Saturday, October 10, 2015

Acne: Everything You Really Need to Know

There's no topic from Healing without Medication that more readers have sent me more inquiries about than acne. I've received nearly 4,000 questions about acne, and the amazing thing is, about half the time the answer is "Don't try to scrub your acne away." I decided to put the basic information on about acne available for free here, where everyone can access it readily. I'll also be posting some product reviews. I don't sell products, but I do review them, and in ten years working for acne product companies I have learned what works and what doesn't.
Acne is a form of chronic inflammation of the pores of the skin. More than 85 percent of young people aged 12 to 14 develop acne. It can also appear or reappear in adults in their 20s and 30s, or even into their 40s, 50s, and 60s.

Across all age groups, acne is the most common of all skin problems. Among teenagers, acne that is bad enough to cause scarring is more common among boys than among girls. The persistence of acne into adulthood, however, is more common among women than among men.

Acne begins with the accumulation of sebum, an oil secreted by the skin.. Sebum is essential to healthy skin. Its primary function is lubrication of the hair shaft, allowing hair to move with the skin. This vital oil also helps prevent excessive evaporation and absorption of water.

Sebum keeps the skin soft and supple. It minimizes wrinkling. It enables the skin to act as a raincoat, protecting the body from water absorption through the skin. 

Sebum also prevents the evaporation of essential fluids from the skin. Because fat is a poor conductor of heat, sebum lessens the amount of heat lost from the body's surface in cold weather. Healthy skin requires sebum.

By itself, sebum does not cause acne. Neither do the two strains of bacteria associated with acne, Propionibacterium acnes and Staphylococcus albus. In healthy skin, these bacteria feed on excess sebum, keeping it from blocking pores. These bacteria have unusually large ribosomes, energy factories that digest fats. As the ribosomes work overtime to digest sebum, they release a chemical related to hydrogen peroxide to release the fatty acids they use for energy. 

This potent pro-oxidant does no damage to the skin as long as it is free to flow to the surface, where ordinary washing with soap and water carry it away. Acne only occurs when the opening of the follicle is blocked and the peroxide is trapped inside, so that it attracts white blood cells that in turn release cytokine hormones that inflame the skin.
 
Stress causes microscopic packets in the ends of the nerve cells controlling the muscles and skin to break open and release two stress hormones, adrenaline and substance P. These chemicals help nerve signals jump from cell to cell. 

Once in the bloodstream, substance P eventually reaches the skin where it signals the cells that make sebum not just to grow in numbers but also to increase productivity. Under conditions of stress, greatly in creased numbers of sebum glands pour out greatly increased amounts of oily sebum. This is the reason people who have acne have more severe outbreaks when they are under stress.

The primary hormonal imbalance that causes acne, however, is an excess of the male-associated sex hormone testosterone. This hormone is produced by the bodies of both men and women, but in vastly greater quantities in men. Most people have some understanding of how testosterone causes the hairiness, muscularity, and aggression of male secondary characteristics, but the role of testosterone in women requires some explanation. 

Women's bodies contain testosterone throughout their lives, but only in vanishingly small quantities until puberty. About the time of a woman's first period, the adrenal glands begin to make massive quantities of dehydroepiandrosterone (DHEA) from cholesterol. Most of the young woman's DHEA is processed by the adrenal glands into the stress hormones so well known in adolescence. 

Some of the DHEA goes to the ovaries and uterus to form the female hormones estrogen and progesterone. Trace amounts of DHEA accumulate as a byproduct, dehydroepiandrosterone sulfate. When a woman's adrenal glands and ovaries turn this byproduct into testosterone, she begins to experience sexual desire. About the time a young woman becomes interested in sex, she also becomes at risk for acne.

Like sebum and acne bacteria, testosterone itself does not aggravate acne. Testosterone becomes a problem only when it is chemically processed by the enzyme 5-alpha-reductase into a more potent form of the hormone, dihydrotesterone. This form of testosterone stimulates the production of the tough protein keratin that lines the interior of the pore. As keratin builds up in the cells lining the shaft of the pore, it narrows the pore's opening. The narrowed pore traps peroxide-producing bacteria, dead skin cells, and pus inside.

Testosterone levels are especially high in both boys and girls aged 10-14. They are also elevated in women who have ovarian cysts, in men who take the bodybuilding aid androstenedione, and in women who use oral contraceptives. All of these groups are especially susceptible to acne.

Acne also results from exposure to industrial pollutants, including machine oils, chlorinated hydrocarbons, and coal tar derivatives. Acne is a frequent side effect of treatment with steroids for asthma or rheumatoid arthritis, and lithium carbonate for bipolar disorder. Overdoses of vitamin B supplements (specifically vitamin B6 and B12) can cause acne. 

