Guest post by Natalie Day
Acne is a common skin condition that causes skin irritation and lesions. There are 3 primary types; Acne vulgaris, Acne conglobata and Acne rosacea. Acne vulgaris, the least severe form, is characterized by superficial irritation that affects the hair follicles and sebaceous (oil secreting) glands of the skin. It appears as whiteheads, blackheads and red irritation. Acne conglobata is a more severe form of acne that manifests as deeper inflammation, cyst formation and consequent scarring. Acne rosacea is a more chronic facial irritation that occurs in adults and is associated with facial flushing. It is typically called Rosacea, and will not be discussed in detail in this article.
Both Acne vulgaris and Acne conglobata primarily affect the face, and to a lesser extent the back, chest and shoulders. Acne is typically more common among young males, with 75% of pubescent boys and about 50% of pubescent females affected. However, though acne is thought of as an adolescent ailment it can certainly last, or begin, much later in life.
Acne develops as a response to blocked skin pores, also called pilosebaceous units. The pore consists of a hair follicle, sebaceous (oil) and suderiforous (sweat) glands, which connect to the skin through the follicular canal. Sebaceous glands are most concentrated on the face, chest and upper back and produce sebum, a special mixture of oils and waxes that help to protect and lubricate the skin, and prevent loss of water.
Acne is most prevalent in adolescents because andogenous hormones, such as testosterone, (levels of which begin to increase and fluctuate during puberty) stimulate the cells lining the follicular canal to start producing more keratin. Keratin is a group of fibrous proteins; the primary structural component of hair, nails and the outer layer of skin. An overproduction of keratin can clog the skin’s pores. In addition to increasing keratin levels, testosterone causes the sebaceous glands to produce more sebum and become enlarged. The combination of these effects results in blocked pores, and the likelihood of acne inflammation is greatly increased. While pubescent males are typically more affected by their changing testosterone levels, there is an increase in testosterone levels in females during puberty, making them subject to acne as well.
Acne pustules, or pimples, begin when pores are blocked by keratin and sebum, causing a whitehead or blackhead to eventually manifest. A blackhead forms if the blockage is somewhat incomplete, allowing excess sebum to rise to the surface of the skin. A whitehead, however, is the result of a completely blocked pore, creating inflammation due to sebum obstruction. When pores are completely blocked, Propionibacterium, a type of bacteria that occurs on the skin, is allowed to grow excessively inside the pore, releasing enzymes that break down sebum and cause inflammation, which is the source of skin redness. This inflammation can cause a rupturing of the follicular canal and can damage the surrounding tissue. When this happens on the surface of the skin it looks like an inflamed pimple, but if it happens deeper in the follicular shaft it can manifest as a cyst, which tends be painful and cause subsequent scarring.
Acne and the Liver:
In ancient and folk medicine acne was widely considered a byproduct of liver stagnation and intestinal toxemia, and was treated with blood purifiers (also called alteratives) and liver cleansing herbs. Recent studies agree that acne can be a result of compromised liver and kidney function, and is often linked to hormone imbalance related to liver stagnation. The skin and the liver are inextricably linked. One of the liver’s major services to the body is acting as a filter for our blood, helping to remove toxins and hormone by-products. When the liver becomes stressed and overworked due to excess toxins in the bloodstream, a common occurrence in the 21st century, it has a harder time processing all of our toxins, and some of them get cycled back into our bloodstream, often including androgenic hormones, the same ones that cause overproduction of sebum and keratin. Diet plays a large role in acne cause and prevention, especially high-glycemic foods, which raise blood sugar quickly and can throw hormone balance for a loop, affecting the skin secondarily. Studies show that avoiding foods that are high in refined sugars and carbohydrates has a positive effect on acne management. Compromised intestinal flora also seems to be a factor in adults suffering acne; those treated with broad-spectrum antibiotics for long periods of time often develop Candida albicans, an overgrowth of yeast, which can make acne conditions much worse.
Conventional Treatment & Side Effects:
Acne can be treated conventionally with a topical application of Benzoyl Peroxide, an over-the-counter cream that acts as an antiseptic for the skin. This treatment is only effective on superficial pustules and can cause dryness, itching, peeling and redness of the skin.
