Originally published on Mayway: https://www.mayway.com/blogs/articles/acne-the-bane-of-teenage-existence
Written by David Heron, DACM, L.Ac.
Teenage acne is extremely common, but for many, it creates physical discomfort and emotional stress. I’m sharing this case study to help teens (and parents) understand why acne develops, why certain treatments plateau or worsen symptoms, and how Chinese Medicine can reduce active acne, hyperpigmentation, and scarring through a structured treatment plan.
Note: This video was AI-generated using Notebook LM based solely on my original article written for Mayway by David Heron, DACM, L.Ac.
Rethinking BHAs and AHAs: How Acids Affect the Skin Barrier
Many teens begin with over-the-counter acne products containing alpha hydroxy acids (AHAs) or beta hydroxy acids (BHAs). These include glycolic, lactic, mandelic, and salicylic acid.
Maintaining a healthy skin barrier is crucial. Excess exfoliation or frequent acid use can disrupt this barrier, increasing inflammation and worsening acne.
What I See Clinically
Patients often report:
- Early improvement with acids
- Followed by sudden worsening
- Often accompanied by dryness, irritation, or increased breakouts
Acids can be effective when used sparingly, but they should not replace a full acne treatment plan.
How Chinese Medicine Understands Acne
n TCM, acne is known as:
- Fen Ci 粉刺 (“White Thorn”)
- Fei Feng Fen Ci 肺風粉刺 (“Lung-Wind White Thorns”)
TCM physicians have treated acne for over 2,000 years. These long-developed strategies align with modern biomedical mechanisms such as inflammation, sebum overproduction, bacterial activity, and follicular blockage.
Chinese Medicine can treat:
- Active acne
- Hyperpigmentation
- Atrophic scarring
- Residual redness
- Recurrence prevention
Case Study: J.K., 16-Year-Old Female With Moderate–Severe Acne
J.K. had a 4-year history of acne that progressed from forehead comedones to cheek and jawline inflammation, with cysts, nodules, and scarring. Her acne worsened during the school year with increased stress, irregular meals, and poor sleep.
Menstrual cycles were 34 days with occasional early cycles. Diet was vegetarian. Bowel movements were normal.
Understanding Acne Lesions (With Photos)
What Acne Is: A Biomedical Breakdown
Acne is an inflammatory disorder of the pilosebaceous unit (hair follicle + sebaceous gland). Hormonal changes—especially androgens—trigger excess sebum, enlarged glands, clogged follicles, inflammation, and bacterial overgrowth.
Lesion progression:
- Sebum overproduction
- Microcomedone formation
- Blackheads & whiteheads
- Papules & pustules
- Nodules
- Cysts
- Scarring & hyperpigmentation
The Healing Process: Hyperpigmentation vs. Scarring
Healing acne sometimes looks worse before it looks better. Hyperpigmentation can look like new acne to patients when in reality inflammation has resolved.
Scarring occurs deeper in the dermis and includes:
- Ice-pick scars
- Boxcar scars
- Rolling scars
TCM Diagnosis and Treatment Strategy
J.K.’s TCM diagnosis:
- Liver Qi Stagnation (stress-induced)
- Blood Heat with Stasis
- Toxic Heat
Core Herbal Treatment Principles
TCM
- Use Cold and Acrid Herbs To Resolve Blood Heat and Blood Stasis
- Drain, Scatter, and Vent Toxic Heat
- Course and Regulate Liver Qi
- Harmonize Qi and Blood
Modern Biological
- Reduce inflammation
- Prevent new cysts/pustules
- Slowly reduce hyperpigmentation
- Restore healthy sebum production
- Support sleep, stress regulation, and hormonal balance
Representative Formula Components
- Chai Hu – move Liver Qi
- Chi Shao, Dan Shen – reduce Blood Heat, invigorate and harmonize the blood to reduce pigmentation
- Hu Zhang, Bai Hua She She Cao – clear Toxic Heat
- E Zhu – move Qi & blood stasis
- Huang Bai – clear internal heat/fire
- Tu Fu Ling, Yi Yi Ren – reduce sebum (dampness)
- Sheng Di Huang – Cool the Blood
- Gan Cao – harmonize
Microneedling for Acne Scarring
After active acne decreased, J.K. completed 3 microneedling sessions. Benefits included:
- Reduced scar depth
- Improved texture
- Smoother overall appearance
- Faster collagen remodeling
Pills (Margarite Acne Pill) were used for maintenance.
Bakuchiol as a Topical Adjunct
Bakuchiol, derived from Bu Gu Zhi, helps:
- Regulate sebum
- Reduce hyperpigmentation
- Improve collagen
- Reduce inflammation
Studies show bakuchiol performs similarly to retinol with fewer side effects.
I struggled with acne as a teen—including cysts and scarring—and would have benefitted greatly from a TCM-based approach. This case demonstrates that even long-standing acne can improve substantially with a structured plan, herbal medicine, and—when appropriate—microneedling.
Schedule a Dermatology Consultation
If you or your teen are dealing with persistent acne, I’m available for clinical evaluation and customized herbal dermatology treatment.
👉 Schedule Online: https://book.securedata-trans.com/y7qmxj7g/
References
- Al-Khafaji, M. (2017). Chinese Medicine Dermatology Diploma Course – Module 4. Seminar attended in October 2017 in San Jose, California.
- Dhaliwal, S., Rybak, I., Ellis, S.R., Notay, M., Trivedi, M., Burney, W., Vaughn, A.R., Nguyen, M., Reiter, P., Bosanac, S., Yan, H., Foolad, N. and Sivamani, R.K. (2019), Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. Br J Dermatol, 180: 289-296. https://doi.org/10.1111/bjd.16918
- Gollnick, H.P.M. (2015), From new findings in acne pathogenesis to new approaches in treatment. J Eur Acad Dermatol Venereol, 29: 1-7. https://doi.org/10.1111/jdv.13186
- Xu, Y. (2004). Dermatology in Traditional Chinese Medicine. Donica Publishing.
Medical Disclaimer:
The information in this article and video is for educational purposes only and is not intended to diagnose, treat, cure, or prevent any medical condition. It does not replace individualized medical advice from your dermatologist, physician, or licensed healthcare provider. Always consult a qualified professional before beginning any new treatment plan, including herbal medicine, topicals, or microneedling.
