Acne is triggered by hormones and can occur in virtually anyone at almost any stage of his or her life. Acne not only disfigures the face and body but can also leave profound, permanent scars on your self-esteem and confidence.
What is Acne ?
Acne is often described as a disease involving the sebaceous follicles and hair follicles of the skin. It occurs in people who have a genetic predisposition. If acne runs in families of both parents, three out of four children may suffer from it.
Sebaceous and hair follicles are associated with a sebaceous gland that produces sebum, a complex mixture of lipids. In the hair follicle, the hair acts as a wick, transporting sebum and other cellular debris to the surface of the skin, where it is ultimately removed. Inflammation of infection is rarely associated with this type of follicle, unless the hair becomes ingrown or the opening of the follicle becomes clogged.
The sebaceous follicle, usually lacking a hair or containing only a fine hair, is generally associated with acne. Activity of the sebaceous gland is stimulated by many factors, including the onset of puberty, hormonal fluctuations, pharmaceutical agents, stress, using inappropriate products, heat, friction and humidity.
To understand the physical changes that cause acne, it is important to understand the microscopic processes that produce it. Our skin has pores, referred to as follicles by dermatologists. A follicle is not a hair, it could either contain a hair or be empty, like a tube extending from the surface of the skin (epidermis) down into the dermis.
This deeper layer of skin, the dermis, is made up of collagen and elastin, which gives the skin bounce and support, it also provides a home for blood vessels, other cells and nerves. Underneath the dermis is a layer of fat that cushions and insulates the skin and contributes to a youthful face. The follicle (pore) starts in the dermis as a tube, from this tube branch glands that look like a cluster of grapes. These are your sebaceous glands that produce an oil substance called sebum.
The Four Main Factors that contribute to Acne
- Over active sebaceous glands
- Cell accumulation (retention hyperkeratosis)
The reason that the sebaceous glands are over active is down to Testosterone. This hormone is secreted by the male sexual organs, and in women it originates from the ovaries and adrenal glands. In both sexes testosterone is released into the body and enters into the sebaceous gland where an enzyme – 5-alpha reductase, converts the testosterone into di-hydrotestosterone, this stimulates sebum production. 5-alpha reductase is sensitive to hormone levels and goes into overdrive when testosterone levels get high. This is noticeable during puberty and results in teenage acne. The excess oil on the skin acts as a binder and when acne is present an accumulation of cells occurs at the neck of the follicle and sticks to the sebum, creating the perfect breeding ground for bacteria (propionibacterium acnes). At this point the result may be closed comedones (white heads) and open comedones (blackheads).
The Grades Of Acne
Scientists use a grading system to categorize the various stages of acne lesions.
Grade 1– Comprises of open and closed comedones (whiteheads and blackheads), the t-zone may be a little oily.
Grade 2 – Mainly open and some closed comdedones and papules, with some pustules. Comedones and pustules located only in the oilier areas of the face. (easily aggravated by comedogenic substances)
Grade 3 – Papules and Pustules present throughout the t-zone and cheeks, with open comedones. Scarring is likely.
Grade 4– The nodule, a large painful solid lesion extending deep into the skin, accompanied by visible inflammation and redness. Macules (flattened crusted lesion) These are the types of lesions found in hormonal mediated acne and found around the lower face in women, there is a lack of comedones.
Grade 5– The cyst – an inflamed, pus filled lesion extending deep into the skin. This occurs when several nodules merge resulting in a giant lesion, when the grading of acne becomes higher, there are fewer comedones to be found.
The term “Comedogenic”means to clog pores, and a comedone is a blackhead or whitehead. Comedogenic substances in cosmetics are a major cause of congestion related skin problems. If the application of a cosmetic that contains comedogenic ingredients is applied regularly and left on, e.g. foundation, moisturiser – then problems can occur. These problems appear as closed or open comedones, this can feel like lots of lumps and bumps under the skin and can be known as “Cosmetic Acne”and is purely caused by using products with comedogenic ingredients that are inappropriate for your skin type. Lots of mainstream cosmetic companies (even very expensive brands!) put pore clogging ingredients into their products, they do this because generally they are cheap ingredients or can serve a purpose in the formulation.
