Acne is often discovered by the person with acne and self-diagnosed and self-treated with over-the-counter medications. Acne can be diagnosed by a dermatologist.
Acne is often discovered by the person with acne and self-diagnosed and self-treated with over-the-counter medications. Acne can be diagnosed by a dermatologist.
Acne typically appears on the face, neck, chest, back, and shoulders because these are the areas with the most oil glands. Acne can come in the following forms:
Acne Vulgaris is the most common dermatologic condition in the United States, affecting more than 17 million people of all ages. 80-90% of adolescents have had acne.7 Teenage acne often begins around the ages of 10 to 13, when teenagers are going through puberty. Some teenage girls get acne at a younger age than boys, but boys often have much more severe acne than girls 2 Teenagers often get blackheads, whiteheads, and inflammatory lesions, often centered around the T-zone (forehead, nose, and chin). However, acne can also affect anywhere on the face and trunk in teens.
Some people, especially women, have adult-onset acne that begins in her 20s and 30s. According to Dubrow and Adderly, more than 50% of adults over the age of 25 experience acne breakouts (2003, p. 23). Often there are less blackheads and whiteheads than teenage acne and there may be mild breakouts of inflammatory lesions on the lower cheek, chin, and around the mouth. For adult onset acne in women, the acne often occurs two to seven days before the woman’s menstrual cycle, when estrogen levels fall and progesterone levels rise and produce excess sebum.2
Acne often occurs in the first trimester of pregnancy, when estrogen and progesterone levels are rising; it often clears up in the second and third trimester. After the birth however, acne can return due to hormonal changes. It is also a symptom in some endocrine disorders, such as polycystic ovary syndrome.
Since acne affects people from all socio-economic levels, there is not a huge health disparity in the incidence of acne. However, there is a health disparity over the treatment of acne. While many acne medications such as benzoyl peroxide and salicylic acid are available over-the-counter, medications for chronic acne such as Retin-A and Isotretinoin are only available with a prescription. Even in Canada, where there is universal health care, Haider, Mamdani, Shaw, Alter, and Shear found that those people who have a lower socioeconomic status were less likely to visit a dermatologist for a consultation, even with a referral from their general practitioner (2006, p. 331).
Many researchers have concluded that acne is due mainly to genetic predisposition and hormonal influences. The role of diet and acne is currently being debated. Some researchers think that genetic factors do not explain the whole situation and there is an environmental influence on gene expression.
Adult onset acne in women is not well understood. Although most women do not have elevated androgens, they seem to have an increased response to androgens. Estrogen is often used to treat acne because it has the opposite effect than androgens (estrogenic effect). Adult-onset acne may also be related to the consumption of hormones and drugs in foods and medications. 2
Katsambas and Dessinioti noted that “…the prevalence of acne is lower in rural, non-industrialized societies than in modern Western population… it has been suggested that the absence of acne reported in non-Westernized societies is attributable to local diets, which have a lower glycemic index than a Western diet” (2008, p. 91). They speculate that adolescents are “hyperinsulinemic” due to a high-glycemic diet. Another consideration is that many non-Western societies do not consume milk, and milk has been associated with acne due to the hormones in it (Ibid.). In a meta-analysis conducted by Spencer, Ferdowsian, and Barnard, a high-glycemic diet and dairy consumption are associated with increased acne. They concluded, “population-based studies have suggested that, as diets Westernize, acne prevalence increases” (2009, p. 344). Observational reports noted that residents in Kenya, Zambia, and the Bantu in South Africa have far less acne than the descendants from these countries that currently live in the United States or United Kingdom (Davidovici & Wolf, 2010, p. 13). Another report observed that only 2.7% of the 9,955 schoolchildren in rural Brazil had acne (Ibid.).
Stress is another factor with acne. The more stress a person has, the more cortisol the person produces, and the “fight or flight” response is initiated. According to Perricone, elevated cortisol levels bring about a rise in blood sugar, which causes a cellular inflammatory response (2003, p. 31). Stress can also increase androgen production (Logan and Treloar, 2007, p. 149). A specific neuropeptide, which is a chemical released by nerve endings on the skin, called Substance P is implicated in making sebaceous glands more active. When someone is stressed, Substance P is released from the skin nerves and causes an inflammatory response with the production of cytokines, which can promote free-radical production and ensuing oxidative stress (Perricone, 2003, p. 31-3, Logan and Treloar, 2007, p. 151).
