OVERVIEW - ACNE
Acne is a skin condition that affects areas containing the largest oil glands, including the nose, forehead,
cheeks, chin, back, and trunk. It is caused by a disorder of the oil glands that result in clogged pores and outbreaks of
lesions commonly known as pimples.
Acne is an extremely common skin condition with a prevalence of 80% in female and 90% in male teenagers. But it can
occur at any age. A growing number of adults are being diagnosed with adult acne, affecting between 17 million and 45
million people, making it the most common skin disease in the United States. While it tends to last longer in
females, males are more likely to get acne and tend to have more severe cases than do females. Some infants may develop
acne, but it is most common in adolescents and it generally disappears by age 30.
Although it is not a serious health threat, severe acne can be painful and may cause permanent scarring, which can
be upsetting for people who suffer from the condition. An estimated $100 million is spent annually on over-the-counter
products to treat acne and reduce the pain, scarring, and emotional distress that can be associated with it.
CAUSES
Acne is a disorder of the skin's oil glands. Oil glands make a substance called sebum that normally rises up through
a hair-containing canal called a follicle and empties onto the skin surface. The precise cause of acne in newborns is not
known, but some researchers speculate that it may be due to the transfer through the placenta of hormones from the mother
or of acne-causing medication (such as lithium and phenytoin) that the mother may have been taking.
During adolescence, rising hormone levels called androgens stimulate increased oil production and also increase the
number of oil glands and the amount of sebum they produce. The increased production of sebum causes blockage of hair
follicles, leading to the formation of small bacteria-filled cysts called comedones. If these comedones remain intact and
do not rupture, they can progress into open comedones (whiteheads) or closed comedones (blackheads). When comedones
rupture, an inflammatory reaction occurs and can spread into the surrounding tissue and all forms of inflammatory lesions
are formed such as papules, pustules, cysts, and nodules.
FORMS OF ACNE
Acne Vulgaris is the most common form of acne which includes several types of pimples. These acne
lesions include blackheads, whiteheads, papules, pustules, nodules and cyst.
Definition of terms:
Papules - inflamed lesions that appear as small, pink bumps on the skin
Pustules (pimples) - inflamed pus-filled lesions that are red at the base
Cysts and nodules - large, inflamed, pus-filled lesions that are lodged deep and can drain, causing pain and
scarring
Lesions can cause scars ranging from small, depressed pits to large elevated blemishes, depending on the severity of
the condition and the individual's skin type.
Acne Rosacea can look similar to acne vulgaris, and the two types of acne are sometimes confused for
one another. Usually occurs in people over the age of 30. It appears as a red rash which is normally confined to the
cheeks, nose, forehead and chin. The redness is often accompanied by bumps, pimples, and skin blemishes. It is more
prevalent in women, but often more severe when found in men. Left untreated, it can cause swelling of the nose and the
growth of excess tissue, a condition called rhinophyma.
SEVERE FORMS OF ACNE
Acne Conglobata is the most severe form of acne vulgaris and is more common in males. It is
characterized by numerous large lesions, which are sometimes interconnected, along with widespread blackheads. It can
cause severe, irrevocable damage to the skin, and disfiguring scarring. It is found on the face, chest, back, buttocks,
upper arms, and thighs. The age of onset for acne conglobata is usually between 18 and 30 years, and the condition can
stay active for many years. As with all forms of acne, the cause of acne conglobata is unknown.
Acne Fulminans is an abrupt onset of acne conglobata which normally afflicts young men. Symptoms of
severe nodulocystic, often ulcerating acne are apparent. As with acne conglobata, extreme, disfiguring scarring is common.
Acne fulminans is unique in that it also includes a fever and aching of the joints. Acne fulminans does not respond well
to antibiotics.
Gram-Negative Folliculitis is a bacterial infection characterized by pustules and cysts, possibly
occurring as a complication resulting from a long term antibiotic treatment of acne vulgaris.
