Acne is the most common of all skin problems. Adult acne can be a condition with many contributing factors and as such may require an integrated approach. Acne is not caused by poor hygiene or oily skin, but both can make the problem much harder to control.
People often try to treat acne by “de-oiling” and “drying” the skin with products that include harsh soaps, strong scrubs and mass-market medicated (drying) cosmetics. This approach to acne can cause intense drying of the skin, and provides only short-term benefits. While drying out blemishes can make skin appear satisfactory for a few weeks, over-drying can cause oil glands to compensate by working harder, resulting in clogged pores and more “breakouts” 3 to 4 weeks later. This often causes the user to resort back to drying products, which are causing the problem. In addition, treating adult acne harshly can create problems such as redness or broken capillaries.
Optimal nutrient status should be maintained. Information on conventional treatments is widely available, but be advised that prolonged use of antibiotics has the potential for causing candida overgrowth and for disturbing normal colonic flora. Probiotic replacement at the end of an antibiotic cycle is recommended. Here is a site with many articles on the subject of Acne.
Risk factors for Adult Acne
Constipation
Bowel toxins from poor digestion or a prolonged transit time may contribute to acne.
Polycystic Ovary Syndrome (PCOS)
Among women with resistant acne (acne not responding to conventional treatments), PCOS is very common.
Adult Acne suggests the following may be present
Recommendations for Adult Acne
Glycolic Acid
Many over-the-counter products contain high levels of glycolic acid, which is a member of the alpha-hydroxy acid family. Glycolic acid used topically can effectively promote skin cells to shed more quickly and has been proven to be very effective in the treatment of acne.
Tea Tree oils (Melaleuca / Leptospermum - Manuka)
124 patients with mild to moderate acne in a single-blind randomized trial were given either a 5% gel of tea-tree oil or 5% benzoyl peroxide lotion. Both treatments resulted in significant improvement of noninflamed and inflamed lesions after three months, with tea tree oil causing more severe facial redness and benzoyl peroxide being more effective in noninflamed lesions. There were fewer unwanted side-effects in the tea tree oil group – 44% versus 79%. It was concluded that tea tree oil may be a valuable alternative to some traditional treatments of acne. [Lancet, December 8, 1990; p.1438, Medical Journal of Australia, 1990;153: pp.455-458]
We believe that this 5% solution is probably not strong enough for moderate to severe acne. Stronger solutions (up to 15%) should provide even better results.
Bentonite Clay
Bentonite masks may be helpful in drawing out toxins. These masks are usually left in place for 10 to 15 minutes, removed by rinsing or gentle rubbing with a soft wash cloth and applied three times per week.
Sugars Avoidance / Reduction
Sugar and refined carbohydrates should be avoided.
Dairy Products Avoidance
Dr. Jerome K. Fisher conducted a clinical study of 1,088 teenage patients over 10 years and reported to the American Dermatological Association that milk was a principal contributor to some patients’ acne. Dr. Fisher found that their acne tapered off as their milk consumption was reduced.
Dr. Fisher noted that dairy products often contain large amounts of butterfat and milk sugar, both of which, he believed, aggravate acne. He also suspected that the hormones produced naturally in the milk of pregnant cows may break down into androgen when consumed, which stimulates the production of sebum, the waxy substance secreted by the sebaceous glands that clogs pores and creates acne when the pores become infected.
Milk may also contain excessive amounts of iodine, which can irritate pores, bringing on acne flare-ups. Iodine gets into the milk through the use of contaminated milking equipment and medication given to the cows.
Grain-free / Low Starch Diet
Those with acne may find that a low or no-carbohydrate diet leads to clearer skin. When breads and cereals are digested, it leads to an increased amount of sugar. This excess sugar allows the body to produce high levels of insulin and insulin-like growth factor (IGF-1). The processes used to manufacture modern breads and cereals may alter the protein structures in the grains, leading to rapid digestion followed by excess releases of insulin. Elevated insulin levels lead to an excess of male hormones, which cause pores in the skin to secrete sebum, a greasy substance that attracts acne-promoting bacteria. Additionally, IGF-1 promotes the multiplication of skin cells known as keratinocytes, a process associated with acne.
