Whether she meant herself personally, or because of modern drugs and treatment acne has become somewhat a past skin disease, I could not tell. But I was surprised at this remark because only days before that, a 13-year-old boy was brought to me in St. Petersburg by a frantic mother (herself an acne victim, still bearing the scars into adulthood). Both the mother and the dermatologist who accompanied the boy were desperate – he looked like the elephant man as a child!
Huge and baggy pustules hung from his little cheeks like overripe fruit – upon these terrible appendages were even more infected pimples. His chest and back were a mass of recent scarring and multiple pustules. It seems that acne has reared its ugly head again the world over – and the popular drugs are now under international scrutiny as creating depressions, self-worth issues, and even teenage suicide. My United Kingdom medical team was just involved in a special BBC documentary entitled “Dying for Clear Skin” that depicted a youth who committed suicide from having acne and being psychologically hooked on a popular acne drug. On the bright side, the documentary also featured another British teenager whom we managed to save and who at age 15, blogs to help other teenagers in the same terrible situation.
A fundamental understanding of acne itself is necessary, before any kind of treatment can be considered. And a drug-free regimen with proper treatment can control nearly any acne condition, if approached both topically and psychologically. Simply because all acne is hormonally-induced – and once it takes place in a young person’s skin, stress factors create more pressure on the hormonal cascade fluxes. And this is where psychology is important to a successful cure or controlled remission.
The word acne comes from the Greek word akne, meaning “point.” It is a chronic inflammatory disorder of the pilosebaceous gland and is characterized by the comedo (primary lesion) macules. There are papules, pustules, and cystic scars and/or cuneiform scars (ice pick). Physiology studies show that starting somewhere before adolescence, perhaps ages nine or 10, the adrenal glands produce dihyroepiandrosterone sulfate (DHEAS). At actual puberty, other androgens, such as testosterone and hehydrotestosterine (DHT), are produced. All these androgens suddenly stimulate the sebaceous gland to secrete more and more sebum. Attempting to dry this excess sebum out, whether by topical treatments or drugs, only exacerbate the glands to pump more sebum, in addition to other contraindications.
The corneum has a very fast renewal system at this age – new cells piling up on the surface of the epidermis faster than old cells are naturally exfoliated. This creates a “dam-like” barrier against the increased oils – and like water behind a dam, the oil flow seeks a way out – usually by congesting in one of the sebaceous glands or hair follicles. This is perceived by the skin’s defense mechanisms as a “foreign material” and new cells are created, forming an encapsulation around the sebum overload, which then forms a pustule or cyst.
The young person tries to get rid of this unsightly pimple on their face by squeezing it. At this point, P. acnes bacteria enter the picture and full-blown acne can spread like wildfire.
Acne can be an inherent, genetic condition or can be caused by many other factors: medications, hot and humid climates, polluted areas, or irritating cosmetics.
Causes of Acne
Where it all really starts is hormonally, followed by stress, No one feels as ugly, worthless, and unlovable as an acne child. During my acne years, my mother would tell me not to eat chocolate because it caused acne – as did greasy foods, cakes, and cookies. Later, the medical field laughed this off as old-fashioned rumors, but research has since then proven my mother was right!
High-glycemic diets, with their higher carbohydrate and sugar contributions do give rise to increased plasma levels of another substance: free insulin-like growth factor (IGF-1). IGF-1 is thought to promote acne in a similar way to insulin – by creating follicular obstruction through inducing androgen mediated sebum production. Even more important, hyperkeratosis, a thickening of the outer epidermis that can become that “dam” to which I referred earlier, blocks the excessive sebum flow to the surface. The encapsulation of new cells around a follicle root overfilled with sebum is epidermal hyperplasia (creating cysts) and studies of post-adolescent women, ages 20 to 25 years, found higher levels of IGF-1 in those who suffered from acne. So what your client eats does chemically affect their acne.Acne can also be exacerbated from blood sugar problems and chronic inflammation. We see this more often in onset adult acne conditions. Glycolic problems trigger hormonal reactions that lead to increased sebum production, blocked pores, and bacterial overgrowth in the stomach, as well as in the skin.
Consuming a lot of breads, cakes, pastas, and other wheat products can also contribute to acne. Gluten causes damage to the small intestine, which could lead to nutritional deficiencies and an increased toxic body load (through leaky gut syndrome). The second link between gluten and acne is inflammation. People with gluten sensitivity cannot digest gluten effectively. As a result, they absorb partially-digested protein molecules. The immune system treats these molecules as invaders and as it attacks these invaders, the white blood cells release histamine, which increases inflammation. Inflammation increases insulin resistance in the nearby cell structures. Insulin resistance leads to blood sugar problems, which is linked to acne.