Another pharmaceutical often used for severe acne treatment is Retin-A, which acts in a similar way to Benzoyl Peroxide and can have more pronounced side effects, including severing burning and drying of the skin, as it literally acts to improve acne by chemically burning the skin.i
Though some have found success using these treatments, they are impractical because they require daily application in order to be effective, and they only address acne on a superficial level, not dealing with its root cause for long term healing of the skin. Natural medicine usually approaches acne by treating the underlying imbalance in the body, rather then simply suppressing the symptoms.
For more severe cases of Acne conglobata oral antibiotics, retinoid or hormonal treatments are used. These have varying degrees of effectiveness and a wide range of undesirable side effects, including potential birth defects, chronic intestinal disruption and depression.
Nutritional treatment plays a major role in preventing and healing acne. Again, avoiding foods high in processed sugars and carbohydrates has shown to be effective in clearing acne, and for some, avoiding dairy is beneficial. Reducing your intake of inflammatory foods can also be very beneficial, Omega-6 fatty acids in particular which are found in many fried, fatty and processed foods. Eating a diet high in whole grains, leafy green vegetables and high quality meat or fish is a good step for helping to nourish the body and keep hormone and blood sugar levels balanced. Anti-inflammatory foods should be added to the diet, specifically Essential Fatty Acids, which fight inflammation and can help to regulate hormone production. EFA’s can be found in several cold-water fish, including salmon, mackerel and trout, in grass-fed meat, dairy and eggs, and in smaller amounts in flaxseeds, sesame seeds and avocados.
There are several minerals that have shown effective in treating acne conditions, one of the leaders being Zinc. When the body contains low levels of zinc andogenous hormone levels become unbalanced, which can create excess sebum and keratin. Zinc stimulates tissue regeneration, inflammation control, and immune function. Many males use it to balance their testosterone levels, as it works by regulating the release and production of testosterone, which can also be beneficial for those with acne. Zinc rich foods include venison and grass-fed meat, sesame seeds, pumpkin seeds and several culinary mushrooms such as cremini and shitake.
Vitamin A works to reduce the size and secretion of sebaceous glands, as well has reduce the amount of sebum in pores, it is also has anti inflammatory actions, and works best in combination with Vitamin E, another anti-inflammatory. Vitamin E is an antioxidant that prevents the propagation of free radicals in tissues. It is found in high levels in wheat germ, as well as in many nuts and oils. Pantothenic Acid, also called vitamin B5, has proven a successful remedy for many with acne. It is found in whole grains, and meats, and its richest sources are cold-water fish ovaries and royal jelly. Pantothenic Acid helps your body break down fats and process them into fatty acids, which will later become hormones. A lack of Pantothenic Acid can lead to excess androgen production, increasing skin irritation.
In some studies, analysis of the level of glucose in the skin demonstrated that patients with acne do not metabolize sugar properly; Chromium is known to improve glucose tolerance and enhance insulin sensitivity, and has been reported in one study to induce rapid improvement in patients with acne.ii Brewers yeast and Propolis both contain high levels of Chromium and are common treatments for acne in Europe.
Acne is typically treated herbally by addressing the liver, and helping to clear stagnation. Most of the herbs recommended have either a hepatic (liver supporting), or alterative (blood cleansing) action, and can be combined with herbs to support hormone regulation and stress control (adaptogens). These herbs can be very helpful for treating acne, especially when used over a period of several months, and when applied in addition to healthy routines and meals. While herbs have incredible healing power, they are really the icing on the cake, secondary to lifestyle and dietary choices.
Burdock, Arctium lappa, is a classic remedy for treating skin diseases. It’s hepatic effect on the liver helps to clear toxins and balance hormone levels in the body. The bitterness of this root also helps to stimulate digestion and releases hydrochloric acid in the stomach, aiding digestion.
Yellow Dock, Rumex crispus, is another bitter root that has long been used to stimulate digestion and aid in liver health. It can also aid in iron assimilation and is safe for pregnant mothers who may be dealing with both pregnancy-provoked Acne vulgaris and iron deficiency.
Other bitter herbs indicated for liver related skin conditions are Oregon Grape Root (Mahonia spp.), Gentian (Gentiana spp.) Dandelion Root (Taraxacum officionale) and Milk Thistle (Silybum marianum)
Alterative herbs, such as Cleavers (Gallium aparine) and Red Clover (Trifolium pratense) help with elimination of toxins through the skin, lungs, feces and urine, also improving lymph, liver and digestive function.