Even more frequently, acne results from the overuse of pore-clogging cosmetics or pomades, or is a complication of skin irritation caused by overwashing and nervous, repetitive rubbing and touching of the skin.

Prescription medications for acne often make the condition worse before it gets better. Most drugs for acne require several weeks to several months to take effect. Any medication for acne must be used regularly to work.
  

Specific Treatments for Acne

Diet:
  • Avoid caffeine, cola drinks, and refined sugars.
  • Avoid shellfish and iodized salt.
  • Drink at least 6-8 glasses of water every day.
  • In general, avoid overeating starchy or sugary foods.
Nutritional Supplements:
  • Brewer's yeast: 1 tablespoon of powdered yeast or 3,000 mg of brewer's yeast capsules 2 times per day. (Persons who are susceptible to gout should take chromium supplements instead of brewer's yeast.) Yeast beta-D-glucan, 20 mg 3 times a day, can be substituted for brewer's yeast.
  • Selenium: 200 micrograms per day.
  • Vitamin A: 100,000 IU per day for up to 3 months. Women who are or who may become pregnant should strictly limit their intake of vitamin A to 5,000 IU per day or less or take mixed carotenoids, up to 25,000 IU per day.
  • Vitamin C: Up to 1,000 mg per day.
  • Vitamin E: Avoid supplements that contain only alpha-tocopherol. Mixed tocopherols in any dosage are helpful for general health.
  • Zinc gluconate: 50 mg per day.
Women who experience outbreaks of acne before their menstrual periods may benefit from:
  • Vitamin B6 (pyridoxine): 50 mg per day, or 1 complete B vitamin supplement tablet (a B-50 or B-100) 3 times per day.
Anyone who has acne who engages in vigorous physical exercise on a regular basis, especially teenagers, should be sure to take vitamins C and E, plus:

Alpha-lipoic acid, 100 mg daily.

Herbal therapies to avoid:
  • Avoid avena, chrysin, muira puama, pine pollen, Siberian ginseng, stinging nettle, and Tribestan. All of these herbs either increase testosterone production or elevate testosterone levels in the bloodstream.
The useful herbal therapy for acne is:
  • Tea tree oil (5 to 15 percent strength), use creams topically.
Other Helpful Natural Products:
  • Alpha-hydroxy acid (lotions containing 5 to 10 percent glycolic acid). 
  • Azelaic acid (creams in 20 percent strength), used topically.
Alpha-hydroxy and azelaic acids are used to exfoliate the skin, keeping flakes of dry skin from blocking pores.

How the Treatments Work

The latest nutritional research has challenged traditional assumptions about acne. Some foods that were once thought to cause blemishes, such as chocolate, are now known not to cause breakouts. Other foods that were thought to be OK, such as creamed corn and tomato sauce, are now known to cause excessive sebum production.

Doctors conducting clinical research have found that a high-protein diet (in this study, 44 percent protein, 35 percent carbohydrate, and 21 percent fat) slows the conversion of testosterone into dihydrotesterone. The effects of the diet were measurable in fewer than 2 weeks. A high-carbohydrate diet (10 percent protein, 70 percent carbohydrate, and 20 percent fat) had the opposite effect, accelerating the conversion of testosterone into its acne-inducing form, also in fewer than 2 weeks.

Most naturopathic physicians also advise avoiding iodine found in shellfish and iodized salt, since it is essential to the production of thyroid hormones that enable the release of sugar into the bloodstream. Of all the diet recommendations for acne care, the easiest is just to drink more water. Keeping the skin adequately hydrated keeps it supple, helping sebum to flow to the surface.

A Dutch study offers detailed insight into the more complex relationships between acne and diet. Dutch researchers enlisted 302 volunteers to agree to have their faces measured with a device called a sebum meter, and to give blood samples for measurements of common nutrients. They also filled out diaries of their daily food selections. Some of the results of the study were expected. Some require a new look at acne and nutrition. 

A not-surprising finding of the Dutch study was that when it comes to acne, there are good fats and there are bad fats. The skin uses lipids to stay supple and moisturized. Flexible, supple skin allows for a normal flow of sebum out of pores that prevents acne. The more beneficial lipids there are in the skin, the less sebum remains to clog pores. 

Human skin makes beneficial lipids from saturated fatty acids, the kinds that appear in avocados, dark chocolate, nuts, and seeds. Saturated fatty acids also prevent the growth of bacteria. A dietary deficiency of saturated fatty acids decreases the suppleness of the skin and aggravates acne by allowing bacteria to multiply unchecked.

