Acne (acne vulgaris) is a dermatologic condition characterized by lesions that most often appear on the face and neck, but also develop on the chest, back, shoulders and upper arms. Approximately 80 percent to 95 percent of adolescents develop some degree of acne, but its prevalence declines over subsequent years until middle age, when it still affects about 12 percent of women and 3 percent of men.Acne can be a significant source of misery, and it is often difficult to treat.
Acne occurs when the pores in the skin are blocked, trapping oil, dead skin and bacteria in the hair follicles. Under normal circumstances, glands (called sebaceous glands) attached to hair follicles secrete an oily substance known as sebum. This sebum typically travels up the hair follicle and onto the skin. However, if the hair follicle is blocked, the sebum can’t get out, sometimes causing the formation of a blackhead. This is the result of the blocked oil oxidizing, causing inflammation and an influx of white blood cells. Meanwhile, normally present bacteria (Propionibacterium acnes) begin to break down the trapped sebum within the hair follicle. This results in further inflammation, as white blood cells attack the bacteria. Pus forms as the lesion enters the whitehead stage. In more severe stages, an abscess—a pus-filled pocket within the skin—may form. Although most pimples won’t leave lasting scars, anything that damages the dermis (the layer of skin just underneath the epidermis) can leave a permanent scar.
Causes of Acne
Acne by its very nature can be considered a hormonal disease. Hormones are responsible for the maturation of the oil glands in our skin. This is why children do not experience acne. There are several times in our lives when our hormones can become unbalanced and wreak havoc, including puberty, pregnancy, menopause, and, well, any other time they feel like it. More specifically, acne may be precipitated by androgen hormones (DHEA and testosterone), male hormones present in both men and women. The oil surplus created by these hormones may be instrumental in clogging hair follicles where bacteria grows and causes acne pimples and blemishes. Hormonal acne is seen mostly in women due to the natural cycles a woman goes through, such as menstruation, pregnancy and menopause. Unlike androgens the female-hormone estrogens have a beneficial effect on acne, which is why some doctors recommend birth control pills for women who have acne. But when a woman’s estrogen levels decline, as they do just before the beginning of a menstrual cycle, acne may worsen.
Acne or acne-like lesions can also develop in response to various substances, including corticosteroids, lithium, and some psychotropic drugs. Other causes include exposure to tobacco smoke, coal tar derivatives, industrial oils, and chlorinated hydrocarbons. Further, oils in aerosol sprays, as well as excessive washing or scrubbing of the skin, can exacerbate acne because these cause increased skin-oil production. The use of certain cosmetics, oil-based hair products, and suntan lotions can block oil glands and worsen acne.
Rebalance Hormones – Estrogen replacement can counteract the effect of excessive androgens but should only be used if current levels are found to be low. Low progesterone levels can cause a shift in the hormone cascade to favor the production of androgens therefore it should be tested for and levels maintained in the optimal range in order to prevent excessive androgen production. Finally insulin resistance can cause increased androgens and thus should be treated in order to reduce androgen levels. For more information on balancing hormone levels refer to relevant sections of this website. This should be a long term approach addressing the cause of the acne and not just the symptoms.
In addition to this approach, in the short term at least, you may also use certain topical products to achieve more immediate results while the hormone imbalances are being treated. The use of an anti-androgen such as spironolactone may be of benefit. This will not reduce androgen levels but will block their effect on skin cells. This drug may be taken orally, or alternatively is available through our laboratory on prescription as a topical cream for a more local effect in order to minimize any potential side effects.
Topical Treatments – All available online in the members section of this website
Niacinamide Gel – Another over the counter gel produced by our laboratory is a 4% Niacinamide (Vitamin B3) gel. In a State University of New York study, a 4% nicotinamide gel was compared to a 1% clindamycin (antibiotic) gel for the treatment of moderate inflammatory acne in 76 patients. Treatment was applied twice daily for eight weeks. At the end of treatment, 82 percent of the nicotinamide patients and 68 percent of the clindamycin patients were improved. The fact that the use of topical clindamycin is also associated with the development of resistant microorganisms makes niacinamide even more preferred. Nicotinamide cream has also been shown to reduce the amount of sebum present on the skin.
10% Azelaic Acid Cream – Azelaic acid reduces the growth of the keratin surface skin cells that can block pores. This helps to unblock the pores and sebaceous glands (glands which secrete sebum) and as a result the sebum can escape. This reduces the formation of blackheads (comedones) and spots. It also kills the bacteria associated with acne, Propionebacterium acnes. This is a common type of bacteria that feeds on sebum produced by the sebaceous glands in the skin. It produces waste products and fatty acids that irritate the sebaceous glands, making them inflamed and causing spots. Azelaic acid also reduces the numbers of these bacteria by reducing their food source (sebum) and by inhibiting their growth. By controlling bacterial numbers, the inflammation of the sebaceous glands is brought under control, and the skin is allowed to heal. This cream should be applied to the affected areas twice daily (mornings and evenings) after washing the skin, and rubbed in well. (People with sensitive skin should use the cream only once a day (in the evening) for the first week of treatment and then increase to twice daily applications.
We also produce a prescription range of creams for more resistant cases which contain a combination of tretinoin, antibiotics, anti-inflammatories and anti-androgens, etc. Contact us for more details.
High dose (5 to 10g daily) Vitamin B5 (Pantathenic acid) has been reported to be an effective and safe natural option to treating acne. Pure Vitamin B5 powder is available in the members section of fthis website. Vitamin B5 is a revolutionary way to fight acne that is just starting to come into mainstream use. Knowledge of its benefits have been relatively unknown until 1997 when Dr. Lit-Hung Leung, M.D. published his studies on B5’s effects in preventing acne. Through years of research, he obtained results that are quite astonishing. The medical community and the public have been slow to recognize the great effects of B5. It has had more success in Asia and Hong Kong where the studies originally began and where the medical industry is structured differently. Basically the cause of acne is a defect or deficiency in a person’s metabolism of lipids (fats) which occurs due to a lack of coenzyme-A in the body. Coenzyme-A is made of ATP (energy), cysteine, and pantothenic acid. Of these 3, pantothenic acid is the only one which is a vitamin and must be supplied through the diet. The other 2 are produced by the body. So if you supplement with pantothenic acid you create more Coenzyme-A in your body and your fats get metabolized. A lack of Coenzyme-A in the body means that fats don’t get broken down. Instead, they get deposited in your sebaceous (oil) glands and get secreted as sebum (oil). As mentioned earlier the acne bacteria (Propionibacterium acne) in your pores feeds on this excess oil. But if you had no oil or very little oil in your pores, you would have no acne or very little acne. Taking large doses of pantothenic acid shuts down your oil production, drying up your pores, and reducing your acne.
Pharmaceutical oral medications are usually reserved for severe cases of acne, and may include antibiotics, oral retinoids, and anti-androgens. Antibiotics may be used to prevent formation of new blemishes by killing bacteria present in the skin (Layton AM 2001). Accutane®, a chemical look-alike of retinoic acid, inhibits sebaceous gland function and keratinization (accumulation of dead skin cells). However, caution is necessary: Oral retinoids are associated with liver damage and a high risk of fetal deformity if taken during pregnancy. They are absolutely contraindicated in women who might become pregnant.
All treatments mentioned in this article are available online through our laboratory. Refer to our on-line pharmacy to order now or alternatively refer the ordering information page to view the various ordering methods available.
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