Just because an ingredient or product is “Comedogenic”, doesn’t mean that everyone who uses it will automatically develop acne or clogged pores. If your skin gets clogged easily then you are at more risk from using those ingredients. Here are the main ones to look out for:
- Isopropyl Myristate, Myristyl Myristate
- Cocoa Butter
- Flax Oil
- Octyl Palmitate, Octyl Stearate
- Linseed Oil
- D & C Red and Orange colours
- Isostearyl Alcohol
- Mink Oil
- Peanut Oil
- Palmitic Acid
- Mineral Oil– A Petroleum by product, there are mixed reviews of Mineral oil, in theory cosmetic grade scores a 0 on the comedogenic list, as it doesn’t actually penetrate into the follicle, it just sits on the surface of the skin. This coating the skin may cause problems for some people as the skin cannot excrete and function, so congestion can build up in the skin. (I personally do not like it, and will not use it as it does cause me congestion)
As you can see there are many ingredients that can cause and exacerbate acne, so look closely at your cosmetic formulations for these substances. Be aware that even if you are using products that have no comedogenic ingredients in them, if they are too rich a formula for your skin, then they can ultimately cause some congestion.
Less common but certainly about, is a type of acne called “Acne of Toxic Origin”. This type of acne can occur from both the side effects of medications (antibiotics, cortisone and tranquilisers), occupational causes, and self-infliction. Establishing the cause is the secret and simply removing the cause can improve the skin dramatically.
Other Factors That Will Influence and cause Acne
- Birth control pills may affect the skin and you may see a change in the amount of breakouts
- Medicines containing bromides and diodides, as found in cold remedies, can cause breakouts
- Barbiturates and amphetamines can cause acne type lesions
- If you have a predisposition to acne it is wise to screen your vitamins for Kelp, seaweed or straight iodine (potassium iodide) and eliminate from your diet (avoid Shellfish)
- Steroids can be a cause of breakouts
- Stress influences and aggravates acne breakouts, so often you think this is major stress, when it is in fact simply just “being uptight”
- Menstruation, pregnancy and menopause, all of these can cause skin problems including acne
- Harsh drying substances and over exfoliation
- High humidity can trigger breakouts
- UV radiation, contrary to what many acne sufferers believe, the sun actually makes matters worse, this is due to the inflammatory effect that happens within the skin
- Food sensitivities, dairy can often cause skin problems in some people
Antiobiotic Resistant Acne
Antibiotics are commonly prescribed by GP’s to help treat acne by attempting to reduce the levels of P acnes bacteria. The resulting reduction in bacteria will consequently result in the decrease of the inflammation. As this approach only treats the symptoms, and not the true cause of the condition, it can have a limited affect. Unfortunately, the use of antibiotics to treat minor grades of acne can lead to the development of antibiotic resistance.
Like many bacteria that have been over treated with antibiotics, the P acnes have developed many strains and a resistance to on or more common antibiotics. Also some antibiotics can cause sensitivity to UV light, so sunscreen is vital.
Post – adolescent acne is on the rise, more people are suffering from the challenges of oily and acneic skin conditions. It is normally in the age group of 20-40 that are diagnosed with a low grade, persistent acne. Acne arising in adulthood is more likely to be inflammatory with fewer comedones that teenage acne, and with lesions located around the mouth, chin and jaw line. It is definitely more challenging to treat, as adults can often have sensitised skin, or a combination of skin conditions in addition to acne and concerns about ageing!
The primary factor leading to adult acne is chronic stress, we all know temporary stress can cause a breakout from time to time, but chronic, continuous stress increases hormone levels, which leads to an increase in oil production. This is frustrating for many people an causes additional emotional stress, which in turn can trigger more breakouts!
The need to “squeeze” and “pick” breakouts opens the skin up to more acne-causing bacteria, and you normally end up with more spots around the area you have picked! You also increase the development of scars and trauma induced pigmentation. I know it’s hard to resist, but they will heal quicker when you leave them alone.
Nutrition For Acne
Does what you eat make a difference ? This is a controversial subject and many dermatologists have different opinions. The prevailing wisdom is that the foods we eat have no effect on the systemic disease of acne. What you eat may not be a direct cause of your acne, but plain common sense tells us that you cannot eat lots of sugar and pro-inflammatory foods without effecting your skin, it is after all the largest organ of the body! We must nourish it from within as well as treating it topically (the skin is always last to get its ration of nutrients, the vital organs get them first).