Not every kind of fat is good for your skin. Unsaturated fatty acids are excellent food for bacteria. These are the kinds of fatty acids found in margarine and shortening. Mass manufacturers of inexpensive desserts use them to stabilize just about any kind of baked good found on the store shelf wrapped in cellophane. 

Not only do these “bad” fatty acids feed bacteria, the skin cannot use them to stay supple. They feed bacteria and trap them in pores. In the Dutch study, no dietary factor was more predictive of the health of the skin than which kind of fatty acid predominated in the bloodstream. Saturated fats such as those found in butter, cream, whole milk, and cheese were clearly protective of the skin. Monosaturated fats such as those found in avocados, chocolate, nuts, and seeds were even more protective. Unsaturated fats were clearly detrimental.
 
This study did not find that sugar was bad for the skin. In the Dutch study, consumption of carbohydrates had almost nothing to do with the health of the pores. The statistics did not suggest that sugar is good for acne, but they did not prove that it is bad. There is a theory that acne results from localized insulin resistance or “diabetes of the skin,” but these clinical data do not support it.

This study also did not find that low-fat, high-protein foods are helpful in acne. The Dutch researchers found that the consumption of protein was associated with greater hydration of the skin, making it soft and supple, but consumption of proteins without fat also seemed to result in greater production of pore-clogging sebum. In fact, protein was almost as closely correlated with sebum production as consumption of the fats in margarine, corn oil, and baked goods.

The Dutch study did not find that eating fiber helps acne, but that could be because the participants, as a group, all ate a relatively high level of high-fiber foods. There may not have been sufficient contrast between highest and lowest levels of fiber consumption in this study to note a difference. 

What about vitamins? Here there were some real surprises. 

Vitamin A seems to protect against acne. The body can make vitamin A from beta-carotene. Higher beta-carotene levels, however, tended toward slightly increased production of sebum and slightly decreased hydration and suppleness of the skin.

Vitamin C seemed to increase sebum production and decrease hydration of the skin, but only slightly. Vitamin E in the form of alpha-tocopherol, however, was linked to increased production of pore-clogging sebum more than any other nutrient considered in the study. Doubling consumption of vitamin E increased production of sebum nearly thirty times. 

There were also some surprises about phytonutrients. Lycopene, the generally beneficial plant chemical found in tomatoes, tended to decrease the production of sebum (an undesirable effect) but had almost no effect on the hydration of the skin (a desirable effect). Beta-cryptoxanthin and zeaxanthin, phytochemicals found in sweet corn, tended to increase the hydration of the skin, softening it, but only in men. On the other hand, they increase production of pore-clogging sebum, but, again, only in men. 

Calcium, found in dairy products, raises the pH of the skin (making it less acidic) and makes it less hospitable to the bacteria that cause bacteria, but the study only found this effect in men. 

And what about water? Water dilutes the acidity of the skin. It raises skin pH, probably just enough to slow the growth of bacteria. In the study, fluid consumption increased the hydration of the skin, but the researchers made no effort to persuade participants in the trial to drink more water. 

One interpretation of the findings of the Dutch study is that drinking just another half a cup (120 ml) of water a day might produce a very small but measurable improvement in the health of the skin. This study simply does not tell what greater increases in fluid consumption could do for skin health.

If you consider all these findings, what are the patterns of healthy eating that heal acne? Let’s start with simple measures. Consuming more fluid increases the smoothness and suppleness of the skin. Anyone can consume more fluids. Just be sure that no matter how big a rush you are in to get to work or school in the morning, drink a glass of water before you leave home. Drink a glass of water at noon, and another in the afternoon, and another when you get home. This is a low-cost or no-cost way to relieve acne that is also calorie, carbohydrate, fat, and allergen free.

Another set of helpful choices in treating acne concerns your choice of snacks. Generally speaking, if it’s made with flour and sugar and it’s wrapped in cellophane, don’t eat it. This rule alone will spare you the majority of polyunsaturated, “bad” fats found in the typical diet. 

This does not mean you can never eat sweets. Just don’t compound the detrimental effects of sugar with the detrimental effects of polyunsaturated fats. Better yet, munch on almonds or dried fruit, especially dried apricots. Or if you just have to have a candy bar (for instance, you’re hypoglycemic and you have to deal with a sugar crash and there is nothing else in the machine)choose one that combines chocolate with nuts, but don’t make a habit of it. 

What if you find you have to eat fast foods? Many fast food restaurants offer Greek salads. You get monosaturated fatty acids from the olives and olive oil, and the fats in the feta help your body process vitamin A. Salads do not provide excessive protein. 

At the opposite extreme, probably the very worst fast food for acne is nachos or Frito pie made with corn chips under a heat lamp loaded with squirt-able cheese. This combination offers a maximum of polyunsaturated fat and a minimum of vitamins and antioxidants. The combination actually destroys antioxidants, especially vitamins C and E.

