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Acne

Acne

Description

Acne is the most common of all skin problems. Acne vulgaris is a disease of the hair follicles and oil secreting glands of the skin. It manifests as blackheads (comedones), whiteheads (pustules) and inflammation (papules). Acne conglobata is a more severe form, with deep cyst formation and subsequent scarring. The lesions occur predominantly on the face and, to a lesser extent on the back, chest and shoulders. It is more common in males and onset is typically at puberty (somewhat later for conglobata form).

As the name "acne rosacea" implies, the usual pimples of acne are accompanied by a pronounced redness, usually facial. Rosacea is a multifactorial skin disorder. Acne rosacea and acne vitiligo may occur together. Sub-types are also recognized e.g. cutaneous rosacea and rosacea keratitis. Such differentiation requires specialist diagnosis, usually by a dermatologist.

Acne is a multifactorial disease requiring an integrated therapeutic approach in order to avoid supplement toxicity while attaining the desired clinical results. Also, because many individuals have been treated with long-term, broad spectrum antibiotics, they often develop intestinal overgrowth of Candida albicans, a common yeast. Chronic yeast infection may actually make acne worse and must be tested for and treated when found.

Causes

Little is known about the etiology of rosacea, although it represents a vascular anomaly occurring in patients with fair skin, who are usually middle-aged. Another group is young (aged 20) women with dry skin.

In one study, histology of the stomach mucosa revealed tht 84% of 31 patients were H. pylori positive. This would confirm the view that the skin reflects the condition of the digestive tract.

The view is also gaining momentum that Rosacea may also signify alcohol misuse. Alcohol affects immune function and changes the cutaneous vasculature.

Cases have also been reported in which rosacea has developed in AIDS patients. This lends support to the factor of a depressed immune system.

At the papulo-pustural stage, a small parasite or mite is found in greater numbers, called Demodex folliculorum. Treatment rests on hygienic and dietary rules.

In acne vulgaris, the onset reflects an increase in sebaceous gland size and sebum secretion due to stimulation by male hormones. The severity and progression are determined by complex interactions between these hormones, keratinization, sebum and bacteria.

The lesions begin in the upper portion of the hair follicle canal, with overgrowth (hyperkeratinization) of the cells lining the hair canal being the first change. This leads to blockage of the canal, resulting in dilation and thinning, and eventually the growth of bacteria and pus formation.

Despite a large amount of pus in whiteheads and cystic lesions, the only bacteria commonly cultured are those normal to the skin. They are believed to release enzymes that breakdown the sebum into products causing inflammation of the skin.

Acne is considered to be a male hormone-dependent condition. These hormones control sebaceous gland secretion and exacerbate the development of abnormal growth of the hair follicle cells. But excessive secretion of male hormones is not necessarily the cause, since there is only a poor correlation between blood levels of the hormones, and the severity of the disease.

What may be more important is that the skin of patients with acne shows greater activity of an enzyme (5-alpha-reductase) which converts testosterone to a more potent form. Another aspect of acne which is rarely recognized is the contribution of intestinal toxemia. One study showed that 50% of patients with severe acne had a positive test for circulating endotoxins. This is important since toxins have been shown to cause an increased copper:zinc ratio, and to enhance tissue destruction.

Acne-like lesions can occur from exposure to: a variety of drugs - steroids, diphenylhydantoin, and lithium carbonate; various industrial pollutants -- machine oils, coal tar derivatives, and chlorinated hydrocarbons; and local actions -- cosmetics, pomades, excess washing and repetitive rubbing.

Signs & Symptoms

Rosacea may follow a course of increasing disfigurement: early stages are characterized by papulopustular and granulomatous appearance progressing to erythrotic rosacea. The presence of telangiectasia (couperose) may require laser surgery.

Rhinophyma often requires excisionsurgery.

General characteristics include:

Dilated follicles with central dark, horny plugs (blackheads);

Small follicular papules with (red papules) or without (whiteheads) inflammatory changes;

Superficial pustules (collections of pus at the follicular opening);

Nodules (tender collections of pus deep in the skin);

Cysts (from nodules failing to discharge contents to surface);

Large deep pustules (from nodules breaking down adjacent tissue leading to scars);

Nutritional Supplements

Structure & Function:
        Immune System &
        Hair, Skin and Nail Support



---------------------------------
General Supplements
---------------------------------

Adolescent and Adult
Bee Propolis*
Beta carotene*
Brewer's yeast*
Chromium400 mcg/d
Selenium200 mcg/d
Vitamin A50,000 IU/d, for 3 months
Vitamin B650 mg/d
Vitamin C1000 mg/d
Vitamin E400 IU/d
Zinc picolinate50 mg/d



* Please refer to the respective topic for specific nutrient amounts.