It is very difficult to get younger people to change their diets, even when faced with acne. In fact, chocolate candy is often consumed a great deal because there are chemicals in the cocoa bean that set off endorphins in the brain, resulting in a feel-good sensation. This takes away depression and loneliness for short periods of time. Depressed young people do not socialize a great deal and will sit at home at the computer or watch television, while eating quick-fix snack foods like chips, cakes, cookies, sugar-rich soft drinks, and candy. Sandwiches with wheat breads are also part of their diet. To remove these things from an acne clients’ diet, they must substitute a protein rich, leafy greens and vegetable diet, and a daily portion of fruits (preferably blueberries, strawberries, and papaya, which are especially rich in enzymes and antioxidants). We do have exact diet plans and food grading charts for acne clients – but these are basic rules for any acne client. The secret is to put them on a time limit!
Any young person suffering the mental and physical agonies of acne will agree to a regimen as long as there is a time limit set for results. Most people have taken antibiotic or other drugs in their life and are accustomed to a course of dosage, whether it is 10 days or one month. The same principle applies here: If you put an acne client on a topical treatment/home prescriptive regimen, plus a food plan, for a specific time period and they see at least a small result in the very beginning, they will have real hope that it could work and will stay on the plan.
For ordinary teenage acne conditions – one month is an adequate time period to allot. For severe acne vulgaris – three months. For active acne and cuneiform scarring – six months. (The acne will disappear in about a month and a half, but the scar revision work takes longer based upon time-tested remove and rebuild resurfacing systems.) Peeling or other exfoliating procedures are not enough – assisting the skin in rebuilding new tissue underneath is also vital.
The main enemy, however, is stress. When a person feels stressed out, their body releases cortisol. The sebaceous gland sacs have receptors for this hormone that increase sebum production, when activated. High levels of cortisol can inhibit collagen production – mainly by overriding the enzyme collagenase, which determines the amount of collagen proliferation to the site of any trauma or injury in the skin, thus creating insulin resistance in the epidermis.
Psychological stress promotes oxidative stress and inflammation, leading to more pimples and pustules. At this point, the sebaceous glands are full of waxy material and dead cells.
This is why it is essential that clients understand that there will be a time frame that they must recognize before their acne is diminished. If you are doing the correct topical treatment and they see results occurring right away, the stress levels coming through their hypothalamus gland down through the hormonal cascade will lessen and chemical homeostasis in the body will begin to take place. They will have an internal healing, as well as a topical healing, creating positive results 80 percent faster!
What About Supplements?
There are all kinds of vitamins, herbs, and supplements currently on the market claiming to cure acne. Indeed, some combinations are very effective, as well as detoxifying systems and body cleansings. There are three rather common supplements, vitamins, and minerals that are vital for all acne clients’ one nearly miracle ingredient that gives amazing results – not only for acne, but for aging skin where the matrix is starting to become too thin.
First and foremost, there are vitamins A and E. Studies have shown that newly diagnosed acne clients have lower levels of vitamin A and E circulating in their bloodstream compared to those who are acne free. Vitamin E, a fat-soluble vitamin, actually protects vitamin A and essential fatty acids from oxidation in the body cells, preventing breakdown of skin tissue. Carotenoids (vitamin and carotenes) are beneficial when a variety of carotenoids are consumed together rather than alone.
Several years ago I made a journey to Inner Mongolia to visit a laboratory near the city of Hahahoheteh. I was looking for a reputable high-tech laboratory for making formulas for our Chinese clientele. The laboratory exceeded my expectations, rivaling even the highest standard laboratory in Germany or Switzerland (who claim to have the highest standards). But what was more important than the laboratory itself was the strange bush with odd shaped leaves and little orange berries that was showcased in the garden in front of the laboratory. It turned out that the plant was the only thing from which this laboratory produced its products – it was called sea buckthorn and the leaves, fruits, and seed oils were rendered into various health drinks and Chinese medicines.
When I asked for an ingredient assay sheet from their research and development scientists, I was amazed. The locally wild-grown sea buckthorn plant had 190 bio-active substances, including full power d-alpha-tocopherols (vitamin E) and was the richest source of carotenoids on the planet! But the most important thing for the acne client is that sea buckthorn oil is beta-sitosterol, which inhibits the enzyme called 5-alpha-reductase, thereby blocking the transformation of testosterone into dihydrotestosterone (DHT). The ingestion of sea buckthorn oil capsules twice a day can lower testosterone overproduction, common to acne prone male and females, and sea buckthorn is also known for its anti-inflammatory powers. Sea buckthorn oil is farmed in many places around the world. It is at its most powerful in its wild form in Inner Mongolia.
Sea buckthorn and evening primrose oil are the two best essential fatty acid supplements for the acne client. They help maintain water balance in the skin, vital to the red and inflamed acne conditions. They aid in control of inflammation in cases of infection and repair. They help the immune system to react properly and improve nerve function. Essential fatty acids help move oxygen through the blood stream and mitochondrial uptake.
