Acne Skin Care Treatments

By Wendy Wells, NMD.

Chronic acne symptoms can result from a broad range of causes that are often misunderstood. In this article we'll try to demystify the path to clear and healthy skin. The skin is our largest organ, and can be viewed as a reflection of our overall health inside and out. The following is a list of the areas we'll be covering:

What is Acne?

Acne vulgaris is a common propionibacteria skin infection, affecting adolescents and adults. Acne bacteria feed on excessive skin oil in a low oxygen environment, deep inside the skin. This resulting in bacterial overgrowth, inflammation and skin erruptions. The United States has seen an increase in the occurence of acne in last several years. 1

The association between diet and acne has been controversial. However, several studies conducted over the past ten years have caused dermatologist to take a second look at the connection between diet and skincare. According to the American Academy of Dermatology, it's clear that "skincare professionals can no longer reject the link between diet and acne."2

Reduce Sugar Intake

The number one cause of acne results from having specific food intolerances. Researchers from the University of Kentucky, College of Medicine, have gathered evidence explaining how acne can be related to a Western diet. This diet is rich in dairy, refined sugars, and complex carbohyrates, contributing to high glycemic loads in the US population. 1 They also note how the rise of acne is related to the US obesity epidemic.

In my practice as a naturopathic doctor in Phoenix, AZ we've had multiple patients find acne relief by removing of a particular food, or food combination. This has resulted in a 99% improvement of acne symptoms.

Various tests are used to optimize acne treatment including:

Good Guy Probiotics

Next, we have to address any Candida overgrowth that may be occuring in the gut. "Bad guy" intestinal microbes such as Candida, can be out-competed by healthy "good guy" microbes, called probiotics by reducing the food that yeast feed on... sugar and carbohyrates. Lactobacillus acidophylisis is one of the many good types of probiotics/micro-flora that live and thrive in the intestines.

The two famous dermatologists Stokes and Pillsbury, hypothesized over 70 years ago how emotional states like depression and anxiety can upset the balance of normal intestinal microflora. This increases intestinal permeability, contributing to inflammation over the entire body, especially skin conditions such as acne. 3, 12

We receive considerable benefit from many resident (commensal) organisms. Healthy resident microbes found on the skin and in the gut, produce antimicrobial peptides. These act to enhance our body's normal production of protective peptides, via keratinocytes, helping to maintain inflammatory homeostasis. 4

What's on the inside often matches the outside. Propionibacterium, the microbe involved in acne inflammation, metabolizes sebum and releases fatty acids thatsignificant slows bacterial activity. But, when an excessive level of skin oil (sebum) is produced, the bacterium overfeeds and creates conditions that cause inflammation. Microorganisms that can be regularly isolated from skin include:

These microbes are typically found near sweat glands and hair follicles. Most microorganisms in the skin microbiota thrive in a high oxygen environment like micrococci. However, propionibacteria require low oxygen concentration in areas isolated deep within the skin. 5

Endrocrine Hormones In Balance

Imbalanced hormone levels play a role the development of acne through the endrocine system. 6 Often patients who have been on birth control for years come in with acne in their 30's and 40's. Birth control pills can overwhelm the body with synthetic estrogen. When women go off birth control, the brain/ovaries shut down and produce much much less estrogen, making the testosterone level high. After reviewing over a 1000 studies, researchers found that subjects with elevated testosterone, progesterone, glucocorticoids, insulin and insulin-like growth factors combined with lowered estrogen levels demonstrate higher occurences acne vulgaris. 6

We also recommend eliminating non-organic dairy trans-fats and milk products from diets. The products may contain unwanted sources of growth hormones that are passed on to the consumer, add to their hormone load.

Improve Liver Function to Detoxify From Common Food Pesticides - Dioxin Exposure

Exposure to polychlorinated dioxins impairs liver function and can cause a type of acne called chloracne. Exposures to dioxins disrupt the nervous, immune, reproductive, and endocrine systems, as well as induce cancer, atherosclerosis, hypertension, and diabetes. 7 Firefighters exposed to toxins such as burning plastic fumes are reported to have a high incidence of chlor-acne, also known as acne caused by exposure to chlornaphthalene, and pitch fumes. 10, 11

Dioxins are "lipophilic toxins" that have an affinity to human fat tissue attachment. Dioxins are relased into the environment as pesticides, by-products of industrial incineration, and electrical component manufacturing. Dioxins are carcinogenic compounds that also affect the production of hormones via the endocrine system. High exposure to lipophilic toxins, like dioxin, canimpair liver function and increase acne. 8

Through widespread distribution of lipophilic toxins in the Earth's biosphere, dioxins have been found in human fat tissue and breast milk. The main source of lipophilic toxins is from pesticides used food production. Body fat reduction and dietary changes can discourage dioxin reuptake by the liver, enhancing the excretion rate of lipophilic toxins. 8

