By Jane Sheppard
Many of us, as teen-agers, have experienced the dread of acne. Blackheads, whiteheads and the red, swollen, pus-filled lesions we call pimples is a disease common in teens called acne vulgaris. Eight out of every ten teens experience it. Mild acne is considered a “normal” condition of puberty, continuing throughout the teen years.
Acne can appear on the face, neck, shoulders, upper back and chest. Acne vulgaris usually consists of noninflammatory (blackheads or whiteheads) or mildly inflammatory lesions. Nodular or cystic acne is more severe. These lesions can be disfiguring and painful. Permanent scarring can occur with large cysts or nodules.
When acne is severe, it can be extremely traumatic to a teen-ager, leaving life-long physical and emotional scars. Severe acne has significant impact on the way teen-agers view themselves. Effects can include social withdrawal, low self-esteem and self-confidence, embarrassment, depression, poor body image, anger and discouragement. Unless it is treated in a holistic way, severe acne will most likely not disappear when entering adulthood. It is a sign that there is something happening within the teen that needs to be addressed on a physical as well as an emotional level.
How Acne Develops
Acne occurs when the hair follicles (pores) of the skin become clogged with sebum, bacteria and dead skin cells. Sebum is an oily substance produced by the sebaceous (oil) glands. Its purpose is to lubricate the skin and hair. Normally, sebum moves through the follicles and is discharged on to the surface of the skin.
During puberty (about age 11 to 14) and throughout the teen years, increased levels of androgen hormones stimulate the sebaceous glands to grow and produce more sebum. When there is excess sebum production, the follicle can become plugged. Also during puberty, the skin cells of the follicle lining shed more quickly and can form sticky clumps. Bacteria and dead skin cells can combine with the sebum in the clogged pore.
One type of bacteria specifically involved in acne is Proprionibacterium acnes (P. acnes). Everyone has P. acnes living in their skin; even people who don’t have acne. P. acnes ingests the sebum that is discharged to the skin. However, when sebaceous glands are clogged with sebum, t he P. acnes multiply quickly and break the sebum down into irritating fatty acids that cause an immune response. Inflammation is the result, with redness, swelling, and pain. Another type of bacteria that can be a factor in acne is corynebacterium acnes. This bacteria can cause skin fats to break down into irritating chemicals that can also lead to acne.
Causes of Acne
Most dermatologists will tell you the exact cause is unknown, probably because there is not any one cause that can be determined for everyone. We know how acne develops, but there are many factors that can cause this development to take place. In teens, a major factor is the change in hormones that affect the sebaceous glands. But what is it that causes some teens to have severe acne while others have very mild, occasional acne and others have clear skin? Like many health problems, the specific causes of acne are multifaceted and can be different for each person.
Heredity is known to be a factor in acne. If you had acne as a teen, your child may also be susceptible. Diet, hormonal imbalance, or nervous system disorders can cause a person to be acne-prone. Premenstrual acne starts a few days before each period, when progesterone hormones are highest. Allergies to molds, foods, chemicals, cosmetics, and other substances can result in acne. Medications that can cause acne include dilantin, lithium, isoniazid, iodine, steroids, and some birth control pills. In severe cases, candida-yeast overgrowth, toxic bowel, liver dysfunction and thyroid, gonadal or adrenal disorders should be looked into.
Conventional treatments are aimed at reducing sebum production, reducing bacteria responsible for acne infection, and exfoliating dead skin cells to prevent clogged pores. Conventional treatments can reduce or even eliminate acne, but in many cases, the breakouts return after treatment is discontinued since the whole picture of health has not been addressed. There are many side effects associated with conventional treatments. Some of these can be very serious.
Benzoyl peroxide reduces P. acnes bacteria on skin and is a peeling agent. Must be used continuously to keep acne at bay. Available over-the-counter in creams, lotions or gels. Often works well for mild cases. Benzoyl peroxide is a bleach. It may bleach clothing and can be irritating. It generates free radicals, which could theoretically increase skin cancer later in life. Side effects include irritation, drying, itching, redness, and peeling.
Topical antibiotics available by prescription only and applied to the skin in creams, gels, pads or lotions. Topical antibiotics are limited in penetrating the skin. They inhibit inflammation caused by bacteria, rather than having a direct bactericidal effect. There is a risk of development of resistant strains of P. Acnes.
Oral (systemic) antibiotics
Oral (systemic) antibiotics, taken by mouth, circulate through the body and into the sebaceous glands. Most common are erythromycin, minocycline and tetracycline. Antibiotics work by killing off the P. acnes, but do not address the other aspects of how acne develops. They are usually used in combination with other drugs that help to “unclog” follicles. They may take several weeks or months to show any improvement. Improvement is usually temporary, while still taking the antibiotics.