Some doctors think that acne is a systemic inflammatory disorder. Perricone noted, "scientists have been puzzled for years because there are so many factors that influence the onset and course of acne, they know hormonal effects are important; that bacteria play a role. Genetics and other precipitating agents contribute to acne. Now they mystery is solved because whether it is endocrine, psychological, excess oil in the skin, the final common pathway of initiation and progression is inflammation (2003, p. 34)."
From a Functional Medicine perspective, acne is caused by:
Digestive, absorptive, and microbiological imbalances. The high-glycemic Western diet and milk consumption has been associated with acne as discussed above.
Detoxification and biotransformational imbalances. One concept in natural medicine is that skin imbalances are due to non-optimal detoxification. According to Yarnell and Abascal, “…if the liver and its detoxification and excretory functions are not functioning optimally, the body will attempt to compensate by eliminating toxic compounds through other routes in the body, including the skin” (2006, p. 303). Pitchford also noted “even though the vitality of the skin is related to the lungs, eruptions surface because of faulty blood cleansing by the kidneys and liver. These two organs purify the blood, and when they are overburdened toxins in the blood are excreted through the skin” (2002, p. 441).
Hormonal and neurotransmitter imbalances. Androgens have certainly been implicated in the production of acne. And the fluctuations of estrogen and progesterone often are implicated in adult women getting acne before their period.
Acne Vulgaris is the most common dermatologic condition in the United States, affecting more than 17 million people of all ages. 80-90% of adolescents have had acne.7 Teenage acne often begins around the ages of 10 to 13, when teenagers are going through puberty. Some teenage girls get acne at a younger age than boys, but boys often have much more severe acne than girls 2 Teenagers often get blackheads, whiteheads, and inflammatory lesions, often centered around the T-zone (forehead, nose, and chin). However, acne can also affect anywhere on the face and trunk in teens.
Some people, especially women, have adult-onset acne that begins in her 20s and 30s. According to Dubrow and Adderly, more than 50% of adults over the age of 25 experience acne breakouts (2003, p. 23). Often there are less blackheads and whiteheads than teenage acne and there may be mild breakouts of inflammatory lesions on the lower cheek, chin, and around the mouth. For adult onset acne in women, the acne often occurs two to seven days before the woman’s menstrual cycle, when estrogen levels fall and progesterone levels rise and produce excess sebum.2
Acne often occurs in the first trimester of pregnancy, when estrogen and progesterone levels are rising; it often clears up in the second and third trimester. After the birth however, acne can return due to hormonal changes. It is also a symptom in some endocrine disorders, such as polycystic ovary syndrome.
Since acne affects people from all socio-economic levels, there is not a huge health disparity in the incidence of acne. However, there is a health disparity over the treatment of acne. While many acne medications such as benzoyl peroxide and salicylic acid are available over-the-counter, medications for chronic acne such as Retin-A and Isotretinoin are only available with a prescription. Even in Canada, where there is universal health care, Haider, Mamdani, Shaw, Alter, and Shear found that those people who have a lower socioeconomic status were less likely to visit a dermatologist for a consultation, even with a referral from their general practitioner (2006, p. 331).
Many researchers have concluded that acne is due mainly to genetic predisposition and hormonal influences. The role of diet and acne is currently being debated. Some researchers think that genetic factors do not explain the whole situation and there is an environmental influence on gene expression.
Adult onset acne in women is not well understood. Although most women do not have elevated androgens, they seem to have an increased response to androgens. Estrogen is often used to treat acne because it has the opposite effect than androgens (estrogenic effect). Adult-onset acne may also be related to the consumption of hormones and drugs in foods and medications. 2
Katsambas and Dessinioti noted that “…the prevalence of acne is lower in rural, non-industrialized societies than in modern Western population… it has been suggested that the absence of acne reported in non-Westernized societies is attributable to local diets, which have a lower glycemic index than a Western diet” (2008, p. 91). They speculate that adolescents are “hyperinsulinemic” due to a high-glycemic diet. Another consideration is that many non-Western societies do not consume milk, and milk has been associated with acne due to the hormones in it (Ibid.). In a meta-analysis conducted by Spencer, Ferdowsian, and Barnard, a high-glycemic diet and dairy consumption are associated with increased acne. They concluded, “population-based studies have suggested that, as diets Westernize, acne prevalence increases” (2009, p. 344). Observational reports noted that residents in Kenya, Zambia, and the Bantu in South Africa have far less acne than the descendants from these countries that currently live in the United States or United Kingdom (Davidovici & Wolf, 2010, p. 13). Another report observed that only 2.7% of the 9,955 schoolchildren in rural Brazil had acne (Ibid.).