The most important vitamin for skin health is vitamin A. Your body best absorbs vitamin A from foods that are prepared in the form of an emulsion, a mixture of the vitamin A-rich food, a fat such as milk fat, and water. Your body has the hardest time processing the vitamin A in fat itself. 

In other words, don’t rely on eating extra butter to get your vitamin A! This vitamin should come from a plant source, but the plant food should be eaten with a fat, preferably milk fat or the fat in avocados, seeds, or nuts. In the same meal, you should eat apricots, cantaloupe, carrots, mangoes, oranges, peaches, pumpkin, or winter squash, any yellow or orange fruit or vegetable, but only in moderation.

Your body can make vitamin A out of beta-carotene. If you have acne, however, you should avoiding loading up on foods that are high in beta-carotene, such the fruits and vegetables listed above. You also need the fat. When you eat foods that high in beta-carotene without eating at least a little fat, your body is less able to convert the beta-carotene into vitamin A. Vitamin A reduces the production of sebum, but beta-carotene increases it. 

Likewise, lutein, lycopene, and zeaxanthin increase the production of sebum. You don’t have to avoid vegetables that contain these nutrients, but you shouldn’t load up on them either. Too many tomatoes (the major source of lycopene) or too much sweet corn (the major source of zeaxanthin) might cause your skin to break out, even if you are not allergic to these foods.

Vitamin C has a neutral effect on acne-affected skin. It slightly increases the production of sebum, but it also slightly increases the hydration of the skin. Vitamin E occurs in eight different chemical forms. The alpha-tocopherol form of vitamin E encourages the production of sebum, but the other forms of vitamin E do not. (I should explain that the Dutch researchers looked at a variety of factors surrounding the metabolism of vitamin E and skin health, and they found that is was possible that people who take vitamin E have conditions that cause skin problems. That is, the increased consumption of vitamin E might not be the culprit in acne. The condition that causes someone to need to take vitamin E might be the real problem.) 

If you have acne, and you don’t have a serious health condition such as diabetes or heart disease that requires you to take supplemental vitamin E, get your vitamin E by eating eggs, seeds, or nuts. Don’t take vitamin E supplements, unless they blend alpha-tocopherol with the other kinds of tocopherols that make up vitamin E. 

What about macronutrients? A high percentage of protein in the diet is achieved by limiting consumption of carbs and fats, not by loading up on protein. Protein loading greatly increases the production of sebum. 

Don’t chow down on steak and burgers, and don’t go an Atkins or South Beach diet. On the other hand, a modest addition of cholesterol in your diet, about the equivalent of an egg a day, slightly reduces the production of pore-clogging sebum. Don’t go out of your way to add cholesterol to your diet, but don’t avoid it, either. 

What About Fat and Fiber?

Some readers may wonder why certain other dietary suggestions are not made here. There is no evidence that high-fat foods, in and of themselves, cause acne. Cholesterol is a building block for testosterone, but the body's supply of cholesterol is mostly made by the liver. 

Eliminating fatty foods generally has very little effect on either the amount of cholesterol in circulation or the progress of acne. Among high-fat foods, chocolate and nuts are frequently singled out as causes of acne. They are not. The tyrosine in chocolate, gelatin, and nuts can aggravate herpes, but does not affect acne.

Another recommendation that is not made here is to take fiber. In addition to the evidence from the Boelsma study, it is also known that fiber absorbs waste estrogen in the intestines, which prevents the hormone from being absorbed through the intestinal wall back into the bloodstream, where it can be converted into testosterone. 

While taking fiber does not hurt, there is no evidence that it produces specific improvements in acne. Nonetheless, if you choose to use fiber, always take fiber supplements separately from other supplements and medications. Fiber keeps medicine from being fully absorbed.

What About Supplements?

The key to using supplements successfully is balance. Don't megadose on any one supplement. Just make sure you don't have a deficiency by taking one or two bottles of the supplement over one or two months, and then making sure you have a varied diet. For treating acne, meeting the minimums is more important that maxing out the amount of any supplement you take.

Chromium

High-chromium yeast enhances the ability of insulin to carry sugar out of the bloodstream and into cells. A preliminary clinical study reported rapid improvement in acne patients who took brewer's yeast for acne. Yeast beta-D-glucan stimulates the activity of macro phages, the white blood cells that are responsible for eliminating bacterial infections.

Yeast is also thought to enhance the elasticity of the skin, and is used in many cosmetics. There are no reports of side effects from using yeast. Yeast may even increase the effectiveness of antibiotic treatments for acne.

