’s not. Skin doesn’t fossilize, and our primal ancestors obviously didn’t take pictures of themselves, so we don’t know exactly what our forebears’ skin health and complexion was like. However, we do know how contemporary hunter-gatherers and non-westernized people look like.
Have you ever seen a picture of a hunter-gatherer? Chances are you have, at least if you’ve been reading this blog. Did you see any pimples? No… Well, that’s not surprising. Hunter-gatherers, as well as other non-westernized, traditional people, don’t seem to get acne. They don’t use moisturizers, lotions, or any of the other products that the modern woman puts on her skin every morning, but their skin looks nice and is free of pimples nonetheless. Their skin obviously doesn’t glow like Jennifer Lawrence’s after it’s been covered in massive layers of make-up and retouched in photoshop, but it looks healthy! It looks natural!
Maybe the fact that they don’t use all of the lotions and creams that the modern woman keeps in her bathroom cabinet is part of the reason why they have such good-looking skin. I’m certainly convinced that it is. While applying a white concoction of chemicals of questionable safety onto your skin can help cover up some imperfections and make you look better over the short-term, it will likely make your skin less healthy and worse-looking over the long-term.
The prevalence of acne is very low among hunter-gatherers and other non-westernized, traditional groups
Okay, let’s get back to the issue at hand. A few pictures of some good-looking hunter-gatherers obviously don’t constitute proof that acne vulgaris is a disease of civilization. It’s merely an interesting observation. To really be able to say that this skin condition develops as a result of evolutionary mismatches – the culprit of all diseases of civilization – we need some hard data. Do we have that? Yes, we do. Thanks to some bright researchers who’ve opened their eyes to the possibility that studying ancestral human populations could yield some clues as to why we get sick, it’s now well-established that acne is indeed a modern disease – a disease that was rare in the past, but that’s highly prevalent today. At least it’s been firmly established in my mind, based on the literature I’ve read.
In order to keep this article short and concise – I know people, myself included, have a short attention span when reading stuff online and prefer that the authors of the articles they read get to the point quickly – I won’t get into all the science in this area. However, I would like to highlight the results of one recent study, entitled The blemishes of modern society? Acne prevalence in the Dogon of Mali (3). This study was published earlier this year and is the latest in a growing list of scientific articles that question the popular idea that getting acne is a natural part of growing up.
The authors of the study looked into the prevalence and severity of acne in Dogon adolescents in Mali, West Africa. The Dogon are no hunter-gatherers, but they are not fully industrialized either – far from it. Among other things, they don’t eat highly processed foods, they don’t use contraceptives, and they don’t sit at a computer all day long. They lead a simple life; one that bears some resemblance to that of ancient humans. Some of the people examined as part of this study did have acne; however, in most cases (90%), it was mild or very mild. In total, the prevalence of acne in the cohort was 28%, which is markedly lower than in industrialized societies (85%+).
Here’s what the researchers had to say in their concluding remarks:
Acne is similar to the ‘diseases of civilization’ in being promoted by the pro-inflammatory properties of modern diets. The low prevalence and severity of acne in the Dogon supports the mismatch hypothesis and suggests that acne should join the list of diseases of modern lifestyles. (3)
The results of this study are not surprising to me. It makes sense that these people do get some pimples, but not as many as contemporary, industrialized humans. Earlier studies have shown that the prevalence of acne is even lower among populations that are less westernized than the Dogon. For example, as part of the Kitava study, Dr. Staffan Lindeberg examined 1200 subjects, and found that none of them had acne (4). Similar results were found in a study of the Aché hunter-gatherers (4). In other words, the prevalence of acne seems to increase as you go from populations that live in environments that are similar to humans’ Environments of Evolutionary Adaptedness (EEA) towards more and more industrialized populations. This is exactly what one would expect to see if acne vulgaris is indeed a disease of civilization.
Resolving the mismatch
Acne vulgaris is similar to the other diseases of civilization in that its primary culprit is an evolutionary mismatch. In order to prevent and treat acne vulgaris, this mismatch has to be resolved. I’ve talked a lot about how to go about doing this here on the blog in the past, so that’s not something I’m going to do again here.
What I would like to say is that I believe, based on my experience and everything I’ve read, that dysbiosis of the skin and gut, hormonal imbalances, and chronic inflammation are at the root of acne vulgaris. This notion is supported by a growing body of evidence (4, 5, 6, 7, 8). Many different behaviors can contribute to causing these problems, including the use of “toxic” skin care products, consumption of an unhealthy diet, and antibiotic use.
Genetics obviously also play a role in acne vulgaris, but it’s unlikely to be the primary etiological factor in most cases, a statement that’s supported by the fact that the global prevalence of acne seems to have increased dramatically over the past millenia, despite the fact that our genes haven’t changed that much. The weight of the evidence suggests that, in most instances, acne develops not as a result of “bad genes”, but rather by the expression of ancient genes in a novel environment, including perhaps suboptimal epigenetic programming during the early years of life.
My general advice to anyone who suffers from acne would be to adopt a species-appropriate diet, stay away from “toxic” skin care products (the best course of action is likely to use little or no skin care products at all (your skin is perfectly capable of taking care of itself)), and take better care of their microbiota. Microbiome restoration may be the key to treating acne. These actions may not bring about perfect, blemish-free skin, at least not for everyone, but they should cause a marked reduction in acne severity in most cases, given that a good treatment protocol is set up and adhered to.
In the future, I may write another post in which I take a more comprehensive look at the etiology of acne vulgaris, if I feel that’s something people are interested in reading about. I don’t claim to have all the answers, but I do feel I have a pretty good understanding of what causes this sometimes debilitating skin disorder.