Acne management at the core

In recent years, consumers have cottoned on to the idea that it’s more than the brain and heart that control the body’s state. The gut is a core part of the body, and not just because it’s located at the body’s core.

It’s responsible for keeping many parts of the body healthy, including the skin. Many studies have shown that the gut is significantly linked to skin health and can be a significant factor for people with acne.

Here, we look at the connection between the gut and our skin, and the latest OTC products that can help manage acne.

The gut-skin link explained 

The gut and skin “enjoy a constant dialogue” through what is known as the ‘gut-skin axis’, according to Carla Oates, skin care innovator and founder of The Beauty Chef, which offers a product range that includes bio-fermented, probiotic-rich wholefood supplements and organic topical products aimed at supporting gut health and glowing skin.

She told the digital publication Byrdie that the skin is often a great sign for what’s going on inside people’s guts.1

“It [the gut] is where we make nutrients, metabolise hormones and detoxifying enzymes, neutralise pathogens and make neurotransmitters, so it’s super-important to get your digestive health in check in order to feel well and, of course, experience clear, glowing skin,” she said.

Issues such as a ‘leaky gut’ can be a major concern and a factor in acne. According to Ms Oates, leaky gut syndrome is a condition closely linked to skin issues, occurring when the lining of the gut is damaged or leaky, and endotoxins that would regularly be processed enter the bloodstream, triggering an inflammatory response, such as acne.2<superscript>

Products for managing acne 

For mild acne cases, over-the-counter medicines that contain benzoyl peroxide, salicylic acids, glycolic acid, lactic acid, sulphur or resorcinol are useful, according to NPS MedicineWise.3

The organisation reports that azelaic acid (gel and lotion), while not commonly used, can be useful in treating post-inflammatory hyperpigmentation from acne in darker-skinned patients.

NPS MedicineWise recommends that for most acne patients who have mild to moderate disease, a GP can manage the condition. Patients can try OTC treatments such as topical antibiotics and/or topical retinoids. Patient follow-up should be within eight to 12 weeks. If no therapeutic benefit has been gained, oral antibiotics or hormonal therapy can be combined with a topical therapy such as benzoyl peroxide or a retinoid.3

For severe acne cases or those not responding to a 12-week course of oral antibiotics, referral for oral isotretinoin should be considered.3

Any topical acne preparation, whether OTC or prescribed, may cause skin irritation, so patients should be advised to:3

  • Apply to a cool, dry face.
  • Avoid the use of facials or scrubs before application.
  • Start with a lower concentration of benzoyl peroxide.
  • Wash off initially after a short application time, and gradually increase.
  • Use every second night initially.
  • Test on a small area of the skin initially.

Diet considerations 

The following foods have been shown to cause acne in some people, according to Healthline:4

  • Refined grains and sugars. Foods rich in refined carbohydrates, such as bread, crackers, cereal, pasta made with white flour, white rice and noodles, soft drinks, sugar-sweetened beverages and sweeteners such as cane sugar, maple syrup, honey or agave.
  • Dairy products. Studies that prove the link between acne and dairy products have been primarily focused on teenagers. Some studies suggest that dairy products may increase insulin levels, which could worsen acne severity.
  • Fast food. Foods such as burgers, nuggets, hot dogs and chips are part of a typical Western-style diet and may increase acne risk.
  • Chocolate. Multiple studies have shown the link between eating chocolate and increased risk of developing acne. However, this doesn’t prove that chocolate is the sole cause of acne.


  1. Lawrenson A. 2022. ‘The gut-skin connection: how to glow from inside out’. com/gut-skin-axis-4799925
  2. Oates C. 2023. ‘Is leaky gut causing your skin issues?’
  3. See J. 2012. ‘Drug treatment of acne’.
  4. 2023. ‘Top 6 foods that can cause acne’.

This feature was originally published in the July issue of RPA e-magazine.