Cause and treatment of acne.
Acne is not only skin inflammation, but a chronic systemic multifactorial disease. Acne originates from a genetic background, androgens, skin lipids, inflammatory reaction, emotional stress, disorders of keratinization ,and regulatory neuropeptides [Bhambri S, Del Rosso JQ, Bhambri A., 2009] The skin reflects the internal health of the body.
Acne vulgaris, or acne of the adolescent, has a peak incidence in 14- and 17-year-old girls and in 16- and 19-year-old boys.
Acne tarda (adult acne) develops (late-onset acne) or continues (persistent acne) after 25 years of age. Adult acne is predominant in women, and when compared to adolescent acne is more inflammatory.
Cause
Acne is a manifestation of internal imbalance that leads to overproduction of sebum (skin oil) by sebaceous glands. This extra sebum together with dead skin cells and dirt creates an ideal condition for bacteria to grow. Skin follicular epithelium with sebaceous gland overactivity and skin bacteria Propionibacterium acnes and Staphylococcus epidermidis form clogged pores.
In the skin, some follicles might be more acne-prone than others, and these follicles will have different levels of susceptibility to circulating hormones.
The skin is our largest detoxifying organ; internal toxicity may be a contributing factor to breakouts on the skin
Androgens
It has been shown that the development of acne is characterized by excessive levels of androgens - male sex hormones (e.g., testosterone, dihydrotestosterone) in the female body.
Androgens are steroids derived from ovaries in females, testicles in male, adrenals, fat, skin and muscles cells. Normally, in females, androgens play more subtle roles than in male. In female:
· Ovarian androgen excess caused by polycystic ovarian syndrome (PCOS) and/or insulin resistance
· Adrenal androgen excess caused by excess stress or a genetic condition
· Androgen sensitivity caused by inflammation and/or use of the contraceptive pill
Not only a high level of androgens, but a normal level of androgens can result in hypersensitivity of the sebaceous glands.
Skin signs of acne with a normal androgen level in the blood can be a result of increased activity of 5α-reductase This enzyme converts testosterone to dihydrotestosterone (DHT), a sex steroid that is five times more active and potent than testosterone.
When DHT levels get too high, it causes oily skin, acne breakouts, weight gain, sexual dysfunction, PMS, irregular periods, hirsutism and sometimes even male pattern baldness.
Acne and PCOS
Acne is the most common cutaneous manifestation of polycystic ovarian syndrome , so dermatologists can play an important role in PCOS diagnosis [ Gowri BV, et al, 2015]. Girls with severe acne or acne resistant to oral and topical agents, including isotretinoin, have a 40% likelihood of developing PCOS.
When addressing the issue of excess androgens, the goal is to reduce ovarian or adrenal androgen production.
Metabolic changes. Insulin resistance.
Consuming high levels of sugars and carbs alters metabolic status and lead to high insulin levels which trigger the ovaries and testis to produce excess androgens.
High levels of insulin increase the production of sebum.
Australian males acne research demonstrated significant improvement of acne severity after 12 weeks of a low-glycemic-load diet, compared to the high-glycemic-load diet control group [Smith RN et al, 2007].
In addition, researchers have noted an association between dairy consumption and acne [Adebamowo CA et al. 2008]
Gut health
Acne patients show high prevalence of gut problem. And many people aren’t even aware that they have gut issues. Because the symptoms can be quite subtle before the problem gets serious. Acne sufferers have significant alterations to their gut flora.
Constipation is a major problem for overall health; gut holds toxic waste and spread toxicity all over the body including the skin.
The skin is our largest detoxifying organ; internal toxicity may be a contributing factor to breakouts on the skin. Regular cleaning and exfoliating of the skin, a healthy diet and mind can help manage the occurrence of acne.
Fatty acid.
The sebum components in acne patients deprive of linoleic acid (LA), which is an essential fatty acid. LA protects the follicular epithelial wall. With the reduction of LA, the epithelium is harmed which results in dermal inflammation.
Stress.
71% patients reported that the stress is worsening the acne. Stress triggers the production of neuromodulators (neurotransmitters). The released neurotransmitters connect to the receptors present in the sebaceous gland stimulating sebum production [ Jovic A et al. 2017].
Skin pH factor
Skin pH is one of the important physiological parameters of the skin. Changes in the pH play a role in the pathogenesis of several skin diseases .