Topical Treatments and Home Use Recommendations
Cleansing the skin on acneic conditions is the first and most important step. Bar soap is not recommended to cleanse skin because alkaline salts, used to solidify oils and surfactants in a bar of soap, also solidify the sebum oil in the skin, leading to congestion. Liquid soaps with strong ingredients that strip oil from the skin increase excessive sebum flow via the law of compensation. The sebaceous oil gland pumps even more oil to replace sebum that has been stripped away.
Benzyl peroxide cleansers are adequate for short-term use, but tend to dry out skin after awhile, again encouraging more sebum flow. In addition, long use of benzyl peroxide becomes a free radical in tissue. A good acne cleanser should be sulfate- and parabens-free with a small amount of salicylic acid as a mild, deconjesting exfoliate and cleansing agent.
Panthenol (vitamin B), which contains antimicrobial properties that are crucial to the control of bacterial growth, can be added to the formula. Panthenol also rebalances sebum production through the increase of coenzyme A, which is involved in the metabolism and breaking down of excess sebum.
Aloe vera is well-known for its reduction of erythema and inflammation. The most important ingredient used in any and all acne products is an herbal combination, which includes white thyme and bitter neem, both having a long track record in India and other countries as helping alleviate acne conditions. This type of compound also can act as an excellent backup or primary natural preservative, depending upon the formulation in which it is put. The base components of this compound are four natural, common ingredients – tea tree extract, castor seed oil, thyme, and rosemary, all known for their natural, antibacterial, and healing properties.
Acneic skin desperately needs protection against transepidermal water loss to keep moisture in skin where sebum is being minimized and to keep the “fire” of inflammation controlled. To seal in the water, a transdermal cream formula would be needed, but nothing with heavy oils. Keep in mind that in areas of broken pustules or cysts, or areas where cuneiform scars may be developing, extra collagen production is needed to rebuild weak tissue to the point where scarring does not happen. Adding ascorbic acid to the formula helps instigate new collagen fibers through the fibroblast cells; krameric trianda root extract helps control the stress hormone associated with acne, and is rich in natural lycopene, long-known as a “super-antioxidant” and a zinc/magnesium ascorbyl phosphate combination that not only controls excess sebum but helps rebuild compromised tissue.
I would create the cream base with safflower oil that is loaded with essential fatty acids and vitamin A, fractionated to occlude the water molecule into the skin and combine it with dimethicone, an unmodified silicone that does not block pores, but helps maintain a skin protective water barrier. Also, I would add good, old-fashioned allantoin and beta glucan. Both are well-known for their calming and soothing properties and getting rid of topical infections by stimulating the Langerhans cells to reach out with those long-armed dendrites and macrophages and destroy any invasion of free radicals and bacteria that attack acne skin. The Langerhans cell is the skin’s immune defense system and the polysaccharides beta glucan particularly enhances Langerhans cell strength to an almost unbelievable level. I have seen first, second, and third degree burns actually start to heal over in less than 24 hours with a liberal application of a gel with beta glucan as the prime ingredient!
Last but not least – teenagers need a secret weapon to control their unexpected break outs – rather than having to squeeze them when they pop up, which only spreads the infections to other parts of the face or body. This can be accomplished with a simple non-petrolatum salve that contains powerful reubecients such as cassia, clove, and capsicum cayenne pepper.
Cassia and clove create pseudo heat when applied to a swollen pustule. This immediately stimulates the capillaries; thus, the skin heats up. The hardened sebum in the pustules then starts to liquefy and the increased blood circulation carries off the toxins. Capsicum is also high in enzymes utilized by the endocrine system, which, in turn, releases hormones into the blood stream, which regulates functions like metabolism and mood. Cayenne also has antibacterial properties and is rich in vitamin A. The client would simply cleanse their skin, pat it dry, and apply a small dot of the salve onto the top of the pustules daily. Usually within 24 hours the pustules simply flush out and become flattened, or dry up and drop off the skin without any pinching or extracting with fingers.
After spending 40 years of my life dealing with every sort of acne condition known to man, I have found the most effective protocol for acne: Professional skin revision treatments in-clinic once a week for at least three months; full home prescriptive regimen, based upon the above suggestions and chemistry; supplement with zinc tablets (at least 50 milligrams) and sea buckthorn oil with evening primrose oil; eliminate or reduce sugar, dairy, and gluten drastically from diet; and increase alkalinity in diet with more vegetables, lean meats, less sodas, and processed foods.
Danné Montague-King is a worldwide leader in the field of skin rejuvenation. He was one of the first biochemists to recognize the power of enzymes to hydrate and tighten the skin and the benefit of vitamin C therapy for collagen in human skin. Montague-King is a tireless educator who annually travels throughout the world, conducting lectures and training for professionals and consumers. As a journalist, he is a regular contributor to many of the world's most important professional journals, including Australian Beauty, Beauty New Zealand, DERMASCOPE Magazine, Health & Beauty, Irish Beauty, Les Nouvelles Esthetique, Professional Beauty, and Shjkonnet og Helse.