I recently got a letter from a reader, Jenny, who suffers from adult acne — a problem that at some point in adulthood affects nearly 50% of women and 25% of men. Jenny has been taking a supplement (Usana’s Palmetto Plus) containing a well-known herb called saw palmetto, commonly used to help symptoms of an enlarged prostate. The capsules have helped quite a lot, she says, noting that her skin is now clear and healthy — but she’s concerned about safety, even though it was recommended to her. Saw palmetto is usually prescribed for men with prostatitis… yet she’s a woman and is using it for her skin.
I took her query to three experts in order to get a balanced view of the herb’s benefits and limitations, whatever they might be. One was Jacqueline Jacques, ND, a naturopathic physician in private practice. Another, Richard Fried, MD, PhD, is a board-certified dermatologist and clinical psychologist who specializes in adult acne. And the third is a familiar name, Daily Health News contributing medical editor Andrew L. Rubman, ND. All agreed that saw palmetto may be helpful for women with acne, though Dr. Fried advises against its use for pregnant or breastfeeding women since saw palmetto may adversely affect their hormones. Also, people with hormone-dependent cancer and those taking warfarin or iron should consult with their physician before taking saw palmetto. I asked each if there is any basis for Jenny’s belief that the herb has helped clear her skin.
HORMONES MAY CAUSE ACNE
All three physicians agreed that acne is often associated with hormones, such as the hormonal changes of adolescence. Everyone sheds cells — constantly and invisibly — from the hair follicles located all over the body (except palms and soles). Small sebaceous glands located beneath the surface of the skin secrete an oily fluid called sebum. The sebaceous glands are sensitive to testosterone and its metabolites — in acne-prone individuals, testosterone may over-stimulate those glands, causing changes in sebum production that may lead to clogged pores, says Dr. Rubman.
WHY SAW PALMETTO?
Here’s where saw palmetto comes in. In both men and women, testosterone converts to DHT (dihydrotestosterone), which is thought to be related to many different conditions, including male pattern baldness, enlarged prostate and, yes, acne. Saw palmetto has been shown in some studies to inhibit conversion of testosterone to DHT and therefore is thought to be helpful in addressing these problems.
According to Dr. Fried, some unlucky people are unusually susceptible to the effects of testosterone. “Their follicles serve as a petri dish for bacteria — and the immune system’s attack against that bacteria leads to inflammation… which is how a pimple erupts into a nasty, red, pustule.” He agreed that down-regulating the conversion of testosterone to DHT could stem the over-production of sebum that clogs pores and creates pimples — and in this way might theoretically be helpful to adults with problem skin. “I think it has the potential to improve acne,” he said. Dr. Rubman concurs, noting that the accumulation of DHT can be associated with inflammation that impairs normal function — and resolving that problem could help clear up problem skin. However, he added that effectiveness varies according to individual physiology — saw palmetto can be exactly the right solution for one person and make no difference whatsoever for another. Furthermore, there are a range of saw palmetto products on the market with varying strengths and composition.
Dr. Jacques was more enthusiastic. “I began using saw palmetto with patients a dozen years ago, and I find it amazing for hormone-driven acne,” she told me. “When the acne is associated with problems related to changes in testosterone levels or issues related to its metabolism — often the case for both teenage boys and menopausal women — saw palmetto can really be a boon.”
So, in response to the second part of Jenny’s question, about whether or not saw palmetto is helpful in battling acne, the answer turns out to be a not-so-definitive maybe. There is some basis for thinking it might be helpful. As Dr. Rubman put it, “it’s certainly worth a try.”