Antibiotics also kill the beneficial intestinal bacteria needed to maintain health. Long-term antibiotic use, as is prescribed for acne, lowers immune function and could increase susceptibility to infection. Adverse affects include yeast overgrowth, vaginal yeast infections, upset stomach, allergies, increased susceptibility to sun-damage, yellowing of teeth, decrease in absorption of some vitamins and minerals, increased risk for cancers, and increased bacterial resistance. Many are not safe during pregnancy and may reduce the effectiveness of birth control pills.
Vitamin A derivatives (retinoids)
Vitamin A Deriviatives (retinoids) or topical vitamin A acid – normalizes the way skin grows and sheds and helps unclog pores. Creates an unwelcome environment for P. acnes. Retin-A cream or gel is available by prescription only. The side effects of higher concentrations include red skin and peeling, sun sensitivity. Not to be used in pregnancy.
Accutane (oral retinoid)
Accutane (oral retinoid) decreases the secretions and size of the sebaceous glands, improves shedding of skin and reduces the P. acnes. Can clear severe nodular or cystic acne. Used for treating severe acne that has not improved by other methods, including antibiotics. There is an extremely high risk of birth defects if pregnant while taking accutane. The FDA issued a statement that advised doctors and patients about reports of “depression, psychosis, and rarely suicidal thoughts and actions” related to using accutane. The most common side effects are dry skin, lips, hair and eyes (as accutane inhibits the oil glands), headaches, nosebleeds and changes in blood lipids.
Birth Control Pills
These hormones can help to counteract the effect of the male hormone androgen on acne. It is used for the treatment of moderate acne vulgaris in women 15 years of age or older. In clinical studies, improvement of acne was reported in more than 80 percent of the studies’ participants. The serious side effects include blood clots, stroke and heart attacks as well as an increased risk of developing breast cancer, particularly at a young age. This risk is related to the duration of use.
Holistic Treatments for Acne
It is important for to address the “whole person” in dealing with your child’s acne. For true healing, acne must be addressed both internally and externally on many levels.
The psychological/emotional aspect of acne requires significant attention. As previously mentioned, severe acne can be extremely traumatic to a teen, with life-long consequences. Acne can create feelings of intense shame and anguish. Other kids can make cruel and damaging remarks about acne. Teen-agers frequently feel repuls ive or dirty and connect their acne with guilt and punishment. These feelings can become deeply buried along with negative self-beliefs that can detrimentally affect every aspect of their lives for many years to come (or for the rest of their lives if these beliefs and feelings are never dealt with). It is crucial for parents to be sensitive to this. Teens with skin problems need to hear constantly how beautiful, precious and special they really are, particularly from their parents.
In addition to talking to your child positively, you can encourage her to spend time looking in the mirror, seeing beyond the acne, and affirming to herself how beautiful she is. I believe that this reinforcement of positive self-image is the single most crucial and effective thing you can do for your acne-prone teen. In addition to emotional support from parents, supportive psychotherapy or hypnotherapy can be beneficial.
Ted Grossbart, a psychologist on the faculty of Harvard Medical School and in private practice in Boston, works with the mind-body connection in skin diseases. He is co-author of Skin Deep: A Mind/Body Program for Healthy Skin (Health Press, 1992). Grossbart points out that the skin is intimately connected with the nervous system. With acne, emotional issues can trigger an outbreak or make it worse, even when there’s a clear physical cause. In addition to working with teen-age acne patients, he is seeing patients between 20 and 40 years old with very difficult acne problems. He has found that each of these patients is dealing with adolescent issues, i.e. sexual or professional identity, separation from parents, and anger. As he works with these adults on their teen issues, their skin clears up.
There is general agreement that emotional stress and fatigue can trigger and exacerbate acne. Stress and/or sleep disturbance can induce higher levels of hormones and adrenaline, which increases sebum production, leading to clogged pores. Severe acne outbreaks have been reported after prolonged sleep deprivation. Skin cells are nourished during sleep so it’s important to encourage teens to go to bed early and get their “beauty sleep”. Regular exercise is important to increase blood circulation and bring more oxygen to the skin. The mental and emotional benefits of exercise can also help a teen suffering from acne.
In addition to plenty of sleep and exercise, it’s important for teens to find a good relaxation technique that works well for them. Relaxation includes breathing exercises, yoga, self-hypnosis, meditation, or listening to relaxing music. Whatever they choose, they must do it every day to be effective, not just when they are stressed.