Stress is another factor with acne. The more stress a person has, the more cortisol the person produces, and the “fight or flight” response is initiated. According to Perricone, elevated cortisol levels bring about a rise in blood sugar, which causes a cellular inflammatory response (2003, p. 31). Stress can also increase androgen production (Logan and Treloar, 2007, p. 149). A specific neuropeptide, which is a chemical released by nerve endings on the skin, called Substance P is implicated in making sebaceous glands more active. When someone is stressed, Substance P is released from the skin nerves and causes an inflammatory response with the production of cytokines, which can promote free-radical production and ensuing oxidative stress (Perricone, 2003, p. 31-3, Logan and Treloar, 2007, p. 151).
Some doctors think that acne is a systemic inflammatory disorder. Perricone noted, "scientists have been puzzled for years because there are so many factors that influence the onset and course of acne, they know hormonal effects are important; that bacteria play a role. Genetics and other precipitating agents contribute to acne. Now they mystery is solved because whether it is endocrine, psychological, excess oil in the skin, the final common pathway of initiation and progression is inflammation (2003, p. 34)."
From a Functional Medicine perspective, acne is caused by:
Digestive, absorptive, and microbiological imbalances. The high-glycemic Western diet and milk consumption has been associated with acne as discussed above.
Detoxification and biotransformational imbalances. One concept in natural medicine is that skin imbalances are due to non-optimal detoxification. According to Yarnell and Abascal, “…if the liver and its detoxification and excretory functions are not functioning optimally, the body will attempt to compensate by eliminating toxic compounds through other routes in the body, including the skin” (2006, p. 303). Pitchford also noted “even though the vitality of the skin is related to the lungs, eruptions surface because of faulty blood cleansing by the kidneys and liver. These two organs purify the blood, and when they are overburdened toxins in the blood are excreted through the skin” (2002, p. 441).
Hormonal and neurotransmitter imbalances. Androgens have certainly been implicated in the production of acne. And the fluctuations of estrogen and progesterone often are implicated in adult women getting acne before their period.
Conventional treatment for acne consists primarily of oral or topical antibiotics, cleansing agents, and chemically modified versions of vitamin A.
Standard treatments for acne include topical retinoids, benzoyl peroxide, azelaic acid, antibiotics, oral isotretinoin, and oral birth control. Some new allopathic treatments are being developed. There is concern of increasing antibiotic resistance to the standard treatments of tetracycline’s, trimethoprim, and macrolide antibiotics; new antibiotics such as lymecycline, azithromycin, and new tetracycline formulations have been developed to combat this resistance. Insulin sensitizing agents such as metformin have been developed to combat hypoandrogenism, a common factor of polycystic ovary syndrome. Zinc gluconate has been proposed as an alternative treatment for inflammatory acne, especially in pregnant women. New topical treatments such as clindamycin/zinc, picolinic acid gel, and dapsone gel have been added to the topical arsenal. Photodynamic therapies using a topical cream of with aminolaevulinic acid or methyl aminolaevulinate then employing lasers, red light, or blue light have been tested for inflammatory acne.1
The “Spirit” section on foundhealth comprises treatments that have to do with intention, energy healing, prayer, and in some cases god. These terms may be volatile for some, and for others they resonate. Some of these treatments have proven to be profoundly healing for certain individuals. Though some people are skeptical, prior notions of these words should be set aside when reading about these healing treatments, as many of the are truly incredible!
Many of the treatments that live in other sections on FoundHealth could easily live in this “Spirit” section as well. For example, Yoga, though a treatment that mostly involves the body, certainly has spiritual undertones and components to its practice. Meditation lives under the Mind category, but really is a blend of body, mind and a spiritual/energetic component as well. Traditional Chinese Medicine and Ayurveda are examples of healing systems that have branches that span all six of FoundHealth’s treatment categories, including spiritual components.
Sometimes acne manifests because of bio-psycho-social-spiritual issues, and many kinds of treatments (including some to treat the spirit) can help in the treatment of acne.
