ACNE - THE BASIC FACTS
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What is Acne?

Acne is characterized by spots on the face, chest and/or back. It occurs when the pores on the skin become clogged with dead skin cells, oil and bacteria.  Acne is a common skin disease which affects almost 17 million people in the USA. Acne can develop at any age, but it most often begins at puberty and gets worse as adolescence progresses. Around 85% of people develop acne between the ages of 12 and 25. It is also found in some newborn babies and women during menopause.

Acne is rarely serious, but it often causes emotional distress and can lead to acne-caused lesions of the skin. Acne Vulgaris is the most common skin disorder in the United States and it is classed as a ‘chronic condition’. Although traditional medicine cannot cure acne, it is highly manageable through a range of both traditional and very successful alternative natural treatments and no one should feel they have to suffer on without help.

Acne affects all ethnic groups and people of all skin colors. The processes that cause acne are exactly the same in people with black or brown skin but the impact is altered by the skin pigmentation. It is a very common condition, affecting approximately 85% of people between the ages of 11 and 30 at some time in their lives.

You will sometimes hear Acne type skin problems referred to by various different terms. Some common ones are: Acne Vulgaris (Common Acne), Comedomes (blackheads), milia (whiteheads), papules (small solid raised bump), pustules (pus filled lesions), macule (skin lesion), nodule (dome shaped lesion), Nodulocystic acne (severe cystic spots) Essentially, they are all types of spots associated with acne affected skin.

 

What Causes Acne?

The exact cause of acne is unknown. It is a bacterial infection of clogged hair follicles and doctors believe it results from several related factors.  It is thought mostly to be due to rising or changing hormone levels particularly during puberty. However there are some other factors that are influential:

Hormone Level Changes: In puberty, hormones known as ‘androgens’ increase in both males and females. Androgens are potent skin irritants and trigger oil ducts on the face, back, neck and upper chest to begin producing oil, which in turn causes acne in some people. Also, acne can break out at time in your life when there is an irregular balance between androgens and other hormones, such as menopause and pregnancy.

Drugs: Certain drugs (i.e. corticosteroids, lithium and some anti-seizure medication) can aggravate acne. Also, when combined certain drugs, medications or toxins may react causing Acne to break out. If you are on a cocktail of drugs or even just one particular type and it is causing you skin problems, speak to your doctor about an alternative solution.

Genetic Factors: There appears to be some level of ‘family trait’ to acne. If other members of your family have suffered from the disease than that is likely that you may have inherited a tendency towards it too.

Oil and Grease: Usually from the hair and scalp can aggravate acne and make pimples worse. Also, people who work with cooking oils a lot (in a restaurant) sometimes find acne appearing or worsening. Hats, helmets and pads used in sports may also contribute to this problem as can humidity, sweating and the prolonged effect of contact with damp clothing.

Bacteria: If you have a tendency towards acne, you will find that the oil ducts in your skin (or more correctly the cells that line them) become larger and produce more oil. Sometimes, this oil gets trapped and blackheads and whiteheads can form. The blocked ducts allow germs in the skin to multiply and produce chemicals that cause redness and swelling and cause the spots which we call acne.

Birth Control Pills: Because these pills are hormone based, they can start off acne, or make it worse (and sometimes better too). You may notice a difference both when you start taking these pills and when you stop.

Cosmetics: Certain cosmetics, in particular greasy ones may alter the cellos of the follicle and cause them to become sticky. This, in turn, could produce a plug or a blockage.

It is important to not that too much scrubbing and squeezing will make acne significantly worse. It spreads the infection and the ‘scrubbing’ action will also stimulate the oil ducts to produce even more oil. Cleansing with a gentle antibacterial cleanser, twice a day will be more than sufficient to keep skin clean.

 

Acne Symptoms

Acne is fairly easily identifiable, particularly be experienced health care skin specialists. Its physical symptoms are straightforward and include:

1. Whiteheads

2. Blackheads

3. Papules

4. Pustules

5. Cysts and lesions

6. Angry and sensitive looking skin

Acne is considered severe when numbers 5 and 6 are present. However, often when the first 4 symptoms are showing, acne can be quite severe in terms of the amount of spots and bacteria around.

Diagnosis of Acne

For experienced dermatologists and health care professionals diagnosing acne is ordinarily quite easy, as the symptoms are self evident. Ordinarily, the doctor will take a complete medical history and do a physical examination. Spots and lesions most often develop in areas where there is the highest concentration of sebaceous glands, such as the face, neck, chest and back.