Notes:

Bee Propolis The Propolis Information Bureau in England cites reports from Austria where bee propolis was found to be useful for acne. Both tincture and oitnment were used.

Brewer's yeast 1 tbsp 2 b.i.d. (if patient is susceptible to gout, increase chromium supplement instead.

Brewer's Yeast is a major phytopharmaceutical given for acne and diarrhea in Germany, with sales in excess of $30 million. It is considered to be an approved herb.

Chromium

Many dermatologists have reported insulin is effective in the treatment of acne, suggesting impaired glucose tolerance and/or insulin insensitivity of the skin. The insulin was given either systemically or injected directly into the lesion. Although oral glucose tolerance tests are normal in acne patients, repetitive skin biopsies reveal their skin's glucose tolerance was significantly impaired. One researcher of the role of glucose tolerance in acne coined the term "skin diabetes" to describe the disorder of acne. Considering the known immunosuppressive effects of sugar, all concentrated carbohydrates should be strictly eliminated.

High-chromium yeast is known to improve glucose tolerance and enhance insulin sensitivity and has been reported in an uncontrolled study to produce rapid improvement in patients with acne. Although double-blind studies have yet to be done to document this effect, it is a safe nutritional supplement (except for those allergic to yeast) and should be considered.

Chromium picolinate has also been tried, successfully, presumably for the same reasons.

Vitamin A

Retinols, including oral vitamin A, have been shown in many studies to reduce sebum production and the hyperkeratosis of the sebaceous follicles. Retinol has been shown to be effective in treating acne, but must be used at high, and potentially toxic, dosages, i.e., 300-400,000 IU per day for 5-6 months. Its use at these levels is not recommended.

Beta Carotene has been tried and found, in one study to be ineffective for acne, itself but beneficial to the skin.

Vitamin A Toxicity

Although dosages of vitamin A below 300,000 IU per day for a few months rarely cause toxicity symptoms, early recognition of toxicity is important and should be monitored by a physician.

The first significant toxic symptom is usually headache followed by fatigue, emotional liability, and muscle and joint pain. Laboratory tests appear unreliable for monitoring toxicity, since serum vitamin A levels correlate poorly with toxicity, and liver enzymes are elevated only in symptomatic patients. Of far greater concern is the teratogenicity of massive dosages of vitamin A. Women of childbearing age should use effective birth control during treatment and for at least one month after discontinuation. Chapped lips (cheilitis) and dry skin (xerosis) will generally occur in the majority of patients, particularly in dry weather.

Massive doses should be reserved for intractable cases under the strict supervision of a physician, and retinol therapy should not be used alone. The major problem with many of the clinical studies using vitamin A and its analogues has been their simplistic use as isolated agents. As noted in this monograph, many other factors are of critical importance.

Vitamin B6

Women with premenstrual aggravation of acne are often responsive to vitamin B6 supplementation, reflecting its role in the normal metabolism of steroid hormones. In rats, a vitamin B6 deficiency appears to cause an increased uptake and sensitivity to testosterone.

Vitamin E and Selenium

Serum vitamin A levels in rats on a vitamin E deficient diet remain low regardless of the amount of oral or intravenous vitamin A supplementation. Serum levels return to normal after vitamin E is restored to the diet. Vitamin E has been shown to regulate vitamin A levels in humans.

Male acne patients have significantly decreased levels of red blood cell glutathione peroxidase, which normalizes with vitamin E and selenium supplementation. The acne of both men and women improves with this treatment. This improvement is probably due to inhibition of lipid peroxide formation, and suggests the use of other free-radical quenchers (such as vitamin C, beta-carotene, etc.).

Zinc

The amount taken (50 mg) should be increased for other forms of zinc.

Zinc is vitally important in the treatment of acne. It is involved in local hormone activation, vitamin A-binding protein formation, wound healing, immune system activity and tissue regeneration.

