As we age, acne should decline because hormonal imbalances are no longer driving increased levels of sebum oil. However, this is no longer the case in westernised societies.

In westernised cultures it has become increasingly common for teenagers to have acne. Around 79-95 per cent of the adolescent population have Acne vulgaris – which presents as white and black heads and skin inflammation. However, rather than being confined to the adolescent years, between 40-54 per cent of men and women older than 25 years have some degree of facial acne, and clinical facial acne persists into middle age in 12 per cent of women and 3 per cent of men.

Epidemiological evidence from traditional hunter-gatherer societies suggests that in these non-westernised societies acne incidence rates are far lower, so why is this happening? Researchers seem to think it's not related to genetics, but instead it is likely to be environmental factors.

One key factor is the impact of the western diet on acne. In populations that eat a Palaeolithic diet with low glycaemic food choices and no consumption of any dairy products, acne is absent.

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An important step in resolving acne permanently is to adopt a diet based on real whole foods. Ensure plenty of vegetables, some fruit, whole unrefined grains such as brown rice and oats, legumes, nuts and seeds, and good quality protein such as eggs, lean meat and seafood for the all-important anti-inflammatory omega 3 oils. Also include moderate amounts of good quality, healthy fats, including monounsaturated fats like cold pressed extra virgin olive and sesame oils. Keep sugary foods, refined carbohydrates and processed food to a minimum, or better still, eliminate them entirely from your diet.

Modern diets are rich in energy-boosting, refined carbohydrates which can affect our hormones, increasing levels of insulin and associated growth factors. Consequently, many changes occur including switching on various enzymes in the body that affect sebum, keratin and inflammation.

Keratin is a fibrous protein and sebum is an oily substance and when both are produced in excess, they can block skin pores. Once the pore is blocked bacteria will proliferate and release enzymes to break down the sebum and promote inflammation which results in the acne.

Epidemiological evidence affirms the acne-promoting effect of milk consumption. Milk significantly increases insulin levels and insulin-like growth factors, and this increases sebum oil production and pore blockage.

Acne can also be caused by excessive consumption of fats, insufficient fiber in the diet to sweep the bowel clean of toxic waste, as well as a lack of foods containing skin nourishing nutrients such as vitamin A, E, and chromium, zinc and selenium.

A modern diet also tends to contain chemicals and substances which interfere with the body's ability to detoxify and eliminate waste through key eliminatory organs such as the bowel. For this reason, liver and kidney cleansing herbs can be key for resolving acne. Dandelion (Taraxacum officinale) is considered a depurative herb, which can purify and detoxify the body. Its action on the liver supports the metabolism of toxins, wastes, pollutants, inflammatory by-products and hormones, resulting in less overall load on the liver and clearer skin.

Some other cleansing plants to try are St Mary's Thistle (Silybum marianum) and Globe Artichoke (Cynara scolymus). Like Dandelion, these plants were traditionally used to protect, strengthen and detoxify the digestive organs and liver, to support assimilation of nutrients, and to eliminate waste.

A 2012 study found that an active constituent in St Mary's Thistle called silymarin was able to decrease acne lesions by 53 per cent in an 8-week clinical trial. It was also able to boost levels of liver detoxifying glutathione.

In persistent or severe skin conditions, kidney cleansing herbs complement the detoxification of the liver because they increase the flushing of wastes and toxins.

Nettles, Golden rod, and Horsetail are traditionally used diuretics. They are best taken alternating with the liver detox herbs twice a day.

Acne sufferers can make use of these natural allies by consuming them daily as a medicinal tea; the water extract is a particularly good format for acne as water additionally helps to flush toxins. Bitter, liver-supporting herbs are best taken before meals, especially first thing in the morning before breakfast. Drink 2-3 cups daily to improve skin concerns, and then 1 cup daily as a maintenance dose once the skin has cleared up.

Supplementing with skin loving nutrients such as vitamin A and E and zinc, chromium or selenium could also be very beneficial for resolving skin conditions such as acne.

If symptoms worsen or do not improve, consult your leading healthcare professional.

- Sandra Clair is a health scientist and registered medical herbalist