Acne

Acne is one of the most common dermatologic disorders affecting men and women. Acne usually begins on the face or back area. Earliest lesions are referred to as "blackheads" or whiteheads. These initiate the acne process. Factors such as emotional stress, circulating hormones and exposure to various environmental agents can precipitate an acne flare. Diet, is thought also, in some instances to play a role in the acne process. has not been shown to play a convincing role in the etiology of acne formation. Acne can be readily managed with the use of oral and topical antibiotics, oil control, exfoliating agents and good skin hygiene.

Figure 1. Acne Vulgaris (grade 2, blackheads, whiteheads and papules)

WHO IS PRONE TO ACNE?

Everyone can develop acne. There are various types of acne conditions that can be due to hormones, environmental exposures to cosmetics, inherited acne conditions etc. This is why it can be a troubling disease of the skin

WHY DOES ACNE OCCUR?

There are four essential reasons why acne is thought to occur:

• An increase in the oil secretion rate.
• A change in the composition of the oil that is secreted.
• Abnormal growth and "stickiness" of the cells of the skin, which allow for bacteria and secondary infection to set in.
• Release of certain growth factors and hormonal influences.

Circulating hormones (which are elevated one week before a woman's period) can increase or change the rate of sebum or oil production. This usually results in the adult female complaining of a flare-up of acne one week prior to her menstrual cycle. If a female or young child has excessive hair growth, abnormal menstrual cycle pattern, persistent headaches or other signs of masculinity, it is possible that an underlying condition may be present ( such as Polycystic Ovarian Syndrome). Estrogen Therapy (Birth Control Pills) or a medication called Spironolactone may be a useful treatment in such instances. It is important to let us know if you are experiencing similar symptoms with your acne flares.

Risk Factors for Developing Acne Vulgaris

- Friction
- Sweating
- Circulating Hormonal Influences
- Heredity
- Resistance Infections
- Environmental Agents (Greases, Solvents)
- Stress
- Exposure to Lanolin or Vegetable Oil Based Cosmetics
- Diet (high glycemic diet)

What is the treatment for acne?

This depends on the nature of the disorder. Often topical or oral antibiotics are used in combination with topical retinoids and oil controlling agents. The latter will help decrease the amount of oil that is secreted and how skin cells adhere to one another. Contact us for a list of ADAS recommended acne systems.

In the office, if blackheads are noted, we may recommend salicylic acid peels, microdermabrasion, acne surgery or Photodynamic therapy (PDT) using a chemical called "aminolevulinic acid" and pulse dye laser or Blu-U™ light. PDT clears acne at a slightly faster rate than traditional therapies in most instances.

It is important to avoid picking or scratching bumps because scarring may result. It is common for pigmentation to persist in areas where acne lesions were severe. In cases due to ingrown hairs, hair removal therapies may be indicated. Finally in cases where acne consists of cysts or deep lesions, a medicine called Accutane™ may be employed. For scarring treatments, Fractional CO2 "DOT"™ laser or Fraxel re:store™ are wonderful options. To see before and after pictures of treatments that ADAS providers have performed, click here.

Complementary and Alternative Therapies

NUTRITION

Although some people with acne report that certain drinks and foods (particularly nuts) make their symptoms worse, there is no scientific evidence that any food (even chocolate) affects acne. It is possible that food allergies may play a role in adult acne, and people may want to avoid foods that appear to aggravate their symptoms. Some doctors may suggest a low glycemic diet, which helps keep blood sugar stable and under control.

• Salvia hispanica (Lifemax™) which is a natural derived food contains omega 3 fatty acids, lignans and high fiber. Omega 3 fatty acids are excellent for reducing sugars in your blood which have been known to in some instance induce acne. Lignans have also been shown to have benefits for your skin.
• Zinc (30 mg two times per day for a month, then 30 mg per day) -- Several studies indicate that the mineral zinc may reduce the effects of acne. However, high doses of zinc can cause anemia, vomiting, and immune system suppression. It also interacts with tetracycline, which is often prescribed for acne. For these reasons, talk to your doctor before taking zinc.
• Niacinamide (as a 4% topical gel) -- One study found that applying a 4% niacinamide gel to the skin two times per day for two months significantly improved acne symptoms. However, the study lacked a placebo, so it is hard to tell exactly how effective niacinamide might be.
• L-carnitine -- Researchers in Greece showed that, among a large group of people, mild side effects from isotretinoin (dry skin, chapped lips, dry eyes, and nosebleeds caused by dry nose) improved when taking L-carnitine compared to those who took a placebo.
• Vitamin A -- has many of the same properties as the retinoid drugs, but often with fewer side effects. Few studies have been done on vitamin A and acne, however. Too much vitamin A can be toxic, so talk to your doctor to determine the right dose for you, and only take higher doses of vitamin A under a doctor's supervision. Do not take extra vitamin A if you are pregnant or have liver disease.

HERBS

Tea tree oil (Melaleuca alternafolia, 5% gel) -- Applied topically, tea tree oil may help reduce bacteria on the skin, lessening inflammation and improving symptoms. One study compared the effectiveness of tea tree oil gel with benzoyl peroxide lotion in 119 people with mild-to-moderate acne. People in both groups improved, and the people using tea tree oil reported less side effects (including stinging, itching, burning, and dryness) than those using benzoyl peroxide.

Guggul (Commiphora mukul, dose equivalent to 25 mg guggulsterones or about 500 mg of guggul two times per day) -- In one study, taking guggul orally had the same effect as taking tetracycline. Guggul should not be taken by pregnant or nursing women. Guggul may have estrogen-like effects, and should not be taken by anyone with a history or family history of hormone-related cancers, including prostate cancer and breast or ovarian cancer. In addition, the herb may interact with anticoagulants (blood-thinning medications), tamoxifen, and birth control pills containing estrogen, as well as herbs that have estrogen-like effects (such as black cohosh, licorice, soy, and others). People who take these herbs or drugs should not take guggul.

Ayurvedic medicine -- Ayurvedic medicine may help improve symptoms, although further studies are needed. In one study, a combination of ginger (zingiber officinale) , Holarrhena antidysenterica, and Embelia ribes reduced the number of inflammatory and non-inflammatory lesions. In another study, combined oral and topical use of Aloe barbadensis, Azardirachta indica , turmeric (Curcuma longa), Hemidesmus indicus, Terminalia chebula, Terminalia arjuna , and ashwagandha ( Withania somnifera ) also reduced the number of lesions.

Homeopathy

There have been few studies examining the effectiveness of specific homeopathic remedies. Professional homeopaths, however, may recommend one or more of the following treatments for acne based on their knowledge and clinical experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. In homeopathic terms, a person's constitution is his or her physical, emotional, and intellectual makeup. An experienced homeopath assesses all of these factors when determining the most appropriate remedy for a particular individual.

• Belladonna -- for people who experience flushes of heat to the face or who have inflamed pustular acne that improves with cold applications
• Calendula -- for skin conditions involving pustules or blisters
• Hepar sulphur -- for painful, pus-filled acne
• Kali bromatum -- for deep acne, especially on the forehead, in persons who are chilled and nervous
• Silicea -- for pustules or pit-forming acne

The staff at ADAS look forward to helping our patients in Jacksonville, Ponte Vedra Beach, and Fleming Island and are happy to answer any questions which you may have about acne. Remember, to follow through with your prescribed treatment to achieve optimal results. Sometimes this may result in your condition worsening temporarily. Though an instant "cure-all" for acne is currently not available, acne can be controlled and scarring prevented only through your medical compliance. If you would like to schedule an appointment, click here or call 904-285-7546. We look forward to helping you.