Skin pH is normally acidic, ranging between 4 and 6. Acne skin pH was detected > 6.0. The acne bacteria grow well in a pH range of 6 – 6.5.
Acid water, with a pH of 2.5 – 2.7 has shown significant promise in restoring the skin’s acidic balance (known as the acid mantle). Apple cider vinegar also help to acidify skin.
Alkaline soap usage can aggravate the skin infection!
It was reported that intake of calcium, vitamin A and monounsaturated fat (olive oil, hazelnuts, avocados, almonds ) can decrease skin surface pH in both sexes [20].
Vitamin D 3
Vitamin D is a fat-soluble pro-hormone steroid with endocrine function. Low D levels are significantly correlated with insulin resistance in women with PCOS.
There have been studies that support the theory that vitamin D has a functional role in acne development [Kramer C et al. 2009].
The level of vitamin D has been inversely associated with the severity of acne.
Vitamin A
Patients with acne believed that vitamin A could help to reduce inflammation. This may be due to reports of high-dose vitamin A therapy used in the past as acne therapy, and the fact that acne medications such as tretinoin and isotretinoin are related to vitamin A.
Alternative treatment
Multifactorial relationship of the skin with other organs and the mind emphasizes the importance of a holistic and interdisciplinary approach to patients with acne.
Long-term treatment over years may be required.
Diet
Acne has been clearly identified as a disease of Western civilization and has been closely linked to Western diet. High glycemic load diets and increased consumption of dairy proteins are the major dietary factors of Western diet promoting the development or exacerbation of acne.
Dark chocolate even when consumed in normal amounts can exacerbate acne in male subjects with acne-prone skin.
Dietary intervention in acne should thus:
· decrease glucose and excluding sugar, hyperglycemic grains
· decrease fat intake
· diminish high dairy protein consumption,
· limit animal protein intake including meat
· enrich diet in vegetables and non-sweet fruits
Tea
Spearmint tea. A study carried out in Turkey and published in Phytotherapy Research suggests that drinking two cups of spearmint tea a day could reduce the level of androgens in women. Spearmint tea is among one of the most popular herbal tea for correction of excess testosterone. After the treatment, the women showed a significant reduction in free testosterone and an increase in luteinizing hormone, follicle-stimulating hormone, and estradiol. It could be a beneficial treatment of PCOS or ovarian adrenal excess.
Green tea.
The green tea contains epigallocatechin that inhibit the conversion of normal testosterone into DHT. It is also regarded as the active anti-inflammatory and anti-proliferative compound of green tea extracts. Topical 2% green tea lotion was effective in the treatment of mild-to-moderate acne vulgaris. Furthermore, a 3% green tea emulsion significantly reduced sebum production after 8 weeks of treatment in male.
Another study investigated antibacterial activity of ethanolic extract of cinnamon bark combined with honey against acne bacteria P. acnes and S. epidermidis
Resveratrol
Resveratrol, a flavonoid from grapes and red wine. Resveratrol is a direct and indirect inhibitor of skin inflammation and may exert therapeutic effects in the treatment of acne. A resveratrol-containing gel (0.01% weight/volume) significantly reduces the number of microcomedones, papules and pustules and also has been shown to inhibit the proliferation of P. acnes.
Essential oils, such as tea tree oil, lavender, lemon and frankincense oils diluted in the carrier oil (jojoba or coconut oil) are beneficial for acne skin.
The skin is our largest detoxifying organ; internal toxicity may be a contributing factor to breakouts on the skin. a healthy diet, body detox, Regular cleaning and exfoliating of the skin, and mind can help manage the occurrence of acne.
Summary. Treatment of acne is not limited only by topical skin care it includes:
Diet enriched in vegetables and non-sweet fruits, low carbs/sugar and dairy product, low animal fat and increased monosaturate fat (olive oil).
Enzymes and probiotics
Linoleic acid - flaxseed, flaxseed oil, hempseed oil, grapeseed oil, pumpkin seeds, wallnuts
Omega-3 fatty acid including borage oil, evening primrose oil, black currant see oil
Resveratrol
Vitamin D3 and vitamin A
Green tea and Spearmint tea
Skin detox bath with 2 cups of Epsom Salts or Sea Salt and couple drops of lavender, peppermint or other preferable oil.
Essential oils, ethanolic tincture of cinnamon bark - for skin treatment
Esthetician treatment with different natural masks and creams