Previous evidence has shown a link between insulin or IGF-1 and acne. It has been found that when IGF-1 is used to treat certain illnesses, male hormones increase, followed by acne. On the other hand, when women with polycystic ovary syndrome, a condition that causes an excess of insulin, were treated with the insulin-reducing drug metformin, acne was improved. Moreover, many women with acne problems overproduce insulin and IGF-1, researchers say. Researchers say that many dermatologists report improvements in their patents’ acne after putting them on low-carbohydrate diets. [Archives of Dermatology December 2002]
Therapeutic Fasting
Fasting clears the skin and whitens the eyes. It is a common experience to see skin eruptions clear while fasting.
Colon Cleansing
Keep the colon clean by a series of colonics or enemas. Bowel toxins from poor digestion or a prolonged transit time may contribute to acne.
Nutritional Yeast
High-chromium yeast is known to improve glucose tolerance and enhance insulin sensitivity [Diabetes 1980:29, pp.919-25.]. Although there is no difference in blood glucose tolerance tests between patients with and without acne, skin biopsies revealed that the acne patients’ skin glucose tolerance is significantly impaired. Based on this it would be appropriate to describe acne as “skin diabetes” [Can Med Assoc J 1959:80, pp.629-32]. High-chromium yeast has been reported in an uncontrolled study to induce rapid improvement in patients with acne [Med Hypoth 1984:14, pp.307-10].
Sunlight / Light Exposure
In the first study of its kind, conducted at Hammersmith Hospital, Dr Chu et al. evaluated the use of a mixed blue and red light (peaks at 415nm and 660nm) in the treatment of acne vulgaris. 107 subjects were randomised into four treatment groups. 1. Blue light. 2. Cool white light (placebo) 3. 5% benzoyl peroxide 4. Mixed blue and red light.
Treatment consisted of 15-minute irradiation in front of a portable light unit each day. (With the exact, special spec, tubes utilised by BeautySkin).
The red/blue mix had significantly better results than the other treatment groups. Improvements were clearly noticeable after only 4 weeks. After 12 weeks, the blue/red treatment achieved a mean improvement of 76% in inflammatory lesions and a mean improvement in comedones of 58%, which exceeded any of the other treatments.
The researchers concluded “We propose that blue light and red light acts synergistically in improving acne by combining anti-bacterial and anti-inflammatory action, rendering phototherapy with blue-red light an effective and safe treatment for acne vulgaris”. [British Journal of Dermatology, 142: 5. Pp 973-978]
Light treatments using these wavelengths of light are being offered at some clinics. It is also now possible to purchase your own lightbox for treating acne at home.
Personal Hygiene Changes
Please see the description of a new soap being used to treat facial skin problems under “Personal Hygiene Changes”.
Homeopathic Remedies / Vaccines
Dr. Smith, a dermatologist, reports, “I find LOMA LUX AcnePill indispensable in treating acne patients of all ages. It is a safe product that really works. I’ve treated over 1,500 of my own patients with LOMA LUX AcnePill, and the majority are pleased with their results.” You can view his webpage regarding this product here.
Zinc
Zinc is important in the treatment of acne. It is involved in local hormone activation, retinol binding protein formation, wound healing, immune system activity, and tissue regeneration. There have been inconsistencies in the results from studies using zinc as a treatment, but this may have been due to different forms of zinc having been used. If zinc insufficiency is suspected, use the more absorbable forms. Treatment may require up to 3 months of supplementation before good results are seen. Success or failure of zinc treatment of acne depends on whether a zinc deficiency is present. [Z Hautkr 1987:62(14): pp.1064, 1069-71, 1075]
Selenium
See link to Vitamin E.
Chromium
High-chromium yeast is known to improve glucose tolerance and enhance insulin sensitivity. In an uncontrolled study, chromium was reported to induce rapid improvement in patients with acne. Repeated skin biopies have shown there to be a localized glucose intolerance in most acne patients. [Ind J Derm 1977:22; pp.139-149] Since insulin treatments have improved acne, it would be suspected that chromium works by improving insulin sensitivity and helping this condition. Acne has also been called “skin diabetes”.