Sometimes environmental toxins can cause acne, and spending time in the environment is also a form of spirituality for some individuals, so consider spending more time outdoors to help your physical and spiritual states.
In a study by Magin, Adams, Heading, Pond, and Smith (2006), 26 subjects were interviewed on their CAM usage for acne. The majority of those interviewed used CAM therapies such as witch hazel, tea tree oil, citrus washes, aloe vera, zinc tablets, “tissue salt” tablets, and evening primrose oil. The researches found that the CAM therapies were considered “to be more efficacious than ‘mainstream’ topical therapies, although less efficacious than oral isoretinoin and, perhaps, less efficacious than oral antibiotics.” The subjects felt the CAM therapies gave them more self-efficacy and control over their acne (p. 452-3).
Other hygiene suggestions are to cleanse the skin daily with a gentle non-medicated soap. You may want to apply 5-50% tea tree oil diluted in jojoba oil once or twice a day after skin cleaning. Use natural skin moisturizers as needed. Continue using exfoliants such as salicylic acid and cell renewal creams like topical retinoids.
Physical Activity is important. Exercise has the potential to help acne by reducing stress, reducing the “flight or fight” response, and increasing circulation. Any exercise is good: walking, running, hiking, biking, strength training, tennis, swimming, etc. for at least 30 minutes most days of the week.
Reducing stress will benefit your skin. Devote time for sleep (7-8 hours) and keep consistent bedtimes and waking times. Keep good sleep hygiene such as keeping the bedroom dark, cool, and quiet, avoiding naps, and only using the bedroom for sleep and sex. Engage in stress-reducing activities such as meditation, gentle yoga, guided imagery, breathwork, prayer, therapeutic art, dance, and music. A regular practice of the relaxation response will help keep cortisol in check.
Magin, P.J., Adams, J., Heading, G.S., Pond, D.C., & Smith, W. (2006). Complementary and Alternative Medicine Therapies in Acne, Psoriasis, and Atopic Eczema: Results of a Qualitative Study of Patients’ Experiences and Perceptions. The Journal of Alternative and Complementary Medicine, 12(5), 451-7.
In a study by Magin, Adams, Heading, Pond, and Smith (2006), 26 subjects were interviewed on their CAM usage for acne. The majority of those interviewed used CAM therapies such as witch hazel, tea tree oil, citrus washes, aloe vera, zinc tablets, “tissue salt” tablets, and evening primrose oil. The researches found that the CAM therapies were considered “to be more efficacious than ‘mainstream’ topical therapies, although less efficacious than oral isoretinoin and, perhaps, less efficacious than oral antibiotics.” The subjects felt the CAM therapies gave them more self-efficacy and control over their acne (p. 452-3).
Other hygiene suggestions are to cleanse the skin daily with a gentle non-medicated soap. You may want to apply 5-50% tea tree oil diluted in jojoba oil once or twice a day after skin cleaning. Use natural skin moisturizers as needed. Continue using exfoliants such as salicylic acid and cell renewal creams like topical retinoids.
Physical Activity is important. Exercise has the potential to help acne by reducing stress, reducing the “flight or fight” response, and increasing circulation. Any exercise is good: walking, running, hiking, biking, strength training, tennis, swimming, etc. for at least 30 minutes most days of the week.
A Nutritional Medicine approach by Elson Haas1 recommends that you reduce fried foods and hydrogenated fats from the diet, as well as increase water consumption, vitamin A, B vitamins, zinc, essential fatty acids, pantothenic acid, calcium, and sulfur.
Anti-inflammatory diet is helpful for acne. To follow this diet:
One interesting study compared a low glycemic load diet against a high carbohydrate diet, and found that the low glycemic load diet reduced acne symptoms.2
Other nutrients that are recommended for acne treatment include chromium, vitamin E, and selenium.
The main environmental issues to consider are contaminants in the food such as mercury in fish, antibiotics and hormones in meat and milk, and pesticides on produce. Eat organically as much as possible and use high-quality supplements.
Yarnell and Abascal1 wrote about different herbal approaches to acne. Antimicrobial herbs could be used to combat P. acnes and S. epidermidis bacterium. The most commonly used antimicrobial herb is tea tree oil (often diluted in jojoba oil). Basil oil, eucalyptus and Oregon grape are also promising antimicrobials. Since inflammation plays such a large role in acne, Orgeon grape, barberry, goldthread, goldenseal, yellowroot, scute, and magnolia are suggested. For anticomedogenic herbs such as guggul can help keep the follicle and pore open and clean. For hormonal acne, chaste tree and saw palmetto are recommended.
