Disease, Illness and Condition Library
Acne
the clothes, fix the hair and look in mirror only to see a gigantic zit forming. Panic now sets in about what step to take next. Perhaps we mash or apply some type of acne medication. Yes, zits probably have played a role in most people lives and possible determined their spouse. How could one little spot have such an impact? I can’t answer that one! Now on to the hard facts. More about Acne Acne is an inflammatory skin disorder characterized by pimples, blackheads, and whiteheads. To some degree, it affects around 80 percent of all Americans between the ages of thirteen and forty five. The American Academy of Dermatologist has reported acne to be the most commonly treated skin abnormality. For those suffering with acne, it is not merely a cosmetic problem but one that can cause a great deal of emotional stress as well as a loss of self esteem. In most cases acne starts to appear during puberty, when the body dramatically increases its production of androgens (male sex hormones). These hormones stimulate the production of keratin (a type of protein) and sebum (an oily lubricant). If sebum is secreted faster than it can move through the skin a blemish is created. The excess oil makes the pores sticky, allowing bacteria to become trapped inside. Blackheads form when sebum combines with skin pigments and plugs the pores. If scales below the surface become filled with sebum, whiteheads appear. In severe cases, whiteheads buildup, spread under the skin, and rupture, which eventually spreads the inflammation. Although proper skin care is important in the treatment of acne, acne is not caused by uncleanliness, but is more likely to be caused by overactive oil glands. Although more than 20 million teenagers suffer from this disorder, acne is not just affecting kids anymore; it is also affecting an every increasing number of adults. While teenage acne tends to occur on the face and/or upper body, adult acne is usually limited to the chin and jaw line, and involves fewer, but possibly more painful, blemishes. Many women suffer premenstrual flare-ups brought about by the release of progesterone after ovulation. Oral contraceptives high in progesterone can cause breakouts as well. The presence of candidiasis can also encourage hormonal changes which encourage the liver to produce the wrong substance for healthy sebum. Factors that can contribute to acne include hormonal imbalances, oily skin, heredity, monthly menstrual cycles, and candidiasis. Other possible contributing factors include stress, steroids, allergies, oral contraceptives, and epileptic drugs. Nutritional deficiencies and/or diets high in saturated fats, hydrogenated fats, and animal proteins can also be involved. Exposure to industrial pollutants such as coal tar derivatives, machine oils, and chlorinated hydrocarbons are some of the environmental factors that can have an adverse affect on the condition. A body pH that is too acidic or too alkaline also promotes the nesting and breeding of acne causing bacteria.
Acne ranges from mild to very severe. Yet even mild acne can be vexing, especially to those in their teenage years who perceive each pimple and skin blemish as a major cosmetic challenge. People with mild (superficial) acne develop only a few non-inflamed blackheads or a moderate number of small, mildly irritated pimples. Most acne occurs on the face but is also common on the shoulders, back, and upper chest. Anabolic steroid use typically causes acne on the shoulders and upper back. Blackheads appear as tiny, dark dots at the center of a small swelling of normal colored skin. Pimples are mildly uncomfortable and have a white center surrounded by a small area of reddened skin. People with severe (deep, or cystic) acne have numerous large, red, painful pus filled lumps (nodules) that sometimes even join together under the skin into giant, oozing abscesses. Mild acne usually does not leave scars. However, squeezing pimples or trying to open them in other ways increases inflammation and the depth of injury to the skin, making scarring more likely. The nodules and abscesses of severe acne often rupture and, after healing, typically leave scars. Scars may be tiny, deep holes (ice pick scars); wider pits of varying depth; or large, irregular indentations. Acne scars last a lifetime and, for some people are cosmetically significant and a source of psychological stress. Conventional Treatment General care of