Selenium

Selenium is an important cofactor for vitamin E. Adult male acne patients have low levels of the antioxidant glutathione peroxidase, which normalizes with vitamin E and selenium treatment. Glutathione peroxidase puts a brake on inflammatory reactions throughout the body, especially in the skin. Selenium depresses the parts of the immune system that cause allergic reactions, but encourages the parts of the immune system that respond to bacterial infection. There is also evidence that selenium compounds control the breakdown of thyroid hormones into forms that do not aggravate acne.

Selenium from yeast is the best form of selenium for treating acne, but it should be taken with care. Taking selenium at the same time as vitamin C reduces the absorption of selenium, and you should never take more that 1,000 mg of selenium a day. The first sign that you have overdosed selenium is usually a garlicky breath odor. Excessive use of selenium can also cause hair loss, fatigue, irritability, and hyperreflexia or "jumpiness." Horizontal streaking, blackening, and fragility of the nails when you take selenium is a sure sign you are taking too much or you are taking a product that has been improperly standardized.

Both men and women with acne benefit from taking selenium with vitamin E in the form of mixed tocopherols. Taking these two nutrients together is especially important for acne that has reached the pustule stage. Vitamin E is also an important cofactor for vitamin A. In laboratory studies with animals, the amount of vitamin A in the bloodstream stays low regardless of intake until vitamin E levels are normal. Vitamin E supplementation is useful even if you do not take vitamin A, since it complements the vitamin A available from the diet.

Vitamin A

Vitamin A is the naturally occurring analog of the prescription drug tretinoin (Accutane). Like its chemical cousin, vitamin A reduces the production of sebum and slows the rate at which skin cells produce keratin. Together, these actions keep pores open and reduce the probability of infection.

The drawback to using vitamin A as a supplement is that a dose that is big enough to stop acne is big enough to cause side effects. Problems from using even up to 300,000 IU of vitamin A per day are rare, but they are significant. The first signs of vitamin A overdose are dry skin and chapped lips, especially in dry weather. Later signs of toxicity are headache, mood swings, and pain in muscles and joints. 

In massive doses, vitamin A can cause liver damage. In the first 3 months of pregnancy, it can cause birth defects. Women who are or may be come pregnant should not use more than 5,000 IU of vitamin A per day, which is not enough to improve acne. Discontinue high-dosage vitamin A at the first sign of toxicity, and never use it for more than 3 months at a time.

Vitamin C

In true vitamin C deficiency, acne, along with gum sores, is a key diagnostic symptom. Just a tiny dose of vitamin C, however, a mere 10 mg a day, is enough to correct acne caused by vitamin C deficiency. For people who do not have scurvy, vitamin C does not have a scientifically demonstrated direct effect on acne, but it makes other vitamins more available. Studies at the Northern Ireland Centre for Diet and Health have found that taking vitamin C increases the amount of available vitamin E in the bloodstream by about 10 percent. Taking vitamin E increases the amount of available vitamin C in the bloodstream by about 60 percent.

Vitamin C also may protect against the side effects of prescription acne drugs. Tetracycline antibiotics for acne, especially minocycline (Cyclimycin, Minocin, or Trimomin), cause a condition known as "blue smile," a discoloration of the tongue and teeth. Scientists at the Baylor College of Dentistry in Dallas have found that giving vitamin C to lab rats at a dosage approximating 1,000 mg per day in humans prevents staining of teeth during minocycline therapy.

Zinc

Several clinical studies report that zinc is only slightly less effective than antibiotics in controlling acne (although antibiotics by themselves seldom are adequate treatment). The key to using zinc effectively is buying the right kind of zinc. Researchers using an effervescent (fizzy) form of zinc sulfate found it to be about as effective as the antibiotic tetracycline. Researchers using a plain form of zinc sulfate found that it appeared to have a somewhat beneficial effect on pustules but not on blackheads, white heads, nodules, or cysts. 

The most recent clinical study found that acne patients given a moderate dose of zinc gluconate (30 mg) per day were about half as likely to be completely cured after 90 days as those given the minocycline. Among patients who did not achieve total remission, however, zinc treatment eliminated over 90 percent as many lesions as treatment with the antibiotic after 30 days and over 80 percent as many lesions as the antibiotic after 90 days.

The bottom line of these studies is, if you have acne, take zinc and be prepared to wait a couple of months for results. The best-absorbed form of zinc is zinc picolinate. Do not take more than 50 mg of any zinc supplement daily. In rare cases, excessive intake of zinc depletes copper to cause anemia, that is, a deficiency of red blood cells, and neutropenia, a serious deficiency of white blood cells. If you take tetracycline antibiotics for skin infections, chances are you are deficient in zinc. Taking tetracycline interferes with the body's absorption of zinc (and taking zinc interferes with the body's absorption of tetracycline).

