Acne

While acne certainly isn’t life threatening, it can significantly affect daily living and is an indicator of an internal imbalance the body is attempting to push out through the skin.  Acne occurs when the amount of oil, or sebum, that the skin produces increases and/or is of poor quality.  The normal bacteria that live on the skin eat the sebum; when the oil is a normal amount and good quality, the skin is healthy.  However, when the sebum is produced in larger quantities and is low quality, the products of bacterial digestion create irritation.  This irritation causes the skin to swell and produce more keratin, which pinches off the pore opening and creates more swelling at the skin surface.  The walls of the pore then expand and rupture and white blood cells come in to clean up the cellular debris.

Conventional treatments typically focus on three main components in the acne process: the bacteria, pore thickening, and sebum production.  The bacteria are killed off with topical benzoyl peroxide, topical and/or oral antibiotics, or Retin A.  The problem with this method is that the bacteria are supposed to be on our skin to provide some protection against pathogenic bacteria, and will return as soon as the treatment is finished.  Also, oral antibiotics kill the beneficial bacteria in the intestines, which can lead to digestive problems, yeast overgrowth, and immune dysfunction.

Pore wall thickening is decreased primarily using Acutane, which is a vitamin A medication.  The problem with Acutane is that women are required to be on oral contraceptives because Acutane at any amount has an extremely high risk of causing severe birth defects.  It is also toxic to the liver and liver enzymes need to be checked regularly to monitor functioning.  Sebum production can be inhibited using estrogen, oral steroids, Acutane, and spironolactone medications.  Any hormone treatments, such as estrogen or steroids, have a wide range of short and long-term health effects, which need to be considered when choosing these treatments.  Spironolactones can significantly alter water and electrolyte balance and have been shown to cause tumors in chronic studies in rats.

Naturopathic treatments focus on changing the quality of the sebum so it flows better and bacteria don’t break it down into irritating products.  High quality sebum also provides natural skin protection.  Changing the quality of the sebum will eliminate the acne, improve the overall health of the skin, and help correct internal imbalances that may have other health effects besides acne.  Treatment focuses on correcting diet and hormone balance.

DIET

The best diet for acne is high in fruits, vegetables, and good oils, such as fish, and raw nuts and seeds.  A high fiber diet will reduce toxin production in the intestines (often produced due to poor diet and bacterial imbalances); these toxins can be secreted through the skin pores, increasing irritation.  The worst foods for acne are:

• Heated, poor quality oils, which directly affect the quality of the sebum;
• Refined sugar and grains, which increase insulin and insulin-like growth factor, causing pore wall thickening; and
• Salt and hydrogenated oils, which cause swelling in the skin.

It is also important to identify and eliminate food sensitivities, as these will increase inflammation.  A short fast can also be considered to quickly reduce the burden on the immune system and improve the quality of the sebum. The importance of diet cannot be emphasized enough.  In treating acne, I recommend patients strictly follow an anti-inflammatory diet for 2 weeks to see what a difference just changing the diet makes.

HORMONE BALANCE

Hormones, especially testosterone, increase sebum production.  A high protein, low carbohydrate diet will increase the 5-alpha-reductase enzyme to decrease the production of 5-dihydroxytestosterone (a testosterone precursor).  This enzyme is stimulated by carbohydrates, leading to increased testosterone production.  Specific treatments to suppress testosterone include zinc, Vitex, and Saw palmetto. While these treatments will provide benefit, they are not permanent solutions for acne.  Women also need to balance estrogen and progesterone, and a healthy balance can be supported by using rotating omega-3 (fish oil and flax/pumpkin seeds) and omega-6 (evening primrose oil and sesame/sunflower seeds).  Specific herbs can also be used to support estrogen or progesterone, depending on the particular imbalance.

It is also important to understand that suppressing one hormone will lead to changes in other hormones due to the complex relationships between different hormones in the body. Therefore, it may be possible to create other hormone imbalances if testosterone suppressing treatments are overused or used incorrectly.

In working with hormones, it is also important to support the liver, as it processes all the hormones in the body.  A liver that is overburdened by toxins, food allergens, stress, and imbalances in the intestinal bacteria will have a harder time processing even normal amounts of hormones.

OTHER

Other treatments that can be considered for acne include:

• Vitamin A – Vitamin A may be needed at amounts similar to Acutane to provide the most benefit, and then it has the same issues of birth defects and toxicity as Acutane.  There may be benefit at lower doses, but it should be used in conjunction with other treatments.
• Vitamin B6 –  Vitamin B6 is specifically used for PMS-related acne, when the change of hormones increases sebum production and skin swelling.
• Anti-inflammatories – Anti-inflammatory herbs, such as Boswellia, and Curcumin, and enzymes, such as Bromelain, can be used to reduce inflammation and swelling.