Pitchford also suggested eating chlorophyll-rich foods and ingesting blood-purifying diaphoretic herbs such as sarsaparilla root, sassafras root, burdock seed, and yarrow leaves and flowers.2
Burdock and red clover have also been suggested as effective treatments for acne.
Yarnell and Abascal1 wrote about different herbal approaches to acne. Antimicrobial herbs could be used to combat P. acnes and S. epidermidis bacterium. The most commonly used antimicrobial herb is tea tree oil (often diluted in jojoba oil). Basil oil, eucalyptus and Oregon grape are also promising antimicrobials. Since inflammation plays such a large role in acne, Orgeon grape, barberry, goldthread, goldenseal, yellowroot, scute, and magnolia are suggested. For anticomedogenic herbs such as guggul can help keep the follicle and pore open and clean. For hormonal acne, chaste tree and saw palmetto are recommended.
Pitchford also suggested eating chlorophyll-rich foods and ingesting blood-purifying diaphoretic herbs such as sarsaparilla root, sassafras root, burdock seed, and yarrow leaves and flowers.2
Burdock and red clover have also been suggested as effective treatments for acne.
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Acne Vulgaris is the most common dermatological condition in the United States and affects a wide variety of people. While not a serious disease, acne can cause scarring and psychosocial distress. This paper article discusses the physiology of acne, the functional medicine perspective on acne, and conventional and complementary and alternative therapies to treat acne.
Physiology of Acne
Skin is the largest human organ that protects the body from infection; it serves as a waterproof barrier to the outside, protects the body from the sun, insulates the body, repairs itself, and produces vitamin D. With so many functions, it has a complex structure. Human skin is made up for three layers: 1) the epidermis (the outside layer), 2) the dermis (located directly beneath the epidermis), and 3) the subcutaneous layer (the bottom fatty layer under the dermis). The skin also has hair follicles, sensory nerves, blood vessels, lymph vessels, and sweat glands.
Acne begins with a hair follicle that gets blocked. Each hair follicle is comprised of a sebaceous gland that produces an oily substance called sebum. Sebum consists of different lipids and serves to keep the skin lubricated and waterproof. It also serves to transport dead skin cells, called karatinocytes, from inside the hair follicle away from the body, where they flake off.
People with acne have excessive sebum production. When the hair follicle that comes out of a person’s pore gets blocked with excessive sebum, then dead cells cannot exit the hair follicle. The keratinocytes and excess sebum clump together and create a clog in the sebaceous ducts and hair canal. This clog or plug is called a microcomedo; as the plug grows larger with trapped sebum, the microcomedo becomes a visible comedo. There are two types of comedones: 1) blackheads occur when the comedo enlarges and pops through the skin. The black color is due not to dirt but to a build-up of melanin. 2) Whiteheads happened when the comedo stays below the surface of the skin; the white bubble seen is the trapped sebum and dead cells. Comedos form over the course of two to three weeks.
Sometimes the microcomedo gets infected by a bacterium called propionibacterium acnes (p. acnes) or staphylococcus epidermidis (s. epidermidis) and creates an inflammatory lesion. There are three types of lesions: 1) a papule is a small red bump that is commonly called a pimple or a zit and does not appear to have pus, which are white blood cells 2) a pustule is a papule with pus, and 3) a nodule is a large, tender, inflamed, and often painful pus-filled pustule that is deep in the skin. (Goodheart, 2006, p. 17-33). These three types of lesions are called inflammatory lesions and can be located under any of the three layers of skin.
The endocrine system plays a large role in the formation of acne. Androgens, otherwise known as “male hormones,” can help regulate how much sebum the sebaceous glands produce. While people with acne may not be producing any more androgens than non-acne ridden people, their glands may be very sensitive to the androgens and react by producing more sebum. Adolescence is often the worst time for acne since androgen production is increasing.
Women also produce androgens at a lesser rate than men, and also produce estrogen and progesterone. Doctors differ in their opinion of the role of estrogen in the production of acne. Some think that as the levels of progesterone decrease as women get older and estrogen increases, the acne gets worse. Other doctors think that estrogen is helpful, as it can bind with testosterone and other androgens and reduce their production (Perricone, 2003, p.28).