Acne sometimes presents itself as a symptom of other more serious conditions. It is vital that you tell your doctor everything in your medical history so that he can evaluate the condition properly.

Medical Treatment of Acne

When you attend a dermatologist or doctor about your skin and he has diagnosed that you have acne, there are several courses of action you can take depending on the severity of your acne and also on the affect it has on your quality of life. Getting help with acne as soon as you notice it is wise as early treatment of the condition can minimize the severity of it. 

It is important to understand that improvement can be slow, and will often take months (not weeks) to work. There may even be an initial dis-improvement in your acne. 

There are four main ways to treat acne conventionally:

1. Home Treatment/Over the Counter

2. Prescribed Topical Medication

3. Prescribed Oral Medication

4. Surgery for Scar Removal

 

 Home Treatment/Over the Counter: This is usually recommended for mild acne. The products usually contain antibacterial agents such as benzoyl peroxide. Along with this antibacterial affect, benzoyl peroxide can dry out the skin, which in turn sheds more quickly, making it harder for pores to get blocked and for infection to develop. It is quite a harsh ingredient and can cause redness when you begin to use it first. If this happens, reduce the number of times you use it until your skin settles and then slowly build the routine back up again.

Despite many claims to work quickly, most over the counter treatments will take 2-3 months to really start to make a difference. 

Prescribed Topical Treatments: Your doctor may prescribe a benzoyl peroxide solution, which will be slightly stronger than the over the counter variety. Other topical treatments, which you may hear about, are azelaic acid (which some patients find gentler on the skin), topical retinoids which are preparations based on vitamin A, or a preparation which combines a topical antibiotic with benzoyl peroxide.   

Prescribed Oral Medication: There is a vast range of oral medication to treat acne, again depending on it’s severity, type and on the gender, age and mindset of the patient. Some of the more common treatments used are:

Oral Antibiotics – i.e. tetracycline, Erythromycin, Minocycline. This is useful for inflammatory acne and is ordinarily taken every day for about 3 months, although the affect can take time to kick in. Often this treatment is limited as the particular bacterial strains are resistant to antibiotics. These drugs are used to treat the bacteria and do not stop pores from becoming blocked. Often the doctor will prescribe benzoyl peroxide alongside a course of antibiotics. 
 

Isotretinoin – which is known as Accutane or Roaccutane and is an oral retinoid, which means it’s molecular structure is similar to Vitamin A. This is usually prescribed only for people with severe acne as there are very uncomfortable side affects associated with it. It works by drying up oily secretions and should only be used under the strict supervision of a professional and experienced doctor. Some of the associated side affects are severe drying of lips and eyes, liver disorders and depression. This drug is harmful to unborn babies so make sure you are certain you are not pregnant before embarking on a course.  

Oral Contraceptives – Used to treat women who suffer from acne. They work by suppressing the male hormone, which is why they are only used to treat women. Usually a combination of the normal pill hormone (ethinylestradiol) and cyproterone acetate (eg Dianette) are used. 

Surgery for Scar Removal – There are three types of acne scars and not all scars require surgery. Some can be treated quite effectively with nonsurgical options like creams, chemical peels and skin fillers. 

The scars associated with acne are:

Ice Pick – Deep pits in the skin. These are the most common kind.

Box Car – Ordinarily around the temple and cheek and can be similar to chickenpox scars.

Rolling Scars – Scars that look like rolling waves

Treatment for removing or diminishing acne scars is quite successful. Using a topical cream will help to smooth very fine scarring by encouraging collagen production in the skin. These work in a similar way to anti-aging creams which improve fine lines.

Other Options are:

Chemical Peels - Whilst these treatments can improve your overall skin condition but are often not very effective at removing scars.

Skin Camouflage/Cover Up Make Up – with advances in cosmetic science this type of solution has become really popular, even for men. If you can afford it, it’s worth investing the time to go and learn how to properly apply it and also it is worth investing in a good brand.  

Skin Fillers – Substances are injected into the ‘scar pit’ which raise it and make it the same level as the rest of the skin. Results are temporary (about 3-6 months). However, another injectable skin implant which has been used for the correction of wrinkles can be used and is longer lasting. It is made of a combination of collagen and tiny spheres of a substance called polymethylmethacrylate, as well as the aesthetic lidocaine. A well known brand of this is Artecoll

Hyaluronic Acid Injection – Again originally used for correcting facial lines and wrinkles Its use in acne scars may be limited. The benefits of these injections usually last for about 6 months.

