Everyone knows someone or has suffered themselves with acne. The word “suffer” is appropriate for the overwhelming effect psychologically and socially with a benign skin condition that can take control of a person’s life. Acne is most prevalent in the teens and 20’s but can also present or return in later decades. Having acne carries a stigma, it can decide whether you get the mate, get the job, even its presence will be linked with a person’s I.Q. Sad but so true!
1There are different types of acne with the worst being the cystic scarring variety. ALL acne is hormonally induced and the deciding driving factor how that impacts is genetics and how it interplays with diet, location in the world, lifestyle and stressors. The prevalence of acne increased as the world technically advanced. The grand masters of old did not “photo shop” acne deliberately from portraits. Also they are still black and white photos from the 1800’s showing close ups of people with beautiful clear skin despite the generally dirtier environment, and less attention to skin cleansing. We have traded purer home prepared food and soaps and makeup produced from animal and plant products for high fat, sugar, and chemically treated synthetic foods and skin care. There has been a literal boom of acne in various forms everywhere that technology has reached its tentacles
What is acne?
It is chronic inflammation from dysfunction of the pilocebaceous “hair oil gland” of the skin. It can be present on the back and chest but most commonly is on the neck and the face. The culprit is an over production of sebum. The primary first lesion is referred to as the comedone (plugged pore) which accumulates with a particular bacteria strain “propionibacterium acne” and sets the stage for walling off in the pore and cystic development as the trapped sebum, that is now infected, forms faster than the body’s natural renewal process can keep up. Puberty bring in the surge of Androgens in boys and girls. The androgens stimulate more sebum development and fires up the congestion in the skin. Androgen levels are more in flux and naturally higher in teens and are required to turn boys into men. They are at higher risk for more aggressive forms of acne although scarring cystic acne will occur in girls as well.
Control and Cures
Cure is a very optimist word in the world of acne! Generally dermatologists aim for long term control and suppression to stop the vicious cycle while the hormone system changes and stabilizes with age.
Antibiotics and Topicals
Systemic antibiotics and rather ineffective topicals were the main stay of treatment for the past many decades. Accutane “Vitamin A” became the “gold standard” for cystic scarring acne but it came with a high price tag for complications. It still is required as part of a treatment program for some of the more severe unresponsive generalized cystic acne types.
In practical terms available only to females. This is available in pill form with secondary benefit as a contraceptive. Hormone therapy is used to supress the effects of surplus androgens from the teen years right through into menopause. It is not unusual with the effects of hormone changes and todays diet and lifestyle stressors to see the 30 to 50 year old age group developing cystic acne.
Skin Care and Topical Vitamins
First and foremost is required a dedicated effective skin cleansing usually with an antibacterial including Salicylic Acid. Over the counter bar soaps if solid, are alkaline and solidify the sebum in the glands there by increasing the congestion. Liquid soaps have ingredients that strip natural oils which adversely increase the sebum production!
Benzol Peroxides and Bleach Bases Products such as ProActive
These maybe Ok in short term but tend to dry out the skin creating increased inflammation and ultimately more sebum production. Inflammation from strong products can lead to hyperpigmentation, slow healing and other skin conditions such as Eczema and Contact Dermatitis. They can also prematurely age the skin. An ideal acne cleanser should be Sulphur-Paraben free with Salicylic Acid in a mild exfoliating decongesting base. At Laser and Skin Care Medspa we have available a reliable cost effective skin care kit (DCL) that fits that description.
Oil by-product makeup that became more popular from the post Second World War on, is responsible for the chronic occlusion and congestion of the skin. There are more products in skin care and cosmetics that owe their success to the oil industry than fuel the engines of the world. Oil by-products have left their signature in the development of acne and other skin problems. Adding minerals to oil based makeup or calling it “oil free” does not make it a healthy choice.
The theater industry 30 some years ago and the particular problem with heavy industry makeup was the birth place of the water based line Jane Iredale. For the past ten years we have been able to offer the Jane Iredale line of skin care that works wonders for acne as well as aging skin.
There has been mixed messages over time about chocolate, soda pop and greasy foods causing acne. Research has shown that high Glycemic (high carb and sugar foods) increase a substance (IGF-01) that stimulates androgen pathways leading to more sebum production. Gluten breads, cookies and pastas create inflammation not only in the gut in gluten sensitive people but also in skin. This inflammation affects the insulin system that monitors blood sugar levels and worsens acne. Diabetics who tend to have higher sugar levels in their blood will frequently have acne that is more difficult to control. It is hard to get younger people, especially teenagers, to change their diets even when faced with acne. If a TIME LIMIT can be agreed to for one to three months during treatment a significant boost in improvement can be seen. That will encourage further compliance.
When a person feels “stressed out” their body releases the hormone Cortisol. The sebum glands have receptors for Cortisol that will stimulate excessive sebum production. Cortisols also over ride other hormone pathways increasing inflammation which, leads to more pimples and pustules. There is an endocrine condition with dysfunctional Cortisols that will result in polycystic ovaries in young females. Acne is a common problem with the disease and again can be more difficult to control in these patients.
There are all kinds of vitamins, or herbs and natural products such as seabuckthorn, evening primrose oil, rosemary and thyme and cayenne pepper that can claim to be helpful for acne. Unfortunately the benefit is tied to the concentration and the form the product is sold as. Generally these are too weak to be truly effective. Recognized through many scientific studies are how vital vitamin A,C and E and the Keratinises from fresh vegetables and fruits are to skin health. (see blog posting titled Plants that Benefit the Skin)
Topicals including these essential skin vitamins are available through skin care lines-Skin Medica, Alyria and Zo from Laser and Skin Care Medspa.
BluU and Photo dynamic Therapy
Despite some of the negative impact in technology particularly with cosmetics, there is also been some positive technology to give us more effective acne treatments. Particularly Blu Light (wave length 415 nm) became available late 1990’s. Research proved that p.acnes attracted a particular pigment called porphrin. Blu light works by activating the porphrin in the bacteria creating a reaction generating free radical (singlet 02 molecules) that cause the bacteria to implode. To accelerate this process a new topical, Levulan from a naturally occurring acid, N-Amino Levunic Acid (ALA) was developed. This process is call photodynamic therapy and has replaced Accutane as the gold standard for cystic acne.
For 11 years Laser and Skin Care Medspa has been successful in helping thousands of patients with our specialized acne program. Consultation and skin treatments can be provided free of charge to patients with Alberta Health Care Coverage. Alternative treatments such as Circadia peels and Skin Bella can accelerate the program for a faster successful outcome.
Making changes to diet and skin care and purging makeup, adding Blu U and photo dynamic therapy with Levulan as well as the microdermabrasions and facial peels enables Laser and Skin Care Medspa to be predictably successful with the acne treatment program.