Zinc supplementation in the treatment of acne has been the subject of much controversy and many double-blind studies. The inconsistency of the results may be due to the differing absorbability of the various zinc salts used. For example, studies using effervescent zinc sulphate show efficacies similar to the antibiotic tetracycline, with fewer side effects from chronic use, while those using plain zinc sulfate have shown less beneficial results. The majority of patients required 12 weeks of supplementation before good results were demonstrated, although some showed dramatic improvement immediately. There have been no studies to date using zinc picolinate, which is much more effectively absorbed than other forms.

The importance of zinc to normal skin function is well recognized. Zinc is essential for vitamin A-binding protein and thus for serum vitamin A levels. Also, low levels of zinc increase the conversion of testosterone to its more active form (mentioned under causes), high concentrations significantly inhibit this reaction. Serum zinc levels are lower in 13 and 14 year old males than in any other age group.

Note 1: Acne patients on tetracycline should wait 3 hours before taking minerals or multivitamins (including antacids) as drug and mineral absorption will be compromised.

Note 2: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Where an amount is not specified, please refer to the respective text for further information.

Dietary Considerations


Medical treatments often include some form of retinoic acid, so it is not surprising to find vitamin A recommended.

Nutritional therapy generally centers around B-complex (niacin, pyridoxine and riboflavin, in particular).

There may also be a need to boost stomach acidity, usually with HCl which is most commonly given with betaine (a pancreatic enzyme).

Substance P has also been suggested.

Theories about direct dietary influences on acne, including those implicating chocolate, have not been proven. While a Dietary Goals Diet is recommended, a few specifics are in order:

All refined and/or concentrated carbohydrates must be eliminated, and high-fat and high-carbohydrate foods should be limited.

Avoid foods containing trans-fatty acids (margarine, vegetable shortening and other hydrogenated vegetable oils).

Foods high in iodine should be eliminated for those who are iodine-sensitive, and milk consumption (due to high hormone content) should be limited.

Homeopathic Remedy

1.* Berberis aquifolium (mahonia tincture) to 30C
2. Kali bromatum tinct. - 3X to 15C

Advanced , by symptom:

1. Hormonal (pimples over face, chest and shoulders) - Kali bromatum tinct.

2. Hormonal but large, pus-filled spots, painful to the touch - Hepar sulphuris calcareum

3. Puberty - Pulsatilla nigricans.

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.

References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Tissue Salts

Calcarea Sulf.

Herbal Approaches

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Herbs
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Calendula
Echinacea
Goldenseal
Milk thistle
Red clover

Note: The misdirected use of an herb can produce severely adverse effects, especially when it is taken with prescription drugs or other medications.

Discussion:

Thorough daily cleansing with calendula soap is recommended.

Echinacea or Purple coneflower has a long folk history of use in inhibiting inflammation, promoting wound healing, stimulating the immune system and killing bacteria. These uses are well substantiated by experimental research. Echinacea also has some cortisone-like activity. Echinacin, a polysaccharide component of echinacea, has been shown to promote wound healing in experimental studies. Other polysaccharide components of echinacea have been shown to have profound immunostimulatory effects.

Goldenseal is particularly well indicated due to its detoxifying and antibacterial properties. Its antimicrobial activity is due primarily to its major alkaloid, berberine, which is effective against bacteria, protozoa and fungi. It also stimulates the immune system, and detoxifies the liver.

Milk thistle aids the liver in cleansing the blood.

Red clover enjoys the reputation of being a powerful blood cleanser.

Aromatherapy - Essential Oils

Bergamot Essence,Cajeput Essence,
Calendula Essence,Chamomile Essence,
Frankincense Essence,Juniper Essence,
Lavender Essence,Lemongrass Essence,
Myrrh Essence,Myrtle Essence,
Neroli Essence,Petitgrain Essence,
Rosewood Essence,Sandalwood Essence,
Spearmint Essence,Tea Tree Essence,
Texas Cedarwood Essence.Thuja Essence,
Verbena Essence.



Impetigo:

Benzoin Essence,Calendula Essence,
Chamomile Essence,Tea Tree Essence.


Related Health Conditions

Infection
Intestinal toxemia
Pain
Stress
Yeast infection

Abstracts

References

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