acne is very simple. Affected areas should be gently washed once or twice a day with mild soap. Antibacterial or abrasive soaps, alcohol pads, and heavy frequent scrubbing provide no added benefit and may further irritate the skin. Cosmetics should be water based; very greasy products can worsen acne. Although there are no restrictions on specific goods (for example, pizza or chocolate), a healthy, balanced diet should be followed. Beyond these routine measures, acne treatment depends on the severity of the condition. Mild acne requires the simplest treatment, which poses the fewest risks of side effects. More severe acne or acne that does not respond to preliminary treatment requires additional treatment. Mild Acne: Drugs used to treat mild acne are applied to the skin (topical drugs). They work by either killing bacteria (anti-bacterial) or drying up or unclogging pores. The two most commonly prescribed antibacterial medications are the antibiotics clindamycin and erythromycin. Benzoyl peroxide, another effective antibacterial, is available with or without a prescription. Older nonprescription creams that contain salicylic acid, resorcinaol, or sulfur (discussed below) work by drying out the pimples and causing slight scaling. These drugs, however, are less effective than antibiotics and benzoyl peroxide. If topical anti-bacterials fail, doctors use other topical prescription drugs that help unclog pores. The most common such drug is tretinoin. Treinoin is very effective but is irritating to the skin and makes it more sensitive to sunlight. Doctor therefore use caution with this drug, starting with low concentrations and infrequent applications, which can be gradually increased. Benzoyl peroxide inactivates tretinon, so the two must not be applied together. Newer drugs with effects similar to tretinoin include adapalene, azelaic acid, and tazarotene. Blackheads and whiteheads can be removed by a doctor. A large pimple may be opened with a sterile needle. Other instruments, such as a loop extractor, can also be used to drain plugged pores and pimples. Severe Acne: Antibiotics given by mouth, including tetracycline, doxycycline, minocycline, and erythromycin, are reserved for the treatment of severe acne. People may need to take on of these drugs for weeks, months, or even years to prevent a recurrence. Some of these drugs have potentially serous side effects, so close monitoring by a doctor is necessary. Women who take antibiotics for a long time sometimes develop vaginal yeast infections that may require treatment with other drugs. If controlling the yeast infection proves difficult, oral antibiotic therapy for acne may not be practical. For the most severe acne, when antibiotics do not work, oral isotretinoin is the best treatment. Isotretinoin, which is related to the topical drug tretinoin, is the only drug that can potentially cure acne. However, isotretinoin can have very serious side effects. Isotretinoin can harm a developing fetus, and women taking it must use strict contraceptive measures so they do not become pregnant. Other, less severe side effects may occur as well. Therapy generally continues for 20 weeks. If more therapy is needed, it should not be restarted for at least 4 months. Other acne treatments are usually reserved for special situations. For example, a woman with severe acne that becomes worse during her menstrual cycle may be helped by taking oral contraceptives. This treatment takes 2 to 4 months to produce results. Doctors sometimes treat large inflamed nodules or abscesses by injecting corticosteroids into them. Occasionally, a doctor will lance a nodule or abscess to drain it. Treatment of severe acne scars depends on their shape, depth, and location. Individual scars of any depth may be cut out and the skin sewn back together. Wide indented scars can be improved cosmetically in a procedure called subcision, in which small cuts are made under the skin to release the scar tissue. This procedure often allows the skin to resume its normal contours. Multiple shallow scars may be treated with chemical peels or laser resurfacing. Dermabrasion, a procedure in which the skins surface is rubbed with an abrasive metal instrument to remove the top layer, also may help remove small scars. Sometimes scars are injected with various substances such as collagen, fat, or a variety of synthetic materials. These substances may raise the scarred area to make it level with the rest of the skin.