Hormones are produced by the endocrine glands. Healthy hormonal activity is dependent on a well-functioning liver and endocrine system. The liver plays a major role in hormonal balance and in removing toxins from the bloodstream. One of the skin’s jobs is to excrete toxins and poisons from the body. If the liver is not functioning properly, toxins can circulate longer and cause not only poor general health, but acne as well. With this in mind, the need to nourish and strengthen the endocrine glands and the liver is important.
Saw palmetto berry extract helps to balance hormones in boys and chaste tree berry (vitex) helps restore female balance. Seaweed (hizike, kelp, arame) is exceptionally high in minerals and is considered one of the best foods for nourishing the endocrine glands. Herbs that can strengthen and cleanse the liver include burdock root, dandelion root, nettle leaf, oregon grape root, and yellow dock root. Consult a qualified herbalist for specific use of these herbs. Herbs work gently and build up in your system over time so allow at least 3-4 weeks of consistent use.
Diet and Acne
Most doctors will tell you there is no conclusive scientific evidence that diet causes acne. However, there are many indications that particular foods do cause acne in some people. Food sensitivities or allergies may cause acne. A food that may cause acne in one individual may not pose a problem for someone else. We are all different. The key is to find the food or foods (if any) that may cause a problem for your teen. Mild acne can be cleared simply by avoiding any food or drink you have found to trigger an outbreak. In some cases, avoiding certain foods can clear even severe acne.
A good way to test for problem foods is to stop eating the suspected foods for a month. Make sure you read labels so you know you are not ingesting any hidden forms of the food. For instance, small amounts of sugar and milk products are hidden in many processed foods. After a month, you may find that the acne is much better or has disappeared. Begin adding one food at a time back into the diet to see if there are any changes. There may be a lag time of a few days between when the food was eaten and when the breakout occurs.
In dealing with any health problem, a good diet is always very important in order to create an environment for healing to take place. The typical teen-age diet includes many things that are detrimental to general health and could be making their acne worse. The foods to eliminate are processed food, refined sugar and sugar products, foods that contain trans-fatty acids, i.e. margarine, shortening, and other hydrogenated vegetable-oils, fried foods, commercial dairy products and meats that contain hormones, sodas (soft drinks), and salty snacks (chips and pretzels).
Studies suggest that people eating a Mediterranean diet, low in animal fat (saturated fats) and high in olive oil have a lower risk of acne. Foods that are important to add to the diet are fresh fruits and vegetables, particularly those rich in vitamin A carotene – dark green leafy vegetables, and yellow-orange vegetables and fruits (apricots, mangoes, carrots, sweet potatoes, yams and squash). Cod liver oil is important and also contains a lot of vitamin A. It’s also beneficial to drink plenty of purified water (up to 4 quarts of water a day) to flush out toxins and transport nutrients.
The following recommendations are from Encyclopedia of Nutritional Supplements, Michael Murray, N.D., Prima Publishing, (1996). Consult a qualified nutritionist for specific guidelines in supplementation for your child:
High-Potency Multiple Vitamin/Mineral
Vitamin C, 500 to 1,000 milligrams 3 times daily
Flaxseed oil, 1 tablespoon daily
Vitamin E, 200 to 400 IU daily
Zinc, 45 to 60 milligrams daily
Chromium, 400 to 600 micrograms daily
Vitamin A –A safe and effective recommendation for vitamin A in the treatment of acne is less than 25,000 I.U. per day. Beta-carotene may be taken in large doses (25,000 to 300,000 I.U.) without toxicity. Vitamin E and zinc are important to the proper function of vitamin A. Although high-dose therapy of vitamin A may be useful for the treatment of acne, a physician should closely monitor the therapy (unless it is from beta-carotene).
Constitutional prescribing by a qualified homeopath may be helpful in treating acne. Homeopathic remedies to try for acne are Anti-monium crudum, Carbo animalis, Hepar sulfur, Kali bromatum, and Sulfur.
General Tips for Your Teen
To cleanse an acne-prone face, gently wash it twice a day. Rinse well with warm water and pat dry with a clean soft towel. Do not scrub with a washcloth or use harsh, high pH soaps or abrasive cleansers. Too much friction can worsen acne. A mild calendula soap is fine. Avoid over washing your face since this can make it dry and irritated. Skin must maintain the proper pH levels to be healthy.
Beware of skin products that contain chemical preservatives, fragrance or coloring agents. These chemicals can make the problem worse. If using cosmetics, use water-based, oil-free foundations sparingly and wash off thoroughly before going to bed. Check for noncomedogenic, or nonacnegenic ingredients that are not likely to cause or aggravate acne. Use a nonscented moisturizer. When skin is dry, it produces more oil and the oil is more likely to become trapped in pores.