The best advice I can give is to ensure you have an all round healthy diet, which includes plenty of antioxidant rich vegetables, whole grains, proteins (in the form of fish, lean meat, soya and beans and lentils), this is a great anti-inflammatory diet (low G.I) and you will benefit on many levels.
The Sugar Connection
While many people say that giving up chocolate doesn’t cure acne, most people find that we feel better all round when we give up sugary refined foods and drinks. There is a link between people with acne and the way they do not transfer sugar into their cells properly. All sugar is pro-inflammatory and by reducing the amount of inflammation in your body can only have positive benefits on your acne. I know it isn’t easy but try to cut down on sugary foods and drinks, including sweets, chocolate, fizzy drinks and any added sugar. Let food be your medicine!
Recommended reading – The acne prescription by Nicholas Perricone MD.
As well as improving your diet there are certain supplements that are worth considering in the treatment of acne. Given that some of the most drastic medical treatments for acne involve Vitamin A, it makes sense to include some in your diet. You will get adequate amounts in your multivitamin formula, too much is toxic so don’t go over the recommended daily allowance.
Healthy skin also requires a good supply of Zinc, a mineral that is essential to all aspects of our health. Some dermatologists recommend up to 100 milligrams of zinc supplements a day for the treatment of acne. However, these higher doses may result in nausea, vomiting and stomach pain. Pregnant women and nursing mothers should not take zinc in higher doses than 15 milligrams per day to avoid causing harm to the foetus. As always I strongly recommend you seek advice from your doctor before taking any dietary or supplement programme.
Vitmain A and Acne
Vitamin A acne treatment was introduced in the early 1970’s. Also known asRetin-A,Tretinoin or Retinoic Acid, this is the acidic form of Vitamin A – (retinoids), when applied topically it normalizes the skin cells and increases exfoliation at a cellular level. This has a positive effect on the skin but can also be very irritating in some people, the skin can get very red and inflamed from the treatment and is not for everyone. Seek advice from a dermatologist as these products are prescription only.
The breakthroughs achieved by using topical vitamin A acid also led to another oral therapy, this one made from a compound belonging to the same retinoid class as Retin-A. This is known asAccutane and when taken for approximately 4-6 months, has been proven to be an extremely effective treatment for a severe form of acne, know as cystic or nodular acne. Accutane is a prescription medication and has a number of possible side effects that are similar to those resulting from large doses of vitamin A. Among Accutane’s potential side effects are dry, peeling skin, inability to see in the dark and inflamed liver. There is also a link between taking Accutane and mental depression and suicide. If your doctor prescribes Accutane, consider increasing your intake of essential fatty acids, as a common side effect is severe dry skin, lips and nasal passages. Try Udo’s Choice Essential Oil Blend , it has the perfect ration of 3.6.9 fatty acids.
Acne and Ageing Skin
Acne is a chronic inflammatory disease, and spends a significant amount of time being inflamed. Inflammation is a well known accelerator of ageing, and can create free radicals that break down the skins structural components like Collagen and Elastin etc, which can contribute to an aged appearance. Treating your acne, at least to the degree of markedly reducing the number of inflamed lesions, is going to be the best anti-ageing step you could make apart from sun protection.
How you treat your acne may have a major impact on the ageing of your skin. As a general rule, any treatment that causes irritation and/or excessive dryness should be used cautiously. The use of Vitamin A at sufficiently low doses to avoid skin irritation will get both anti-acne and anti-ageing benefits. Vitamin A is still the most effective anti-ageing ingredient that you can use on your skin.
Excercise and Acne
As you can see eliminating Acne and controlling it is a multi layered task! and we must treat the whole body, not just the symptom. We all know that moderate exercise is a vital part of a healthy lifestyle, this is especially true for the acne patient, but moderation is key. Acne is unique and the exercise that is good for people without acne, can spell disaster for those with acne. For example weight lifting: regardless of gender, this type of exercise makes the body more susceptible to acne breakouts. The reason is simple – weight lifting and weight training increases levels of male hormones, such as testosterone, and male hormones can contribute to acne.