Alpha-Lipoic Acid and Vitamin B6

One other supplement is helpful if you exercise and you have acne. Aerobic exercise helps acne by increasing circulation to the skin, but anaerobic exercise (huffing and puffing to the point of exhaustion) without antioxidant supplementation may aggravate acne. Strenuous exercise depletes glutathione. This naturally occurring antioxidant slows inflammatory reactions and is essential to the normal function of estrogen and testosterone. Laboratory studies with animals have found that supplementation with alpha-lipoic acid keeps glutathione from breaking down, especially in the liver and in the bloodstream.

Also in laboratory experiments with animals, vitamin B6 (pyridoxine) deficiencies cause increased sensitivity to testosterone. Women who have flare-ups of acne along with PMS often improve after taking vitamin B6. Women who develop acne during testosterone treatment usually benefit from taking B6.
 

What About Herbs and Other Natural Products?

A study conducted at the Royal Prince Alfred Hospital in New South Wales, Australia, found that a 5 percent tea tree oil solution was as beneficial as a 5 percent benzoyl peroxide cream in reducing the number of pimples. Benzoyl peroxide got faster results, but tea tree oil had fewer side effects. 

Tea tree oil is antibacterial against 27 of 32 strains of Propionibacterium acnes, the infectious agent most commonly associated with the disease. Tea tree oil may be used at a strength of up to 15 percent for especially severe cases of acne. There are very few reports of problems with tea tree oil, although it can cause allergies and should be kept away from small children.

Tea tree oil has a big advantage over the more commonly used benzoyl peroxide for treating facial acne. Tea tree oil not only kills acne bacteria, it also "gets the red out." Neither benzoyl peroxide nor tea tree oil will get rid of whiteheads and blackheads, but tea tree oil reduces redness and inflammation around pimples.

Benzoyl peroxide has a big advantage over tea tree oil for treating acne on the back. The skin of the back is tough and hard to penetrate. Foaming benzoyl peroxide does a much better job of opening blocked pores on the back and torso.

Calendula Soap for Pimples (Not Blackheads or Whiteheads)

Calendula and marigold are the same herb. The botanical term calendula is used to name bath products and the common term marigold is used to refer to the plant as a healing herb. Calendula soaps are a very useful complement to tea tree oil. They kill Staphylococcus aureus, a bacterium not affected by tea tree oil or benzoyl peroxide. 

The essential oil in the herb is a potent anti-inflammatory agent, offering about the same degree of pain relief as the over-the-counter nonsteroidal anti-inflammatory agent indomethacin (Indocin), but without side effects on the digestive tract. Marigold oil applied to the skin with a cotton swab has the same analgesic effect. 

About 1 in 500 people is allergic to calendula. Test the soap or oil on a small area of skin before using it on a large patch of skin.

Natural Exfoliants
There are several other natural products you can use to treat acne. Alpha hydroxy acids are commonly found in and isolated from fruits of all sorts. Exactly how they help control acne is not fully understood, but they function in at least two ways. They act as a humectant, increasing the water content of the skin and moisturizing the outer layer of the epidermis. This makes the skin softer and more flexible. Secondarily, alpha-hydroxy acids reduce skin cell adhesion and accelerate skin cell proliferation within the basal cell layers.
Alpha hydroxy acids encourage the growth of blood vessels to oxygenate the skin. They activate an internal clock inside skin cells at the surface reminding them of the time to die and be sloughed off, providing room for the growth of new, healthy skin. The growth of skin underneath the follicle forces it open and allows the release of dead skin cells and irritants.

Alpha hydroxy acids are a good match for skin that is oily, firm, and pigmented in persons who are not prone to allergies. In rare instances, alpha hydroxy acids can cause temporary pigmentation of the skin in people who have chemical sensitivities. Alpha hydroxy acids may make dry or wrinkle skin more sensitive to sunlight.

