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Acne Treatment's Missing Link

Written by Tom Porter

More and more, aestheticians and trained spa professionals are promoting and performing acne face and body services, joining dermatologists in co-managing this common, often disfiguring disease. As they expand their understanding of acne conditions, they also are questioning popular treatment methods and the topical compounds commonly used to fight acne.
The next generation of care for acne will be a preventive and reparative approach of influencing hormonal imbalance, killing bacteria and reversing tissue scarring with a sharp focus on oxidation management.

What many professionals do not know is that acne is a disease of oxidation. Oxidation affects acne both in terms of internal hormone function, and with regard to side-effects of treatment such as damage to skin following peels, and the potentially dangerous action of benzyl peroxide.
Whether or not most professionals understand that most acne treatments employ oxidizers, it is common knowledge that they can be very drying and result in overexposure of the skin to damaging environmental factors such as ultraviolet radiation. Skin care professionals know that both hydrating and protecting this uniquely sensitive skin is critical to its improvement and long-term health.

Oxidation: Where Disease Begins
Oxidizing elements are all around us, and we, and everything in our environment, are constantly oxidizing. While we don’t yet have the knowledge to stop or reverse the process as a whole, we can avoid making it worse, and there are steps we can take to make it less severe. Our goal should be to manage our oxidation - a lifestyle approach I call Total Oxidation Management - and the first step toward taking control is understanding.
Oxidation is the fundamental process that ultimately leads to disease and cell damage. This includes acne and related conditions. When too much oxygen is present, oxidation occurs. When oxygen is accompanied by certain catalytic agents, such as heat or UV radiation, aggressive oxidation can occur. An unstable chemical compound that increases the incidence of oxidation and the creation of free radicals is called a Reactive Oxygen Species (ROS). Chlorine is an ROS, as is peroxide (including hair bleach). The sun acts as an ROS catalyst which increases the oxidation of water and lipid compounds within the skin.
The damage begins when numerous free radicals occur in one concentrated area of cells. Oxidizers and ROS compounds in and on the body cause the oxidation of cell structures, leading to abnormalities which can compromise the integrity of surrounding healthy cells. The body responds to this attack by initiating another sequence of actions which we recognize as inflammation, and which extends to cellular lipids, cell walls, and cellular DNA, resulting in disease and damage.
I refer to this process as the “Oxidation Cascade”. The oxidation cascade illustrates that a single action of oxidation leads to the proliferation of free radicals, abnormal changes to hundreds, thousands, and even hundreds of thousands of otherwise normal skin cells and collectively triggers an inflammatory response. When inflammation of skin occurs, long-term, progressive damage results.
While oxidation at a cellular level may seem complex, it is the same process we see all around us. Common examples provide excellent evidence of the effects many environmental, lifestyle, and genetic factors have on the severity of oxidation.
Most hair services, for example, are accomplished through oxidation with ingredients such as hydrogen peroxide (H2O2), one of the harshest oxidizers known. To achieve fast results with highlights, coloring, perming, and straightening hair, it’s necessary to speed up the chemical action with oxidizers. Unfortunately, these oxidizers also dry out and damage the hair and scalp and, in combination with other factors, result in fading as well.
It is interesting to note that an increasing number of hospitals and clinics across the U.S. are prohibiting the use of hydrogen peroxide on patients’ skin, which has been used for years to kill bacteria on the skin surface. Hydrogen peroxide applied repeatedly to specific areas of skin, such as bed sores, gradually deteriorates skin layers.
When it comes to acne treatment, oxidation is a big part of the picture both from the standpoint of the products used (think benzyl perOXIDE) and the oxidation produced as a side effect of chemical peeling protocols. If we’re to get a handle on the disease, we are going to have to learn to manage the oxidation that contributes to its severity and to the long-term damage that can result.

