Why is cystic acne so stubborn? Why does it keep coming back no matter what ointment, gel or cream you slather on your face? Acne is a common and multi-faceted condition. Over 80% of the population experiences acne at some point in their lives, however the impacts are far reaching for chronic acne sufferers. Alarmingly, chronic acne sufferers are more likely to experience anxiety, depression, suicidal thoughts, poorer employment outcomes and lower self-esteem than non-acne sufferers. Dealing with acne is neither trivial, nor exclusive to teenage-hood.Many women are prescribed hormonal medications like the oral contraceptive pill, yet find that when they come off the pill, their acne returns. Like most conditions, a holistic approach is the best way to get long lasting results. So what can be done for a chronic case of acne?Check your dairy intakeIf you thought the link between acne and dairy was a myth, consider it busted. Dairy products including cheese, cream, milk, ice cream, yoghurt and milk solids have been found to increase levels of insulin-like growth factor 1 (IGF-1). IGF-1 increases circulating androgens such as testosterone which, in turn, up-regulates the production of facial sebum. As well as affecting sebum production, androgens cause keratinocytes (a type of skin cell) to go into over production. This all results in clogging of follicles and comedome formation, otherwise known as acne.Aim for a low GI dietSimilarly to dairy, foods that are high on the glycaemic index (GI) increase IGF-1 and androgen production. High GI foods are often refined carbohydrates, full of sugar and burn up quickly. They cause a spike in insulin, wreaking havoc on your blood sugar levels, yet don’t keep you full. Avoid these foods for your skin’s sake! Restrict your intake of refined sugar, desserts, pastries, bread, pasta, lollies, chocolate and sweetened drinks.Make sure your lymph is movingA major factor in cases of adult acne is lymphatic system health. When lymphatic fluid is congested, it can accumulate beneath the skin and the body is forced to excrete metabolic waste products out through the skin. Unlike the blood, lymphatic fluid doesn’t have a heart to pump it. Movement and exercise is essential as muscles compress on lymphatic vessels, pushing the lymph towards the liver. Drinking plenty of water, avoiding congestive foods like dairy and wheat can be helpful. Check out the Wellspring article "Lymph – a forgotten piece in the clear skin puzzle" to read more about the lymph.Get enough zincZinc is THE mineral for acne. Suboptimal levels are pretty much guaranteed if you experience acne, with the risk of deficiency higher in women – especially if you are on the pill or follow a vegetarian diet. In acne, zinc can help to:Reduce androgen productionSpeed up skin healingReduce the appearance of scarsBalance sebum productionDampen inflammationReduce keratin production to unclog poresZinc is found in pumpkin seeds (pepitas), oysters, beef, salmon, eggs and vegetables like spinach.Addressing these factors can make a huge difference to your skin. In many acne cases, digestive issues such as leaky gut is also implicated. It’s worthwhile seeking individualised support when working on gut health as there are so many variables at play! The same goes for finding a suitable topical approach – a clinic using corneotherapy techniques is a great place to start. It is also important to stick to these measures for at least 6-8 weeks due to the cycle of skin cell turnover. Don’t quit cheese and give up after a week! Healing skin takes time, but it is possible.