How do you recognize alpha-hydroxy acids? The label may say:
  • Alpha hydroxy botanical complex
  • Alpha hydroxycaprylic acid
  • Alpha hydroxyethanoic acid + ammonium alpha hydroxyethanoate
  • Alpha hydroxyoctanoic acid
  • Citric acid
  • Glycolic acid
  • Glycolic acid + ammonium glycolate
  • Glycomer in crosslinked fatty acids alpha nutrium (three AHAs).
  • Hydroxycaprylic acid
  • Lactic acid
  • L-alpha hydroxy acid
  • Malic acid
  • Mixed fruit acid
  • Sugar cane extract
  • Tri-alpha hydroxy fruit acids
  • Triple fruit acid
The most common alpha-hydroxy acid is glycolic acid. Glycolic acids are most appropriate for treatment of skins that are: 
  • Dry, resistant, pigmented, and smooth. 
  • Dry, resistant, pigmented, and wrinkled.
  • Dry, sensitive (to chemicals or allergens in general), pigmented, and smooth. 
  • Dry, sensitive, non-pigmented, and wrinkled. 
  • Oily, resistant (not sensitive to chemicals or allergens in general), pigmented, and wrinkled. 
  • Oily, resistant, pigmented, and smooth. 
Azelaic acid is a naturally occurring hydrocarbon, found in wheat, rye, and barley. It is one of the acids used in "facial peels" performed in a doctor's office. This organic product prevents the process of hyperkeratosis, or overgrowth of skin cells, forcing follicles shut. By reducing the rate at which skin cells grow in the linings of pores, it keeps pores open. It is antibacterial, controlling both Propionibacterium acnes, the microorganism that flourishes in clogged pores, and Staphylococcus aureus, the bacterium that also causes abscesses, boils, and impetigo. 

Physicians at the University of California at San Francisco have found that a cream containing 20 percent azelaic acid is as effective in treating acne as benzoyl peroxide gel (5 percent concentration), tretinoin cream (0.05 percent concentration), erythromycin cream (2 percent concentration), and oral tetracycline given at a dosage of 500-1,000 mg per day, provided it is used to treat pimples and mild to moderate inflammatory acne. However, azelaic acid is less effective than Accutane for the treatment of acne conglobata, the form of the condition that produces large, deep pustules that join under the skin.

Azelaic acid cream should be applied twice daily for at least 2-3 months. It can be used for up to 1 year. Im provement should be detectable within 1-2 months. To ensure adequate penetration, the cream should be rubbed thoroughly (but not too vigorously) into clean skin for 2-3 minutes. 

An advantage of azelaic acid over antibiotics is that azelaic acid does not cause bacteria to become antibiotic-resistant. Azelaic acid seldom produces adverse effects, the most common being short-term itching and burning sensations. About 10 percent of people who use azelaic acid will experience burning and itching during the first 2-4 weeks it is used.

Azelaic acid has a special application for persons of Asian, especially Korean, descent who use skin lighteners. Alternated with hydroquinone products (which are available in the US, although not in Asia) every 2 to 4 months, azelaic acid may prevent the freckles and age spots that can occur as a paradoxical effect of hydroquinone skin care products.
In my own experience consulting to Asian manufacturers of skin care products, occasionally women complain of paradoxical effects of skin lightening agents, including creation of new age spots and acne. In every case, these women lived nearby a chemical plant that made the chemicals used in the creams. To avoid an environmental overdose, do not use of azelaic acid and vitamin B5 creams if you live near unregulated chemical plants that make their raw ingredients.

Once this complication has occurred, the way to reverse it is to use other, more appropriate products such as antioxidant cleansers, toners, and gels, and oil-free foundation for cosmetics. Evening application of a retinol- (vitamin A-) enriched product will eventually control both redness and brown spots caused by this kind of reaction.
 

More Methods for Getting Better

For most people who have acne, the cardinal rule of skin care should be "Wash less." Washing the surface of the skin does not remove embedded oils or cellular debris, but it can make the skin dry and wrinkle-prone. Rubbing too hard can injure the skin so that infection sets in. Washing with soap and water in the morning and in the evening is enough.

In taking care of acne, it is particularly important not to try to dry out oily skin. Drying the skin with alcohol or alcohol-based astringents or gels does not eliminate the pus that clogs pores. It only tightens the skin and makes the natural elimination of sebum and dead skin cells more difficult. Dry skin ages more quickly.

Caffeine, colas, and sugary soft drinks induce an adrenaline surge. This triggers the release of substance P. In turn, substance P signals the glands to make more sebum. It is especially important to avoid caffeinated, sugary soft drinks and coffee during times of stress.

Alpha-hydroxy acids (glycolic and lactic acids) are not recommended for oily skins in persons who are sensitive to sunlight, allergens, or industrial pollution. They are generally appropriate for dry skins because they remove dead skin cells from the epidermis and stimulate collagen production beneath.

Acne in babies is caused to a reaction to the mother's hormones that surge just before delivery. These small white or pink bumps usually disappear in about two weeks.

About one in three users of Accutane develops high cholesterol, and about two in five develop high triglycerides. ""This is a side effect that we have known about all along. We've been monitoring patients since the day the drug came on the market," said Dr. Stephen Stone, president of the American Academy of Dermatology and professor of clinical medicine at Southern Illinois University School of Medicine in Springfield told the web magazine HealthDay. "The only thing that is different is the number of patients who have elevated cholesterol or triglyceride levels is greater than the number stated in the original package insert."