Does Oxidation Cause Acne?
Oxidation is a major factor in inflammatory acne. Without oxidation, the extent of the condition would be blocked pores. The visible manifestation of acne begins in the network of pores and hair follicles connected to sebaceous glands throughout the skin. These glands produce sebum, an oily substance that lubricates the hair and skin. Along with dead cells, sebum is continually shed and expelled up to the skin surface.
When this normal function of elimination is interrupted and pores or follicles become blocked, they may erupt, potentially inflaming surrounding cells. How this interruption occurs is a fundamental question that appears to have one common factor: Oxidation.
Even simple blackheads form from melanin in dead skin in combination with cells and sebum. These harden into an oxidized mass which seals the pore opening and may lead to inflammation of surrounding tissue. Lesions, comedones, pustules, nodules, and cysts all involve inflammation which is both caused, and severely aggravated, by oxidation.
Research has shown that oxidation’s link to acne begins on the inside of the body at sites of hormonal production known to affect the regulation and functions of glands, such as the sebaceous glands. The hormone most often linked to acne is testosterone, which is a necessary and important hormone. However, when testosterone oxidizes in the body it forms a chemical called dihydrotestosterone (DHT), the same hormone that can advance the loss of hair. Unlocking the mystery of why some people oxidize testosterone more than others is at the very heart of much of today’s acne research.
Besides the possible genetic connection of oxidation to acne, there is also the potential connection of food. While most medical professionals dismiss food as a direct aggravating factor in acne, they agree that foods affect hormone levels. If foods, in fact, affect the fluctuation of hormones in the body, and the oxidation of certain hormones affect the function of the sebaceous glands, then food, in combination with oxidation, could indirectly affect the incidence of acne.

Acne Treatments: Is the Oxidation Worse Than the Disease?
All acne requires attention of some kind. Mild acne may respond to gentle cleansing and non-comedogenic moisturizing, along with sun protection, and sensible diet. More severe grades may require increasingly harsh or even invasive approaches to keep the disease under control. This is when the effects of oxidation become a serious factor. Repeated use of oxidizing compounds, which can lead to increased oxidation and oxidative damage over the long term, should be carefully considered before use and steps must be taken to minimize accelerated aging and other resulting problematic skin conditions.
The two common acne treatments which are of most concern to me are the use of topical benzyl peroxide and chemical peels. Because acne is by definition a chronic condition, requiring a disease-management approach, treatment protocols tend to become long-term “lifestyles” which can have negative consequences over time.
Benzyl peroxide is the most popular over-the-counter ingredient used to combat acne. It works by killing bacteria with powerful oxidizers. Any topically applied oxidizer, used frequently and over an extended period of time, will provoke progressive oxidative damage to the skin. The results of peroxide oxidizers are an appearance of premature aging, loss of elasticity, tone and texture, as well as susceptibility to even more serious skin conditions and diseases.
Chemical peels have also become popular in the full-service salon, day spa, and medical spa settings for achieving “quick results” with visible acne. It makes sense that dissolving and removing the upper layers of skin will expose and allow for the removal of blocked sebum, creating an improved appearance in the short term once the inflammation subsides. The problem with this approach is that most peels are not localized to affected areas and they remove necessary protective layers of the skin. Every skin care professional should know that removing the protective surface layers of the skin exposes the under-developed proteins and often the more sensitive dermis to more ultraviolet radiation, chlorine in water, and other environmental oxidizers. The more exposure to oxidation, the higher the chances for long-term cellular damage.
Also, while peeling surface layers removes dead cells and sebum, as well as possibly infected tissue and bacteria, as the layers regenerate, so does the sebum, inflammation, and acne. This can easily lead to a lifestyle of peeling skin as often as every four to six weeks. While peels might provide desired, short-term results, this constant exposure to oxidation will accelerate skin damage in numerous ways all associated with symptoms of aging.

Topical Wellness Approaches to Acne Treatment
Oxidation management can serve as both a treatment for acne and a remedy for treated skin, depending upon the client’s individual condition and disease characteristics. As a professional, you know that a thorough understanding of your client’s health history, lifestyle, and disease progression are critical prior to starting any treatment program, and that each client must be viewed individually. That being said, my primary concerns are helping you minimize both the risks and the realities of oxidation on effected skin toward improving the condition and appearance of the disease and limiting the long-term negative effects of most treatments.
The answer to managing chronic acne is not the use of oxidizers, no matter what the infomercials say. Most acne treatments result in an increase in inflammation on and below the skin surface. This inflammation must be stopped to prevent further damage to the skin. Antioxidants have proven themselves to be extremely effective in accomplishing exactly that.

Antioxidants are NOT a Fad (They’re Just Misunderstood)
There are so many conflicting messages about what antioxidants are and how they work, and so many products claim to provide antioxidant activity on the skin. It would be impossible for most skin care professionals to do the research required to get to the truth. Our industry continually brainstorms new and ever more exotic antioxidant sources, from mountain vegetation to ocean flora to synthetic compounds with catchy names that sound so technical they MUST be good. It’s little wonder that aestheticians are always anticipating the next great ingredient or the next miracle piece of equipment. Why does something so simple have to seem so complicated? In truth, it doesn’t.