I would definitely recommend some form of Yoga or Pilates, you can achieve a fit, toned and flexible body as well as clear radiant skin at any age.
Yoga and Pilates will:
- Exercise and tone the body
- Energizes and soothes the mind
- Increases blood circulation and lymph flow
- Helps you achieve a deeply relaxed state – stress reduction
Because acne is aggravated by stress, yoga will help induce relaxation, focus your breathing and ultimately lower stress levels.
Topical Products For Acne
There are many advances in ingredient technology for acne, we need ingredients that ultimately stop the cascade of events leading to acne development. We must regulate the sebaceous glands, promote exfoliation, kill bacteria and calm inflammation.
Cleansing – make sure you perform a double cleanse in the evening, this will remove make-up and sunscreens and other debris before you do your second cleanse, which will ultimately cleanse your skin and pores. If not done properly, poor cleansing can result in breakout and clogged pores. ALWAYS take your make-up off before you sleep!!! Use an acid balanced cleanser and avoid soap, it is far too alkaline and will strip your skin’s barrier, making it pump out more oil and letting bacteria in.
Exfoliate– Acneic skin produces five times more dead skin cells than other skin, this means that proper exfoliation can give great results for acne. Hydroxy acids will be effective, as they help cells detach and prevent dead skin cells from clogging the follicle. 1% -2% Salicylic acid is effective in a product formulation, this is a Beta Hydroxy Acid, this is better at exfoliating inside the follicle. (if you are allergic to Aspirin avoid BHA’S, try Alpha Hydroxy Acids instead, like Lactic Acid or Glycolic Acid) Sulphur and Papain are also useful ingredients, avoid physical scrubs with grains in them, they will only aggravate and inflame your skin.
Oil Control– this is one of the trickiest skin care problems, you can’t stop it by applying products, but we can control it and help absorb it. Harsh products will only make you feel oilier, so avoid those at all costs. Once or twice a week use a non irritating caly mask, to help absorb sebum and deep cleanse. Milk of Magnesia is also a great facial mask, it is nothing more that magnesium hydroxide, which does a fine job of absorbing oil.
Bacteria Control – the following are good at controlling bacteria: Benzoyl Peroxide, this is the most effective over the counter choice, as it can penetrate the follicle to reach acne causing bacteria, it can be drying though. Salicylic Acid, Tea Tree Oil, Suphur, Zinc Gluconate, Triclosan – this has had a bit of bad press lately, but it is very effective, it is also in toothpaste – that is why dabbing it on spots can be effective, however the peppermint can be irritating and inflammatory.
The Jan Marini Skincare Management System contains some of these key ingredient and the products actually work!
Key Tips For Acne
- Avoid comedogenic ingredients in all your products, 75% of skincare products make acne worse.
- Keep your skin barrier intact, do not over-exfoliate, too much exfoliation is worse than none.
- Try to eat a low Glycaemic load diet
- Make sure you are hydrated with enough water
- Avoid barrier stripping ingredients like – Acetone, SD Alcohol, Isopropyl Alcohol and menthol, irritation will cause inflammation.
- Use lukewarm water to wash in- not hot or extreme cold.
- Change your pillowcase regularly
- Clean the handsets of your phones to reduce bacteria
- Try NOT to pick and squeeze your spots, they will only get worse. If you do, do not squeeze until they bleed! and apply a good anti-bacterial product afterwards
- If you have no success with over the counter products, seek advice from a dermatologist about a topical retinoid – like Differin Gel
- Don’t forget to wear a sunscreen!!, you will be more prone to sun-damage due to the hydroxy acids and some anti-biotics make your skin sun sensitive. There are good oil free choices available from Dermalogica
- Some anti-androgen contraceptive pills work wonders for acne, however everyone is different and it can be trial and error and your acne may get worse temporarily
Other treatments that have been useful for some people are IPL Laser Therapy, and some Light Therapies with blue and red lights, seek advice from a dermatologist or medical skin clinic.
As you can see acne is a complex skin condition and what works for other people may not work for you, results are not instant and you may never cure your acne but can control it. By following some of these guidelines hopefully you will have a better understanding of Acne and how to treat it, and not let it rule your life!