Although dermatologists often prescribe antibiotics for long-term use, two recent studies find that the benefits of antibiotics max out at 12 weeks. The less you use antibiotics, the lower the risk of your developing or passing along an antibiotic-resistant infection.

The new UVA-blocking sunscreen Anthelios can cause acne as a side effect. This side effect wears off when the sunscreen is discontinued.

Avoid touching your hands to your face. Squeezing and picking at pimples will make them worse.

Wear your hair so it stays out of your face. Keeping your hair out of your face keeps oils from reaching facial skin.

Avoid heavy makeup, moisturizing creams, and oily hair preparations.

Always use a clean towel to dry your face, to avoid reinfecting your skin with acne-causing bacteria.

If you experience periodic outbreaks of acne not related to stress (in both sexes) or your menstrual cycle (in women), the problem may be cumulative stress to your skin from the way you wash your face. Do not scrub too hard-rough treatment of your skin opens pores to bacteria.

If you have been prescribed tetracycline or minocycline antibiotics, be sure to take them at least 1 hour before or 2 hours after meals to avoid stomach upset. Never take antibiotics with milk. It is best to take these medications with water at bedtime.

Do not try to get a tan to "dry out" acne. Exposure to sun does not help acne and can cause wrinkles.
Homeopathic medicine offers a number of treatments for acne. While homeopathic preparations are generally more effective than a placebo, the full benefit of homeopathy is found through interaction with a homeopathic physician who can match the symptoms of the whole person to a specific remedy.

Because homeopathy treats people rather than diseases, homeopathic remedies match not only specific symptoms, but "central delusions," the essential ways people misperceive their life issues, that lead to illness.

If you choose to try homeopathy without the assistance of a homeopathic physician, start with a single dose of the lowest strength (6C, 6X, or 12C) of the remedy matching the symptoms to be treated, and then wait for a response. If there is an improvement in symptoms, let the remedy continue to work until there is no more improvement, then take another dose. If there is no improvement, try a different potency (30X or 30C). Sometimes homeopathic medicines work for a few minutes, and sometimes they work for an entire day before another dose is needed.
  • Antimonium tartaricum treats acne in people who tend to get frequent infections and who are generally irritable. The specific manifestations of acne may be bluish marks that remain on the skin after pimples have cleared up, or large pustules that are tender to the touch.
  • Calcarea carbonica treats acne in people who have a tendency to sweat (especially in the hands and feet), are overweight, tend to become anxious when on a tight schedule, and who have cravings for sweets. For this person, acne outbreaks are frequent and coincide with other infections.
  • Hepar sulphuris calcareum is usually recommended for people who are sensitive to cold and who respond to cold with irritability. Skin eruptions may be sensitive to the touch and easily infected, but slow to come to a head.
  • Pulsatilla, sometimes labeled as silverweed, is helpful when acne is aggravated by eating too many sugary foods. The person often has a fair complexion and is inclined toward soft emotions. Homeopathic physicians often recommend it to women whose acne breaks out near menstrual periods.
  • Silicea (silica), a homeopathic remedy made from the most common material in the earth's crust, relieves deep-seated acne with swollen lymph nodes and fatigue. People who benefit from this remedy are generally chilly but may wake up in the middle of the night drenched with sweat. They may have to endure deep depression stemming from deprivation in life.
  • Sulfur treats inflamed and itchy outbreaks of dirty-looking skin. Homeopaths tend to recommend it to patients who suffer a general lack of order and neatness in their lives.
Home microdermabrasion kits are available in pharmacies and skin care salons for US $10 to $300. There's no doubt they are useful for treating small acne scars, enlarged pores, clogged pores, fine lines, and uneven skin coloration. Microdermabrasion directs a stream of microscopically small aluminum oxide crystal through a tube under pressure into the skin. These crystals exfoliate the skin, encouraging the formation of collagen, and producing healthier, thicker, often "glowing" skin after five or six treatments. Microdermabrasion is painless and effective with minimal side effects-but not recommended for continuous use.

Why not? Although microdermabrasion machines remove aluminum crystals and dead skin cells as they exfoliate the skin, regular use of the technique almost certainly leaves some aluminum behind. 

Scientists do not know for a certainty that low levels absorbed into the body from any source of other than drinking water increase risk of Alzheimer's disease, but until the relationship between aluminum and Alzheimer's has been thoroughly researched, it's a good idea to use microdermabrasion occasionally (treatments once or twice a year, for example), rather than regularly. In the meantime, microdermabrasion cloths are a safe alternative.

This is a lot to take in, and maybe you're really looking for specific answers. That's OK. Ask any question you'd like, and over the next few days I'll be providing some specific information on acne products.

1 comment:

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