Photorejuvenation - Using laser or broadband visible light, 5-6 treatments that are performed every 3-4 weeks will improve mild acne scarring by causing new collagen to form.

Microdermabrasion - very fine aluminium crystals are used to abraise the skin. It improves the overall skin tone and condition as well as helping mild acne scars.

Surgical Scar Removal – Removal or excision of acne scars is especially effective for ice pick and boxer scars.

Laser Treatments – Usually laser resurfacing and pulsed dye laser. With resurfacing the skin is removed layer by layer, which removes the uppermost portion of the scars, at the same time heat produced by the laser tightens the skin, which will help smooth out the scars. After laser skin resurfacing, you won’t see the final results for about 18 months.
 

Acne Complications

Acne can have several complications, some of which can be quite traumatic. Sometimes these side effects occur as a result of treatment rather than as a result of the acne itself and it’s important to be able to distinguish between the two. Usually, different solutions can be found, both traditional and natural in the event of drug induced side effects becoming unbearable or simply inconvenient.

The more common acne complications are:

1. Psychological

2. Permanent Scarring

3. Pain and irritation

4. Change in skin tone and colour

5. Side effects of medications.

Natural Treatments for Acne

Acne can be kept at bay and sometime cured by a range of natural treatments. Some of these treatments are quite severe and take a good degree of commitment whilst others are less so but may not be quite as effective. The important thing, as with any natural remedy, is to research it properly and make sure it’s right for you and your wallet.  You may need a treatment to help with spots and blackheads or you may be looking for something to reduce the effects of scarring. Some natural acne treatments will be specific (i.e. they will help spots), where as others will be more all round treatments.

Most people will see a benefit in their skin from using good quality acne supplements and in general they can be safely combined.  Remember though, just because something is natural doesn’t mean it is always safe. The very reason some natural products are so successful is because they contain powerful herbal or plant extracts and agents so if you have any medical conditions or are taking any other drugs make sure you read the label carefully and if you are unsure, discuss it with your health care professional.  Generally speaking however, natural acne supplements can be used in conjunction with traditional and mainstream acne medications.

Good quality acne supplements usually contain a combination of ingredients. Vitamin A is important as it plays a role in the overproduction of sebum. Vitamin B6 can be helpful in controlling hormonal acne and vitamin C promotes a healthy immune system which may help to keep the bacteria which cause acne at bay. Also commonly found in acne supplements are zinc, copper and oils rich in omega 3, 6 and 9.  Probiotics and prebiotics which help maintain a healthy digestive are good acne supplements to invest in as they keep bad bacteria in the gut as bay and enable the absorption of essential vitamins and minerals which are important for good skin. Furthermore, bad digestion leads to constipation and this means that sometimes waste products get expelled through the skin causing even more spots.

Practical Tips for Acne Sufferers

If you suffer from acne then there are several easy and practical things you can do to help your skin:

1. Do not be tempted to pick, squeeze or scratch the spots.

2. Invest in a mild antibacterial cleanser and moisturiser and gently wash and moisturise your face twice a day. Don’t rub too vigorously or you will irritate the skin and the sebaceous glands.

3. Drink plenty of water. You need at least 8 glasses (about 4 pints) per day. This helps flush out your system and allows toxins to be expelled effectively.

4. Keep your hair clean. Wash regularly with a mildly medicated shampoo and try to keep your hair off your face as much as possible. If you can’t bear the thought of keeping it back off your face during the day, tie it back at night at least.

5. Avoid greasy or oily make up or creams. Try to buy products which are labelled ‘non-comedogenic’. This means they will not cause black heads or block pores.

6. Shower well after exercise or working up a sweat. Dead skin and grime can collect in sweat and may clog your pores and cause spots.

7. Whilst there is little scientific evidence to support the theory that what you eat affects acne, most suffers know that there is a link. A diet high in fruit, vegetables, complex carbohydrates, good quality protein and acne rich supplements can make a real difference. Most acne sufferers find that if they cut out sugar and refined carbohydrates their skin improves generally.

8. Do not expose your skin to extremes of heat or cold and this makes already sensitive skin even worse. Also remember, that some acne preparations and medication makes skin more sensitive to light so take care if going out in the sun to wear a high factor sun protection.

9. Avoid stress as much as possible. Easier said than done, however stress does play a part in worsening acne. Practise deep breathing techniques or other stress reduction methods. This will help you cope in the event of a stressful situation and decrease the levels of stress hormones in your system.

10. Reduce your intake of caffeine as this increases the levels of stress hormones in the body which can aggravate acne.

 

 

 

 

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