The intact dioxin, polychlorinated biphenyls (PCB) is found in excreted skin oil and are appreciably higher in this skin oil before detoxification. PCB dioxin excreted in skin oil is accelerated up to five-fold during detoxification treatments. 9

Detoxification And Antibacterial Herbs

The Skin Reserach Institute, Pacific R&D Center in Yongin, Korea suggest that Angelica dahurica, Rhizoma coptidis (chinensis) and Glycyrrhiza glabra could be helpful preventing and treating acne lesions due to Propionibacterium. The herbs where compared to Erythromycin and retinoic acid, using similar formula strengths for all compounds tested. 12

The herbal extract of Angelica dahurica "suppressed neutrophil chemotaxis," resulting in effects similar to erythromycin. 12

Rhizoma coptidis (Coptis chinensis) extract exhibited a strong anti-lipogenic effect that out-performed retinoic acid results. 12

Glycyrrhiza glabra revealed a strong antibacterial effect against Propionibacterium without creating bacterial resistance, especially when compared to the high level of bacterial resistance created by overuse of erythromycin. 12

Green tea, vitamin B6 and feverfew have been shown to be effective for clearing skin acne. 13

Low Stomach Acid

Low hydrochloric acid in the stomach limits optimal digestion, directly affecting skin health. 14, 15 Increasing dietary fiber intake produces positive results with many of my acne patients.

Essential Vitamins and Minerals

Sufficient intake of vitamins and mineral are essential for good skin health. Low blood levels of vitamins A and E significantly influence the development and aggravation of acne. 17 Products containing alpha-tocopherol (vitamin E), L-ascorbic acid (vitamin C), retinol (vitamin A), and niacinamide (vitamin B3), are effective for the treatment of inflammatory dermatoses, acne, pigmentation disorders and wound healing. 18 Vitamin E keeps Vitamin A active. 21

25,000 IU of Vitamin A every other day, not beta-carotene, reduces excessive skin oil (sebum). Oral intake ofvitamin A (isotretinoin) works so well it's probably entirely linked to its effect on sweat glands by stopping the production of sebum. 19

Zinc is important for proper immune function and skin wound healing. Low HCL reduces absorption of zinc. Zinc deficiencies have also been related to the occurence of acne. 16

Vitamin A retinoid reduces keratin buildup. Retinoids have been shown to regulate many genes associated with the skin cell cycle and programmed cell death. 20 The water-soluble antioxidant vitamin C can reduce free-radicals directly and indirectly thereby supporting the antioxidant activity of vitamin E. 22 High doses P5P (activated B6) increases sensitivity and uptake of testosterone as high testostrone levels can be related to the prevalence of acne symptoms. 23 High dose Pantothenic acid (B5) increases fat metabolism in liver and decreases sebum production. 24 Omega-3 Essential fatty acid deficiency is associated with acne symptoms. 25, 26

When eating too much sugar, skin cells affected by acne have been found to be insensitive to insulin. The trace metal, chromium picolinate can be an effective acne treatment for skin cells showing insulin insensitivity. 16

I often measure fasting insulin and now will add IGF1 in a blood test. When eating carbs often the pancreas secretes extra insulin anticipating the extra carbs. This causes insulin insensitivity which causes excess epithelial cell growth and androgen mediated sebum production. Low glycemic diet is best for those with acne.

See: Connection between eating sugar/carbs and acne.

The trace mineral, selenium has been shown to keep glutathione active, thereby reducing inflammation associated with acne. 16

Other Considerations for Acne Skin Care

Benzoyl peroxide is used as a topical antibiotic for mild cases of acne. However acne organisms can quickly become antibiotic-resistant to this compund. 27

Avoid sunscreens that contain para-amino-benzoic acid (PABA). Sunscreens containing PABA have mostly been abandoned due to its known photosensitization and photoallergic properties when applied topically to the skin. 28 I also recommend "mineral wear" type of make-up that comes in powder form, plus suggest that my patients use oil free sunscreens, and products.

Conclusions About the Assessment and Treatment of Acne

Environmental, nutritional and psychological factors can play a part in creating a ripe terrain for Propionibacterium acnes to flourish.

For those suffering from acne it's easy to be overwhelmed by information on acne causes and treatments. Assessing individual test results helps us focus on the most appropriate treatment. Because everyone's risk factors are different, some patients will respond better to one treatment over another. This broad approach to acne treatment provides relief in the shortest amount of time. By understanding of the root causes of acne, optimal skin health is achievable, even for the most difficult cases.