There are a series of key aspects to consider in the treatment of acne. An integrated therapeutic approach is necessary in order to achieve the desired results. Additionally, because many individuals have been treated with long term, broad spectrum antibiotics, they often develop intestinal overgrowth of the yeast Candida albicans. This chronic yeast infection may actually make acne worse and must be treated when present. In addition to orally administered antibiotics, another popular treatment for acne is the use of over the counter preparations containing benzoyl peroxide (e.g., Oxy 5/Oxy 10, Clearasil, Benoxyl, etc.). Benzoyl peroxide acts as a skin antiseptic to keep the growth of bacteria under control. It is most effective in superficial pimples that are inflamed. In order to be effective, benzoyl peroxide preparations must be applied on a daily basis. The primary side effect of benzoyl peroxide preparations is that they have a propensity to dry out the skin and/or cause redness and peeling. The prescription topical medicine most often used is tretinoin (Retin-A). Side effects are more common with Retin-A than with benzoyl peroxide. The peeling and drying can be unusually severe. It quite literally acts to improve acne by chemically burning the skin. Taking a Look at Diet Theories regarding direct dietary influences on acne are to some extent controversial in the medical literature. One example would be chocolate; theories implicating chocolate are extremely conflicting. Rather than becoming too focused on specifics, many natural health experts feel that is most important to support the health of the skin by providing it with the very best nutrition possible. In addition to a generally healthy diet, a few specifics are in order. All refined and/or concentrated simple sugars should be eliminated form the diet, and intake of high fat foods should be restricted. Foods containing trans- fatty acids (milk, milk products, margarine, shortening, and other synthetically hydrogenated vegetable oils) or oxidized fatty acids (fried oils) ought to be avoided. For those who are iodine sensitive, foods high in iodine should be eliminated, including foods with a high salt content (most salt is “iodized”; this means that it has iodine added to it). Milk consumption should be limited due to its high hormone content in addition to its trans-fatty acid content. A diet high in protein may be of benefit: In one study, subjects fed a high protein diet (40% protein, 35% carbohydrate, and 21% fat) had the opposite effect. These results suggest that a higher protein intake may help with acne, but this has yet to be positively confirmed. Sugar, Insulin, and Chromium: Many dermatologists have reported that the hormone insulin is effective in the treatment of acne. Insulin is the hormone that regulates blood sugar levels by promoting uptake of sugar by body cells. On study that compared the results of oral glucose tolerance which pared the results of oral glucose tolerance tests in acne patients showed no differences between those who received insulin and the control group. However, analysis of the level of glucose in the skin demonstrated that patients with acne do not metabolize sugar properly. One researcher of the role of glucose tolerance in acne actually went so far as to refer to acne as “skin diabetes.” The mere fact that insulin appears helpful also suggests that impaired uptake of blood sugar by skin cells due to insensitivity to insulin. In several studies, insulin given either systemically by injection (5 to 10 units two to three times a week) or injected directly into the lesion resulted in noteworthy improvement. Rather than use insulin, it makes more sense to endeavor to improve the situation by eliminating all concentrated refined sugar from the diet. Additionally, chromium supplementation is important. Chromium is know to be helpful for glucose tolerance and enhance insulin sensitivity (see Diabetes), and has been reported in an uncontrolled study to induce rapid improvement in patients with acne. Vitamin A: Vitamin A has been shown in many studies to reduce sebum production and the buildup of keratin in the follicle. Unfortunately, the dosages that have been shown to be effective in treating acne (300 to 400,000 IU per day for five to six months) are high and potentially dangerous. High dose vitamin A treatment should not be used without close supervision by a physician. The current slate of laboratory tests seem unreliable in monitoring for vitamin A toxicity buildup until it has developed. The first significant toxic symptom is usually headache, follow by fatigue, emotional instability, and muscle and joint pain, Chapped lips and dry skin are also early warning signs. Because high doses of vitamin A during pregnancy can cause birth defects, women of childbearing age should use effective birth control during vitamin A treatment and for at least one month after discontinuation. Most