#90 - When Acne Isn't Hormonal: The Hidden Gut Causes of Chronic Acne

Can acne start in the gut? In this episode of The Turd Nerds, we're joined once again by Dr. Megan Larravey for a fascinating case-based discussion exploring the connection between chronic acne, gut health, H. pylori, dysbiosis, and inflammation. We walk through the case of a woman in her 30s who developed persistent cystic acne despite eating a clean diet, using clean skincare products, exercising regularly, sleeping well, and trying many conventional and natural treatment approaches. With no obvious hormonal pattern and no significant digestive symptoms, her case challenged many of our assumptions about what drives chronic acne. What we found highlights the powerful relationship between the gut microbiome and skin health—and why some skin conditions may be rooted in underlying gastrointestinal dysfunction, even when the gut appears perfectly healthy. ✔ Why acne isn't always a hormone problem ✔ The surprising connection between H. pylori and chronic skin conditions ✔ How dysbiosis can contribute to persistent acne ✔ The role of biofilms in chronic inflammatory conditions ✔ Why some patients with gut dysfunction have no GI symptoms ✔ Pseudomonas, endotoxins, and systemic inflammation ✔ Leaky gut and its impact on skin health ✔ How we approach stubborn acne from a functional medicine perspective ✔ Stool testing, organic acid testing, and evaluating the gut-skin axis ✔ The role of probiotics, spore-based probiotics, and immunoglobulins ✔ Biofilm disruptors and antimicrobial herbs ✔ Why healing the gut often takes longer than people expect ✔ The importance of fiber, fermented foods, and rebuilding microbiome resilience Acne is often viewed as a skin condition, but for some patients it may be a manifestation of deeper immune, inflammatory, and microbiome imbalances. This episode explores why chronic acne can persist despite doing "all the right things" and how addressing gut dysfunction may be an important piece of the puzzle. Whether you're struggling with acne yourself or you're a clinician looking to better understand the gut-skin connection, this conversation offers a practical and thought-provoking look at how the microbiome influences skin health. Music provided by Blue Dot. 👋 Connect with Dr. Meghan Larivee ⁠https://www.integrativedermatologysolutions.com/about⁠ 👋 Connect with the Turds! Rebecca Sand ND, LAc, MSOM