Research References

1. Cutis. 2011 Aug The association of acne vulgaris with diet. University of Kentucky College of Medicine PMID:21916275

2. American Academy of Dermatology 2010 JulDiet and acne. Department of Dermatology, State University of New York Downstate Medical Center PMID:20338665

3. Gut Pathogensis. 2011 Jan. Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future? Department of Dermatology, State University of New York Downstate Medical Center PMID:21281494

4. Journal of Investigative Dermatology. 2011 Oct Microbial symbiosis with the innate immune defense system of the skin. Department of Medicine, Division of Dermatology, University of California, San Diego, VA San Diego Healthcare Center, San Diego, California PMID:21697881

5. University of Leeds, UK. The human commensal microbiota

6. Clinical Biochemistry. 2011 Sep. Role of hormones in acne vulgaris. Department of Biochemistry, Lady Hardinge Medical College, New Delhi, India. PMID:21763298

7. Arh Hig Rada Toksikol. 2010 Dec 1;61(4):445-53. Dioxins and human toxicity. Department of Chemistry and Biochemistry, Zagreb University School of Medicine. PMID:21183436

8. Lipids. 2001 Dec. Factors affecting the storage and excretion of toxic lipophilic xenobiotics. The University of Cincinnati, Department of Pathology PMID:11834080

9. Human Experimental Toxicology. 1990 Jul. PCB reduction and clinical improvement by detoxification: an unexploited approach? University Medical Department of Gastroenterology, Ljubljana, Yugoslavia. PMID:2143911

10. Trans St Johns Hospital Dermatology Society. 1970;56(2):79-99. Chloracne. A critical review including a comparison of two series of cases of acne from chlornaphthalene and pitch fumes. PMID:4252606

11. Lancet. 1986 Jan 25;1(8474):210-1. Chloracne in firefighters. PMID:2868232

12. Skin Pharmacology Application Skin Physiology. 2003 Mar-Apr Anti-acne effects of Oriental herb extracts: a novel screening method to select anti-acne agents. Skin Reserach Institute, Pacific R&D Center, Yongin, Korea. PMID:12637783

13. Journal of Drugs Dermatology. 2010 Jun. Innovations in natural ingredients and their use in skin care. University of Louisville, Division of Dermatology PMID:20626172

14. Dermatology Monatsschr. 1971 Sep;157(9):648-52. Gastric acid secretion and the morphology of the gastric mucosa in patients with acne vulgaris. PMID:4259226

15. Z Gesamte Inn Medicine. 1971 May. Correlations between disorders of gastric secretion and skin diseases. PMID:4108641

16. Medical Hypotheses. 2007 Apr. Acne vulgaris: nutritional factors may be influencing psychological sequelae. START Clinic for Mood and Anxiety Disorders PMID:17448607

17. Clinical Experimental Dermatology. 2006 May. Does the plasma level of vitamins A and E affect acne condition? Department of Biochemistry and Molecular Biology, Jordan University of Science and Technology, School of Medicine, Irbid, Jordan PMID:16681594

18. Journal of Drugs in Dermatology. 2008 Jul;7(7 Suppl):s2-6. Topical vitamins. The Center for Dermatology and Dermatologic Surgery, Washington, DC, USA. PMID:18681152

19. Dermatology. 1997;195 Suppl 1:1-3; discussion 38-40. Oral isotretinoin. Where now, where next? Department of Dermatology, Hôpital Cantonal Universitaire, Geneva, Switzerland. PMID:9310738

20. Journal of Cell Physiology. 2009 Aug;220(2):427-39. Retinoid-responsive transcriptional changes in epidermal keratinocytes. New York University School of Medicine, Department of Dermatology, Biochemistry and The Cancer Institute, New York, NY, USA. PMID:19388012

21. Dietary Supplement Fact Sheet: Vitamin E. NIH, Office of dietary supplements http://ods.od.nih.gov/factsheets/vitamine

22. Ann NY Academy of Science. 1992 Sep 30;669:7-20. Antioxidant functions of vitamins. Vitamins E and C, beta-carotene, and other carotenoids. Institut für Physiologische Chemie I, Universität Düsseldorf, Germany. PMID:1444060

23. Journal of Steroid Biochemistry. 1984 May;20(5):1089-93. Increased target tissue uptake of, and sensitivity to, testosterone in the vitamin B6 deficient rat. PMID:6727359

24. Medical Hypotheses. 1995 Jun;44(6):490-2. Pantothenic acid deficiency as the pathogenesis of acne vulgaris. Department of General Surgery, Hong Kong Central Hospital. PMID:7476595

25. Archive Dermatology. 2003] Omega-3 fatty acids and acne.

26. Clinical Dermatology. 2010 Jul-Aug;28(4):440-51. Healing fats of the skin: the structural and immunologic roles of the omega-6 and omega-3 fatty acids. Department of Dermatology University of Connecticut Health Center. PMID:20620762

27. Lancet. 2011 Aug 29. Acne vulgaris. Centre of Evidence-Based Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, UK. PMID:21880356

28. European Journal Dermatology. 2010 Mar-Apr;20(2):217-9. 2010 Feb 15. Uro-dermatological problems of a construction worker: paraaminobenzoic acid as a systemic photosensitizer. Department of Dermatology, Venereology and Allergology, University of Würzburg, Germany. PMID:20153994




Wendy Wells

Author Wendy Wells is a licensed naturopathic physician in the state of Arizona.
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Skin Care Topics include age spot removal, acne remedies, skin cancer, and dry skin remedies.