Pyoderma Faciale - this type of severe facial acne affects only females, usually between the ages of
20 to 40 years old, and is characterized by painful large nodules, pustules and sores which may leave scarring. It begins
abruptly, and may occur on the skin of a woman who has never had acne before. It is confined to the face, and usually does
not last longer than one year, but can wreak havoc in a very short time.
RISK FACTORS THAT MAY CAUSE OR WORSEN ACNE
Family history of acne.
Greasy/oily cosmetic or hair products containing vegetable or animal fats - pore-clogging (comedogenic) cosmetics,
sunscreens, moisturizers, greases, and oils.
Hormonal changes associated with adolescence, pregnancy, or menstruation (acne tends to flare up 2 to 7 days before
menstruation begins)
Certain medications such as corticosteroids, androgens, oral contraceptives, lithium, halogens, isoniazid, phenytoin,
phenobarbital, and high levels of iodine (such as from kelp)
Environmental irritants such as industrial cutting oils, tar, wood preservatives, sealing compounds, and other
pollutants
Sweating and friction, such as from headbands, back packs, bicycle helmets, or tight collars
High levels of humidity
Squeezing and picking comedones
Being overweight--increased insulin production can signal the body to release extra male hormones, called androgens,
which are involved in pimple formation
Stress
Poor diet--Excessive sugar, trans fats, fried, salt, and processed foods. Insufficient intake of water, healthy
oils, fruit and vegetables, and fiber
Excessive intake of foods such as chocolate, caffeine, carbonated beverages, milk products, and seafood and other
iodine-rich foods
Tumors in the adrenal glands, polycystic ovarian syndrome (especially when adult acne occurs with irregular menstrual
periods), and other health conditions can cause acne. Examination by your family physician is recommended to rule out
these conditions
DIAGNOSIS
Acne has a characteristic appearance and is not difficult to diagnose. Healthcare providers can treat most individuals
with mild and moderate forms of acne. People with more severe cases of acne however, are often referred to a dermatologist
or a skin disease specialist
Your naturopathic doctor or healthcare provider may take a complete medical history that includes questions about
skin care, cosmetic use, and diet; factors that trigger flare-ups; medication use; occupational and environmental
exposures; and prior treatment and an examination of the face, chest, back, and other areas for blemishes, lesions and
scars
Under the concepts of naturopathic medicine, assessment is oriented toward determining what is impeding your body's
ability to function normally
TREATMENT APPROACH
The main goals of acne treatment are to prevent scarring, reduce the number of painful lesions, and minimize the
stress and embarrassment related to the condition. The basic principle of skin care is to wash the affected area no more
than one to two times per day with a mild, non drying soap. Frequent washing and the use of harsh soaps can actually make
the condition worse
Healthcare providers may recommend topical medications as their first choice for treating acne (generally either
benzoyl peroxide or a class of drugs known as retinoids), which are designed to wear away the top layer of skin
(exfoliate) as well as to reduce abnormal clumping of cells in the follicles, oil and bacteria production, and inflammation.
Additionally, facial steaming with accompanying manual extraction of the comedones is valuable for exfoliation as well.
Expect to use medications and/or complementary and alternative remedies for at least 6 to 8 weeks before seeing a noticeable
improvement in symptoms. Seek medical care if infantile acne does not improve within three months
DIET
A diet based on whole, unprocessed foods may benefit people with acne. Try to eat at least five servings of vegetables
per day and at least one serving of fruit per day. Avoid eating refined sugar. Fried foods and trans fats such as milk,
milk products, margarine, shortening, and other hydrogenated vegetable oils should be eliminated
Foods containing healthy omega-3 oils such as ground flaxseeds and sardines should be increased. Some people find
that chocolate, caffeine, carbonated beverages, iodized salt, shellfish, wheat and/or milk products aggravate acne
Regular bowel movements are important. Drink at least 8 glasses of day of water. Increase fiber intake. In addition
to eating fresh vegetables and fruit, choose whole grains. Some people may benefit from a one- to four-week liver detox
diet based on fresh vegetables and fruit.