natural health experts current believe that using high dosages of vitamin A is not necessary, and generally not suggested if other nutritional factors, such as zinc and vitamin E, are included. These nutrients work with vitamin A in promoting healthy skin. Zinc: Zinc is a very significant nutrient for the health of the skin. Optimal zinc levels are a primary therapeutic goal in the natural treatment of acne. Zinc plays a role in the proper metabolism of testosterone. When zinc levels are low, there is an increase in the conversion of testosterone to DHT. Remember, DHT stimulates the manufacture of sebum and keratin. Zinc is also involved in vitamin A function, wound healing, immune system activity, inflammation control, and tissue regeneration. Low zinc levels play a central role in many cases of adolescent acne, as zinc levels are lower in thirteen and fourteen year old males than in any other age group. There have been several double blind studies on zinc supplementation in the treatment of acne, but the subject continues to be controversial. The controversy arises from the fact that zinc has produced excellent results in some studies and virtually no effect in others. The unpredictability of the results may be due to the differing rates of absorption and utilization of the forms of zinc used. For example, studies that used effervescent zinc sulfate showed effects similar to those of tetracycline (one of the most popular of the brad spectrum antibiotics commonly used to treat acne), with fewer side effects from chronic use. Studies that used plain zinc sulfate have shown less favorable results. The majority of patients who responded to zinc required twelve weeks of supplementation before good results were demonstrated, although some showed impressive improvement immediately. In a recent study, sixty six patients with inflammatory acne were give zinc gluconate (30 mg of elemental zinc) or a placebo for two months. Based on the number and severity of lesions, an “inflammatory score” was credited to each patient. In the placebo group, the inflammatory score dropped from 58 to 47 during the two month period, while in the treatment group the score dropped from 49 to 27. Physicians rated twenty four of thirty two patients in the zinc group as responding to treatment, compared to only 8 of 34 in the placebo group. This study, which produced excellent results, utilized a common form of zinc (zinc gluconate). Sadly, there has been very little interest in initiating studies using zinc picolinate or zinc monomethionine, two of the better absorbed forms of zinc. Vitamin E and Selenium: Vitamin E is important in its own right in the treatment of acne, but it also is important for the proper functioning of vitamin A. During a vitamin E deficiency, blood levels of vitamin A remain low despite the amount of oral or intravenous vitamin A supplementation. Blood levels or vitamin A return to normal after vitamin E is restored to the diet. Vitamin E is also important for its interaction with selenium. Selenium is an important antioxidant trace mineral that functions in the enzyme glutathione peroxidase. This enzyme is very important in preventing the inflammation of acne. Characteristically, acne patients have significantly decreased levels of glutathione peroxidase. After treatment with vitamin E and selenium, the level of this enzyme increases and the acne is significantly reduced. Pyridoxine: Women with premenstrual aggravation of acne are often responsive to vitamin B6 supplementation, reflecting its role in the normal metabolism of steroid hormones. In rats, a vitamin B6 deficiency appears to cause both increased uptake of and sensitivity to testosterone. Pantothenic Acid: Pantothenic acid is important in fat metabolism and may prove helpful at high dosage in the treatment of acne. This possible benefit was evaluated in a study of 100 Chinese with acne. The study group consisted of forty five males and fifty five females between ten and thirty years of age; 80% were between the ages of thirteen and twenty three. They were given 10 grams of pantothenic acid per day, in four divided doses. They were also given a cream consisting of 20% pantothenic acid by weight, and were told to apply the cream to affected areas four to six times a day. Within one or two days after starting, there was a noticeable decrease in sebum secretion. Within one to two weeks, the frequency of new acne eruptions began to decline and existing lesions started to regress. No side effects were noted. Hypothyroidism Correcting an underlying thyroid problem can result in a marked reduction in acne. For additional information on thyroid function, see Hypothyroidism. Topical Treatments Currently there are a wide range of topical gels, ointments, and creams containing natural products for the treatment of acne. The focus of these preparations is no different from the popular over the counter preparations containing