Iodine
According to James E. Fulton Jr., M.D., head of the Acne Research Institute in Newport Beach, California, “In some who are acne-prone, … one milligram of iodine a day could be a problem.” Foods high in iodine should be eliminated on a trial basis.
Ozone / Oxidative Therapy
Ozonated olive oil used topically has a reputation for benefiting acne.
Vitamin E
Vitamin E regulates retinol levels in humans. Male acne patients have significantly decreased levels of erythrocyte glutathione peroxidase, which normalizes with vitamin E and selenium treatment. The acne of both men and women improves with these treatments, probably by reducing the development of lipid peroxides.
Vitamin Niacinamide
Though harder to find, a topically applied 4% solution of niacinamide compared very favorably to Clindamycin in one trial. Oral niacinamide is unlikely to be of benefit.
Systemic and topical antimicrobials are effective in the treatment of inflammatory acne vulgaris; however, widespread use of these agents is becoming increasingly associated with the emergence of resistant pathogens raising concerns about microorganism resistance and highlighting the need for alternative nonantimicrobial agents for the treatment of acne. Nicotinamide gel provides potent antiinflammatory activity without the risk of inducing bacterial resistance. METHODS. In our double-blind investigation, the safety and efficacy of topically applied 4% nicotinamide gel was compared to 1% clindamycin gel for the treatment of moderate inflammatory acne vulgaris. Seventy-six patients were randomly assigned to apply either 4% nicotinamide gel (n = 38) or 1% clindamycin gel (n = 38) twice daily for 8 weeks. Efficacy was evaluated at 4 and 8 weeks using a Physician’s Global Evaluation, Acne Lesion Counts, and an Acne Severity Rating. RESULTS. After 8 weeks, both treatments produced comparable (P = 0.19) beneficial results in the Physician’s Global Evaluation of Inflammatory Acne; 82% of the patients treated with nicotinamide gel and 68% treated with clindamycin gel were improved. Both treatments produced statistically similar reductions in acne lesions (papules/pustules; -60%, nicotinamide vs. -43%, clindamycin, P = 0.168), and acne severity (-52% nicotinamide group vs. -38% clindamycin group, P = 0.161). CONCLUSIONS. These data demonstrate that 4% nicotinamide gel is of comparable efficacy to 1% clindamycin gel in the treatment of acne vulgaris. Because topical clindamycin, like other antimicrobials, is associated with emergence of resistant microorganisms, nicotinamide gel is a desirable alternative treatment for acne vulgaris.
Vitamin A
Vitamin A has been shown to be effective in treating acne when used at very high doses (300,000 to 400,000IU per day) for many months, but caution must be advised because vitamin A toxicity can result. The toxicity potential means that this therapy must be monitored closely, conducted with a water-soluble form of vitamin A and probably be used in lower doses (100,000 to 200,000IU) along with other therapies, not as a single treatment.
Vitamin B6 (Pyridoxine)
Women with premenstrual aggravation of acne are often responsive to vitamin B6 supplementation, reflecting its role in the normal metabolism of steroid hormones. Vitamin B6 can be used during the flair or continuously at 50 to 200mg per day.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| May do some good |
| Likely to help |
| Highly recommended |
| May have adverse consequences |
| Reasonably likely to cause problems |
Glossary
Acne
A chronic skin disorder due to inflammation of hair follicles and sebaceous glands (secretion glands in the skin).
Candidiasis
Infection of the skin or mucous membrane with any species of candida, usually Candida albicans. The infection is usually localized to the skin, nails, mouth, vagina, bronchi, or lungs, but may invade the bloodstream. It is a common inhabitant of the GI tract, only becoming a problem when it multiplies excessively and invades local tissues. Growth is encouraged by a weakened immune system, as in AIDS, or with the prolonged administration of antibiotics. Vaginal symptoms include itching in the genital area, pain when urinating, and a thick odorless vaginal discharge.
Colon
The part of the large intestine that extends to the rectum. The colon takes the contents of the small intestine, moving them to the rectum by contracting.
Probiotic
Derived from the Greek word for "life." Probiotic refers to organisms and substances which contribute to intestinal microbial balance. They are beneficial or "friendly" intestinal bacteria.