Some specific supplements that may help acne:
Vitamin A may help to reduce sebum production
Zinc, especially in the form of zinc gluconate or zinc sulfate, can help prevent acne
Vitamin B6 may help premenstrual or mid-cycle acne
HERBS
Once your naturopath has identified what lifestyle and dietary factors affect or aggravate your acne, they may decide
to give you a combination of herbs that are specific to your case and symptoms.
TEA TREE OIL
Tea tree oil contains antimicrobial substances that helps eliminate Propionibacterium acnes (the bacterial strain
associated with acne), thereby potentially reducing inflammation associated with the skin condition. One study compared
the effectiveness of tea tree oil gel with benzyl peroxide lotion in 119 people with mild to moderate acne. Individuals
in both treatment groups showed a significant reduction in the number of inflamed and non-inflamed lesions over a 3-month
period. Seventy-nine percent of the benzyl peroxide group compared to 44% of the tea tree oil group reported side effects
included stinging, itching, burning, and dryness.
ACUPUNCTURE
Auricular (acupuncture applied to the ear) and electro-acupuncture therapies may reduce the symptoms of acne.
HOMEOPATHY
There have been few studies examining the effectiveness of specific homeopathic remedies. Usually one or more
homeopathic remedies are prescribed for acne based on the homeopath’s knowledge and clinical experience. Before prescribing
a remedy, homeopaths take into account a person's constitutional type – i.e. is his or her physical, emotional, and
intellectual makeup.
MIND / BODY MEDICINE - BIOFEEDBACK AND COGNITIVE IMAGERY
Emotional stress can worsen acne, therefore that relaxation therapies such as hypnosis, biofeedback together with
cognitive imagery may improve acne symptoms. Through relaxation using hypnosis, an individual becomes more relaxed and
this positively influences the activity of hormones and the immune system (which may contribute to reduced
inflammation).
Biofeedback is a technique in which an individual is trained to control certain internal bodily processes that
normally occur involuntarily, such as heart rate (measured by an EKG) and muscle tension (measured by an EMG). During
biofeedback training, an individual participates in a relaxation technique, such as guided imagery, while hooked up to
an EKG or an EMG. Guided imagery involves the formation of mental pictures to promote a variety of favourable physical
and emotional effects. This combination of biofeedback and cognitive imagery allows the person to visualize and
understand the bodily changes that occur when he or she changes from being tense to being relaxed
PROGNOSIS AND COMPLICATIONS
Acne is not a serious health threat, but severe acne can be painful, emotionally upsetting, and may cause permanent
scarring. Squeezing lesions can rupture comedones and cause inflammation. Infants with acne have an increased risk of
developing acne in adolescence. Symptoms generally diminish after adolescence and disappear by age 30. However, the
incidence of adult acne, especially in women, seems to be increasing and is not unusual in women in their 30s and 40s
HOW CAN OUR NATUROPATHIC CLINIC HELP YOU?
If you do have acne and you are unsure what is causing it, we can help you identify the cause and help you with a
treatment strategy that is specific for your symptoms.
Your symptoms will be discussed in depth to find out what exactly is the root cause of your problems at the first
visit, accompanied with a standard blood and urine test.
Our clinic offers conventionally accepted medical approaches of assessment for this condition, which include a
physical exam and various laboratory tests that help identify the type of acne you have, and reveal any underlying
conditions that may impede your body’s ability to function optimally. In the case of hormonal based problems, a
hormonal panel will be done to identify what area of the endocrine system is responsible.
The naturopathic doctor will determine which assessment tools are most helpful in establishing a treatment strategy
specific to your health needs.
The primary goals at the clinic are to identify and treat the underlying root cause, and correct damaging
grooming practices.
You will be given a comprehensive treatment plan include a range of complementary and alternative therapies.
Please ask your doctor or naturopath before starting on any supplements. Its is better to first identify the cause
and then treat it with the right remedies, even though those mentioned above have minimal side effects.
The information on this handout is the property of Toronto Naturopath SUSHMA SHAH ( N.D. ), and is not intended to
treat, diagnose or cure any disease. For any questions, or concerns, please contact me at 416 913 4325 (HEAL) or
email me at info@naturesintentionsnaturopathy.com