Vitamin C: Nature’s Antioxidant
Most vitamins and some minerals have become recognized as the gentlest, safest, and usually most effective overall topical approach to managing oxidation. Recent studies have confirmed and clarified their remarkable qualities for both internal and topical use. When applied in the correct form, in the correct percentages, and in the absence of other compounds which effectively negate their positive results, these elemental antioxidants offer a wellness option that most closely represent nature’s approach to skin care.
Vitamin C, or Ascorbic Acid (a.k.a. L-Ascorbic Acid), is arguably the most important antioxidant vitamin for preventing and combating acne. Vitamin C has the ability to aid in the mitigation of the disease, as well as to normalize and improve the appearance of skin characteristics associated with acne.
Probably the most amazing characteristic of vitamin C, when used topically, is its ability to gently repel harsh or harmful substances through its anti-oxidation action. In nature, vitamin C surrounds every living thing at the point of reproduction. Providing this nurturing, nourishing, and protective environment is designed to give skin a way to better repair damage from disease and trauma as well as to normalize its growth and reproductive functions. As such, vitamin C is a very effective way to help improve the appearance of skin affected by acne. For vitamin C to be active, however, you must ensure that it is at full potency at the point of application.
Ascorbic Acid, in the food-grade state, is stable in crystalline or powder forms. Once dissolved in liquid, it begins to degrade rapidly until it eventually becomes nothing more than sugar – now thought to be a comedogenic substance which may, ironically, promote acne. Most products containing vitamin C are premixed compounds hyping “stable” as a feature. Most of these are not the ascorbic acid form of vitamin C and have lost their active ability to help with acne or any skin condition for that matter.
Products with dry, crystalline vitamin C, which allow you to freshly activate the antioxidant at the point of application, better ensure full potency. You can estimate the activity of a vitamin C product by sight (yellowing or browning products indicate degradation to sugar) or by using the apple test (DERMASCOPE, April 2007, page 62).
Vitamin C products, which also contain Zinc, may be especially helpful in soothing and reconditioning post-treatment skin. Zinc has been shown to have antibacterial qualities appropriate for infected skin.

Vitamins B5, E, and A
Vitamin B5, also called Panthenol, is another highly useful topical antioxidant that has received significant attention for its soothing and protective qualities. A minimum 5 percent concentration of DL-panthenol (liquid) as a mist, cream, or lotion can be effective, but be sure to check the product ingredients to avoid anything which may be comedogenic or otherwise aggravating to acne-prone skin.
Vitamin E, particularly in the food-grade form of mixed tocopherols, has been shown to be very effective in breaking the oxidation chain reaction in dermal lipids and in creating a very good trans-epidermal moisture seal. Because vitamin E is a lipid (oil) soluble vitamin, in the form of an oil, there is a risk that it could aggravate some acne conditions. I urge caution when considering its use for clients with acne.
Vitamin A is also recommended with some frequency for acne sufferers. Again, use caution because vitamin A is a skin irritant and definitely not appropriate for every skin type. Plus, like vitamin E, it is a lipid-soluble vitamin.

The Total Oxidation Management Perspective on Acne
As stated earlier, oxidation is the initiating factor and well may be the primary underlying cause of aging and disease, internally and externally. Shift your focus on acne toward an understanding of the role of oxidation, and you will begin to see a bigger picture – a wellness approach that can lead to an overall skin-healthy lifestyle. Educating your clients on lifestyle issues, genetics, and environmental effects can lead to newfound respect for you and your treatment approach as well as better compliance with your recommendations.
Take time to evaluate your current treatment protocols to see how oxidation enters in, and consider how oxidation management might improve both the results of your treatments and the long-term condition of your client’s skin.
When it comes to product and ingredient choices, demand proof of activity. Just because something is new does not make it better; the trend toward ayurvedic, holistic wellness, and well-being are certainly evidence of that. It can also be said that tried-and-true beats cutting-edge at least some of the time; but remember that even the most trusted, long-standing ingredients must still be applied in the correct form and percentage to give you reliable performance and successful results. Once you understand oxidation, how it happens, and how to manage it, you can begin to apply this knowledge to your practice. You will be amazed at the new levels of success you will achieve.  

Tom Porter is the founder and CEO of Malibu Wellness, manufacturer of EC Mode (Esthetician Cosmeceuticals skin care). He is the author of the book, You’re Not Aging, You’re Just Oxidizing, and developer of the Total Oxidation Management system. He has been researching the action of ascorbic acid and other antioxidants as they apply to skin, scalp, and hair since the early 1980s when a serious car accident allowed him to experience first-hand the healing qualities of these powerful nutrients. For more information, please contact Malibu Wellness at 800-622-7332 or visit www.malibuwellness.com.

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