benzoyl peroxide: reduce the bacteria level and reduce inflammation. While there are many possibilities to choose from, the most popular formulas are those that feature either tea tree oil, azelaic acid, or sulfur. Tea Tree Oil: Melaleuca alternifolia, or “tea tree,” is a small tree native to only one area of the world: the northeast coastal region of New South Wales, Australia. The leaves – the portion of the plant that is used medicinally – are the source of this very well respected therapeutic oil. Tea tree oil possesses considerable antiseptic properties and is considered by many as the ideal skin disinfectant. This claim is supported by its efficacy against a wide range of organisms (including twenty seven of thirty two strains of P.acnes) and its good penetration and lack of irritation to the skin. The therapeutic uses of tea tree oil are based largely on its antiseptic and antifungal properties. In a study conducted at the Royal Prince Hospital in New South Wales, Australia, a 5% tea tree oil solution was shown to display beneficial effects similar to those of 5% benzoyl peroxide in treating acne, but with considerably fewer side effects. Nevertheless, this 5% tea tree oil solution is in all probability not strong enough for moderate to severe acne. Stronger solutions (up to 15%) should provide even better results. Numerous studies have shown that tea tree oil is extremely safe for use as a topical antiseptic, but it can occasionally produce contact dermatitis. Azelaic Acid: This naturally occurring acid has exerted antibiotic activity against P.acnes. Clinical studies using 20% azelaic acid creams have shown that it produces results equal to those achieved with benzoyl peroxide, Retin-A, or oral tetracycline. It has been shown to be effective in treating all of the different forms of acne. For benefits to be achieved azelaic acid must be applied to affected areas twice daily continuously for a period of at least four weeks. Treatment usually has to be continued for at least six months to sustain the benefits produced after the first month. A review article establish that a topical cream containing 20% azelaic acid to be as effective as 5% benzoyl peroxide, 4% hydroquinone cream, 0.05% tretinoin, 2% erythromycin, or oral tetracycline in relieving superficial acne, but less effective than oral Acutane (isotretinoin) in treating cystic acne. The authors suggested that the few side effects of topical azelaic acid and its lack of overt systemic toxicity make it a superior choice for chronic use. The lower incidence of side effects and allergic reactions offer a apparent advantage over conventional drugs. Sulfur: Products containing sulfur for the treatment of skin disorders have been in existence for thousands of years. Sulfur is a topical antiseptic, like benzoyl peroxide, but not as potent or irritating. Although sulfur containing formulas are still around, they have been replaced by newer compounds, such as benzoyl peroxide. This doesn’t mean that sulfur is not effective. In fact, preparations that contain 3 to 10% sulfur have produced such good results, and are so widely accepted as therapeutic, that the Food and Drug Administration (FDA) has approved sulfur as a safe and effective acne treatment. Sulfur containing products for the treatment of acne are available in health food stores as well as drug stores.
* Changing Hormone Levels in adolescent girls and adult women 2 to 7 days before their menstrual period starts * Oil from skin products (moisturizers or cosmetics) or grease encountered in the work environment (for example, a kitchen with fry vats) * Pressure from sports helmets or equipment, backpacks, tight collars, or tight sports uniforms * Air Pollution * High Humidity * Squeezing or picking at blemishes * Hard Scrubbing of the skin * Stress 5 Simple Ideas to Reduce Acne Outbreaks
get going acne can’t be far behind. * Wash Your Face! – Gently wash your face a couple of times a day. * Don’t Touch – This is a hard rule to follow for anyone who has ever has a pimple but the fact of the matter is that time is the medicine not your hands. * Minimize Makeup – Cosmetics clog glands and clogged glands tend to produce acne. A good rule here is to stick with water based products that are easily removed with soap and water. * Watch What You Eat – There is little scientific evidence to correlate diet and acne but if you detect that you get an acne outbreak every time you eat fries then skip the fries next time. You may be pleasantly surprised.
Encyclopedia of Natural Health Smart Medicine for Healthier Living Natural Acne Spot Treatment Clear Skin Acne Gel - Acne spot treatment ClearSkin-A Acne Gel contains extracts of a variety of herbs especially chosen to treat acne on a number of levels. Clinical trials have demonstrated the effectiveness of its ingredients as well as its anti-bacterial properties. Continue |
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