Holistic approach key to appropriate acne care

PETALING JAYA: In conjunction with Acne Awareness Month, a leading dermatologist has urged Malaysians to move beyond creams and antibiotics, and adopt a more holistic approach that considers gut health, diet, mental well-being and the emotional toll of the condition.
'Acne is a multifactorial skin condition that extends far beyond visible lesions. A holistic approach not only improves outcomes but also addresses the emotional burden carried by many patients,' said Consultant Dermatologist Dr Teeba Raja, who also serves as president of the Malaysian Allergic Contact Dermatitis Subcommittee.
She explained that emerging research has drawn attention to the gut-skin axis, where imbalances in gut bacteria – known as gut dysbiosis – can drive skin inflammation.
'Increased intestinal permeability, or 'leaky gut', allows endotoxins such as lipopolysaccharides to enter the bloodstream and trigger inflammatory responses in the skin.
'While gut-directed therapies are not yet part of standard acne treatment, patients with both acne and gastrointestinal symptoms may benefit from addressing underlying gut issues,' she said.
Teeba also highlighted the role of diet, noting that high-glycaemic foods and dairy have been linked to acne severity.
'Low-glycaemic diets help by lowering insulin and IGF-1 levels – hormones that stimulate oil production and skin cell growth.
'Dairy, especially skim milk and whey protein, can aggravate acne in some individuals due to its hormonal effects.'
She added that probiotics, particularly strains such as Lactobacillus and Bifidobacterium, may help reduce skin inflammation, but should be seen as complementary rather than primary treatments.
Mental health is another critical yet often overlooked aspect of acne care.
'Many patients experience depression, anxiety and social withdrawal due to acne. Some studies have found it to be more psychologically distressing than chronic conditions like asthma or diabetes.
'In Malaysia, adolescent surveys show acne is a common cause of emotional distress and social stigma.'
Teeba called for routine mental health screening during dermatology consultations.
'We should normalise checking in on patients' emotional well-being. Tools such as dermatology-specific quality-of-life questionnaires can help identify those who need psychological support.'
She recalled one case involving a 19-year-old male with severe nodulocystic acne.
'After years of failed treatments, he was started on isotretinoin. In six months, not only did his skin improve dramatically, but his self-esteem and overall quality of life returned. It was a reminder that acne care can be life-changing when
done right.'
Teeba also warned against common self-treatment mistakes, such as over-cleansing, pimple-popping and frequent product switching.
'These habits worsen inflammation, damage the skin barrier and increase the risk of scarring. Patients should be educated to follow a consistent, gentle routine and apply treatments across the entire acne-prone area, not just on visible spots.'
She pointed out that social media has become a double-edged sword in acne management.
'Teens are constantly exposed to filtered images and miracle-cure content, which creates unrealistic expectations. Some abandon effective treatments in favour of viral trends. We must teach patients to critically evaluate online content and follow credible sources.'
While public awareness of acne in Malaysia is growing, stigma remains a persistent barrier.
'Studies show that over 76% of people view acne negatively in photographs, associating it with poor hygiene or unattractiveness. We need greater public education to dismantle these harmful myths.'
Ultimately, she said acne treatment must extend beyond prescriptions.

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