Because their bodies are adjusting to the hormonal changes of adolescence, virtually every teenage boy and most teenage girls develop some form of acne. This may range from the common pimple (“Oh God! Another zit!”) to the large inflamed nodules of cystic acne.
But the condition is not confined to adolescents. Even adults in their fifties-about 6% of men and 8% of women, according to one estimate–can experience outbreaks of acne on their faces, backs or chests.
Doctors are not completely certain about the causes of acne or why some people develop it and others do not. Although conventional treatments for acne can be effective, any of the commonly prescribed acne medications has potentially significant side effects (including birth defects).
We question the wisdom of prescribing these medications without first trying some nutritional supplements and lifestyle changes that can help the skin heal itself.
What is Acne?
Acne is a chronic skin condition characterized by outbreaks of pimples and other eruptions, most often on the face but also on the neck, shoulders, upper back, chest, and buttocks. Acne occurs when the sebaceous, or oil, glands at the base of hair follicles in the skin secrete too much sebum, a thick oily substance that keeps the skin lubricated and moist. Excess sebum can back up and clog pores, forming light-colored bumps, called whiteheads, and dark-colored spots, called blackheads. If a clogged pore becomes infected by bacteria normally found on the surface of the skin, the result can be a raised inflamed blemish or a pus-filled pimple.
There are two forms of acne. The milder, more common form of acne, acne vulgaris, is generally limited to whiteheads, blackheads, bumps, and pimples. In the more severe form of acne, called cystic acne, painful, inflamed fluid-filled cysts and thick, firm painless lumps appear in clusters beneath the surface of the skin. Cystic acne and chronic common acne can lead to permanent pitting and scarring, especially if skin lesions are picked at and squeezed.
Acne occurs most often among teenagers, for whom it can be an embarrassing and emotionally distressing condition. Because male hormones, or androgens, promote overproduction of sebum, boys are more likely to develop acne than girls. Acne eruptions tend to wane after age 20, although in some people they can persist well into middle age. Hormonal imbalances during menstrual periods and pregnancy can also trigger outbreaks in women.
Except when it causes widespread skin lesions and scarring, acne is usually a harmless condition that clears up by itself. Although it can’t be prevented or cured, most acne cases can be controlled with simple self-care measures, over-the-counter topical medications, and supplements, especially vitamin A, which helps regulate sebum production.
Whiteheads, blackheads, inflamed bumps, and pus-filled pimples, mainly on the face, but also on the shoulders, neck, back, chest and buttocks
In cases of cystic acne, clusters of painful fluid-filled cysts; red or purple inflamed areas on the skin; and thick, hard lumps below the skin surface
Pitting, pockmarks and scarring resulting from chronic or cystic acne
What Causes Acne?
The exact cause of acne is not completely understood. However, the increased production of sebum coupled with outbreaks of acne seem clearly linked to hormonal imbalances. The overproduction of androgens in teenage boys, for example, and the hormonal fluctuations in women caused by menstruation and pregnancy are both factors in the development of acne.
Other factors influencing acne include heredity, emotional stress, and certain medications (especially corticosteroids, oral contraceptives, and other drugs that affect hormone levels). Cosmetics, tight clothes, and anything else that can block skin pores can also trigger acne. Even climate changes may play a role. Some doctors and acne sufferers believe that certain foods or food allergies play a role in some acne outbreaks. Contrary to popular belief, however, there is no evidence that drinking colas or eating chocolate, nuts, shellfish, or fatty foods will lead to acne.
Treatment and Prevention
Regular, careful washing of the face and the application of over-the-counter topical anti-acne preparations are usually enough to control outbreaks. Supplements that help moderate sebum production, regulate hormonal imbalances, or boost the immune system are often beneficial as well. Supplements recommended for acne control can be safely combined and taken long-term and used along with conventional acne medications.
For severe cases of acne, a doctor may prescribe oral or topical antibiotics or tretinoin (Retin-A), a synthetic form of vitamin A that is applied topically to treat whiteheads and blackheads (and, less successfully, pimples). Oral tretinoin may be used to treat cystic acne. Because tretinoin can cause birth defects, women who are pregnant or contemplating pregnancy should not take it and those considering its use must be using a reliable contraceptive.
Although you can’t do much about any tendency you might have to develop acne (rest assured you won’t be trapped in adolescence forever–it just seems that way), you can certainly can reduce the number and severity of acne flare-ups by keeping your face clean and avoiding known triggers, such as oil-based cosmetics and tight-fitting clothing or sweatbands.
Nutrients that assist in the normal processing of hormones in the liver and tissues can lessen the intensity and frequency of acne episodes. In fact, many naturopathic physicians (naturopaths) emphasize the importance of good liver function in the treatment of acne and often recommend liver-strengthening herbs and nutrients.
Just a reminder:
If you have a serious medical condition or are taking medication, always talk to your doctor before starting a supplement regimen.