Anti-inflammatory herbs can be helpful in keeping skin inflammation minimal. These include Licorice (Glycyrriza glabra) and Turmeric (Curcuma longa), which can be taken tonically.
Another category of herbs that can be beneficial are Adaptogens, plants that help the body deal with non-specific stress or overwork, a major factor for many experiencing acne. These herbs can be taken tonically and help to balance the pituitary, adrenal and hypothalamus glands. Tulsi (Ocimum sanctum), Milky Oats (Avena sativa) and Ashwagandha (Withania somnifera) are all examples of Adaptogens.
This formula contains herbs with many of the above actions and comes from Dr. Aviva Romm:iii
20 ml Skullcap (Skutellaria lateriflora)
10 ml Oregon grape (Mahonia spp.)
20ml Echinacea (Echinacea spp.)
20 ml Dandelion (Taraxacum officionale)
20 ml Licorice (Glycyrriza glabra)
10 ml Ashwagandha (Withania somnifera)
Dosage: 5ml of tincture 2x a day
Azelaic Acid is an organic compound found in Barely, Wheat and Rye and is used to treat acne topically. It can kill the bacteria that infect the skin, as well as decrease the production of keratin. It is also an anti-inflammatory and is used topically in the form of a cream or ointment. It can interact with the synthesis of melanin, sometimes causing hyperpigmentation, and is considered to have mild success.
Tea Tree oil, which comes from Melaleuca alternifolia, a native Australian tree, is an effective topical treatment that has antiviral, antibacterial, antifungal and antiseptic properties.
“In the treatment of moderate common acne, topical application of 5% tea tree oil has shown an effect comparable to 5% benzoyl peroxide. Albeit with slower onset of action, patients who use tea tree oil experience fewer side effects than those that use benzoyl peroxide treatments.”iv
Some people also find herbal facial steams helpful, often using Chamomile (Matricaria recutita) or Tea Tree oil, both of which are antimicrobial. Regular cleansing and occasional exfoliation of the skin is a general recommendation for helping to open pores and keep them free of bacteria. Avoiding the use of synthetic cosmetics and avoiding touching the inflamed skin with hands are practical ways to avoid transferring bacteria and clogging pores.
In summation, acne is a common condition that, with dedicated efforts, can usually be controlled and effectively treated without the use of pharmaceuticals. The treatment is affordable and can be as accessible as making small dietary changes. Nourishing a positive body image is an important part of helping someone deal with acne, especially for adolescents who may be emotionally vulnerable. A healthy diet and lifestyle choices, as well as liver supporting herbs and antimicrobial topical treatments are great allies for treating and preventing this condition.
Beers, Mark (EIC), The Merck Manual of Medical Information. New York, 2003
Gladstar, Rosemary, Herbal Healing for Women; Simple Home Remedies for Women of All Ages. New York, 1993 Hoffman, David, Medical Herbalism, The Science and Practice of Herbal Medicine. Rochester, VT, 2003
Murray, Michael & Pizzorno, Joseph, The Encyclopedia of Natural Medicine. New York: Atria, 2012
Romm, Aviva Jill, Botanical Medicine for Women’s Health. New York, Churchill-Livingston
Applied Health: Acne, http://www.appliedhealth.com/index.php?option=com_content&view=article&id=100022
Acne & Pregnancy, http://www.ncbi.nlm.nih.gov/pubmed/23657872
Implications for the role of diet in acne: http://www.sciencedirect.com/science/article/pii/S1085562905000283
Beliefs & Perceptions of Acne, http://www.ncbi.nlm.nih.gov/pubmed/11209112
Relationship of Diet & Acne, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2836431/
Tea Tree, http://en.wikipedia.org/wiki/Tea_tree_oil
i Page 194, Encyclopedia of Natural Medicine
ii Article: High chromium yeast for acne? M. Mcarthy medical hypothesis. 1984: 307-10
iii Page 120, Botanical Medicine for Women’s Health, Aviva Romm
iv Bassett, IB; Pannowitz, DL; Barnetson, RS (1990). “A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne”. The Medical journal of Australia 153 (8): 455–8.