How Supplements Can Help
Vitamin A helps prevent overproduction of sebum, making it a key anti-acne supplement. Try taking high doses (25,000 IU a day) of a high quality vitamin A until acne begins to clear up, but for no more than a month. After a month, reduce dosage to 10,000 IU a day, if necessary. Women who are pregnant or considering pregnancy should not take more than 5,000 IU of vitamin A a day.
If menstrual cycles trigger acne outbreaks, take vitamin B6, which helps regulate levels of certain hormones associated with acne.
Add zinc to your vitamin regimen. Not only does this mineral boost immune function and reduce inflammation, it also helps balance hormone levels. If you take zinc for more than a month, combine it with copper, because long-term zinc use can interfere with copper absorption.
Also combine zinc with essential fatty acids, which help dilute sebum so that it’s less likely to clog pores. Flaxseed oil and borage or evening primrose oil are good sources of essential fatty acids.
Wash your face every day, with ordinary soap and water, but don’t wash too often or scrub roughly.
Apply an over-the-counter topical anti-acne cream or lotion to affected areas. Products containing benzoyl peroxide, sulfur, or resorcinol help control acne by drying the skin and promoting peeling.
A product containing tea tree oil at a 10% to 15% strength can be an effective alternative to benzoyl peroxide. Wiped on twice a day, this solution is antibacterial and can help dry out active lesions.
Use only cosmetics that are labeled “oil-free” or “noncomedogenic.” Wash off cosmetics with soap and water every night before going to bed. Avoid cosmetics altogether if you have severe acne.
Make a strong chamomile tea, allow it to cool, and wipe the liquid over your face each morning. It makes an effective daily rinse because it both tonifies and cleanses.
Avoid tight-fitting nonabsorbent clothes, especially exercise outfits and sweatbands, which tend to trigger acne. If you can’t avoid them, at least change out of them as soon as you can.
Stay away from any food items you feel may trigger your outbreaks. Even though there’s no proof that food causes acne, it can’t hurt to avoid any potential problems. Try eliminating the “junk” fats (called trans-fatty acids, like the hydrogenated oils) and replacing them with the “healthy fats” like those found in flaxseed and fish oils.
Don’t pick at your face. Squeezing and picking pimples and other acne blemishes can increase inflammation and result in permanent scarring.
Homeopathic medicines prescribed by a health-care practitioner skilled in their use can improve severe acne significantly.
When to Call a Doctor
If an outbreak of common acne does not respond to self-care measures within three months
If you develop cystic acne, with fluid-filled cysts, red or purple inflamed areas and hard nodules under the skin
If your skin is persistently red and flushed, even if pimples and other lesions do not develop
If acne causes you to feel self-conscious, depressed, or frustrated
The supplements listed here can safely be taken together on a long-term basis. All can be used with conventional medications for acne, except for Accutane. If you’re prescribed this drug, discontinue taking vitamin A, because the vitamin and Accutane work in a similar way. At least a month is needed for benefits of the supplements to become noticeable.
Consider a food elimination diet to detect hidden food sensitivities that may be associated with your acne.
How to Take the Supplements
If you have mild acne, start all the supplements, both internal and external, at once. And be patient.
Vitamin A is a key nutrient helping to control production of sebum. This substance is secreted by the skin and forms plugs that block pores and cause pimples. (Pregnant women should take no more than 5,000 IU of vitamin A a day, remembering to account for the amount in their multivitamin).
For unclear reasons, the blood cells of acne patients are deficient in the antioxidant glutathione peroxidase. This can be brought to normal levels simply by taking the antioxidants vitamin E and selenium. One study confirmed that adding these nutrients improved acne status.
Zinc stimulates the immune system to fight acne-causing bacteria and promotes the healing of skin lesions. Double-blind studies have shown good results using this mineral. If you take zinc for more than a month, add some copper, because the body’s absorption of copper can be blocked when you’re taking zinc.
Although physicians agree that cutting down on junk foods and saturated fats is good, some fat is needed for healthy skin. Both flaxseed oil and evening primrose oil (or borage oil) are good sources of omega 3 and omega 6 essential fatty acids.
Several studies have demonstrated the positive effect of antiseptic tea tree oil applied directly to the acne lesions at least three times a day.
When applied externally, the herb chamomile is approved in Germany for bacterial infections of the skin. Rinse your face each morning with a strong, cooled chamomile tea, or purchase a commercially available chamomile cream.
If you think your acne flare-ups have a premenstrual component, consider vitamin B6 (50 mg every morning), which can help quell acne that is triggered or aggravated by menstrual cycles. You may also need a treatment for PMS, such as chasteberry (400 to 500 mg standardized extract a day) or a combination PMS herbal product (follow label directions) during the week before your period.
Although no studies have confirmed their effect, herbal teas made from yarrow, burdock, and red clover are frequently on an herbalist’s recommended list for acne. These can be taken several times a day.
For product recommendations and orders click here for the Natural Apothecary or call 773-296-6700, ext. 2001.
David Edelberg, MD