Skin Treatments Inside and Out

For years, skin care practitioners have known that regular use of benzoyl peroxide, salicylic acid, and other topicals offer effective acne treatments. We have also known that certain peptides, some botanicals and vitamin C can help brighten the skin, even tone and ease pigmentation problems. But combining these and other topicals with specific nutrients – or, in some cases, avoiding certain foods and supplements – can result in even more dramatic effects.
Here is a look at today's most effective treatments for fighting acne, rosacea and hyperpigmentation, using both an internal and external approach.

Treating Acne from the Top
In essence, acne is nothing more than a big traffic jam under the skin. When overactive sebaceous glands pump out excess sebum and a constantly shedding keratin lining clogs the skin's hair follicles, the oil and dead cells back up the pore, creating the perfect anaerobic environment for Propionibacterium acnes, a bacteria that thrives in the closed, oxygen-deprived environment of a clogged hair follicle. The result? Inflammation, blackheads and whiteheads.
To treat acne topically, the Food and Drug Administration (FDA) recognizes four over-the-counter (OTC) drug treatments for acne − benzoyl peroxide, salicylic acid, sulfur and resorcinol − in addition to prescription medicines, which include antibiotics, azelaic acid and tretinoin (vitamin A).
Benzoyl Peroxide (BPO): A common ingredient used to treat mild to moderate acne, benzoyl peroxide has been well documented in treating acne either alone or in combination with other topical medications. BPO reduces inflammatory lesions by introducing oxygen into the clogged pore where the anaerobic P. acnes bacteria harbor. BPO also helps reduce oil production, rid the follicle of excess dead skin cells and unclog pores. Unlike some other antibacterial treatments, multiple studies show that P. acnes does not manifest a resistance to BPO.1 However, this topical ingredient can sometimes irritate skin, especially when used at a higher percentage of 10 percent versus a two and a half or five percent level. Clinical studies have shown that lower concentrations are just as effective as higher concentrations and with less irritation.2
Salicylic Acid: Derived from the same substance used in aspirin, salicylic acid unclogs pores, increases cell turnover and neutralizes bacteria, all of which make this OTC active a popular and effective acne treatment. As an OTC active ingredient, salicylic acid is used in concentrations of 0.5 to two percent.
Sulfur: One of the oldest acne treatments, sulfur helps clear comedones and is found in both OTC and prescription remedies. On the downside, sulfur can cause dryness and irritation and has a pungent odor.
Resorcinol: Often used in combination with sulfur, resorcinol helps break down rough skin, making it useful for treating blackheads and whiteheads. But, like sulfur, resorcinol also has a drying, irritating side and so should be used in moderation.
There are many additional blemish-clearing topicals that, while are not classified as OTC drug treatments specifically, can have a big impact on breakouts. Vitamin A derivatives known as retinoids, namely retinol, help by ensuring proper cell division, clear plugged pores and minimize oil glands. According to the Mayo Clinic, the irregular shedding of skin cells serves as a leading cause of acne. Retinoids help correct this problem by normalizing the shedding of the skin cells, while helping reduce inflammation.
Azelaic acid also offsets inflammation associated with acne by reducing the P. acnes bacteria and clearing pores. The Mayo Clinic reports that a 20 percent azelaic acid cream seems to work as well as other conventional acne treatments, including five percent benzoyl peroxide and oral tetracycline.
Natural acne remedies include gels containing the natural anti-microbial tea tree oil, the anti-inflammatory boswellin extract and sea buckthorn oil.

The Acne Food Connection
Many foods, like pizza, chocolate and French fries, were once villainized as causing acne but have been since exonerated by today's acne experts. A few foods, however, may be better left out of the diet or at least kept to a minimum, while others still demonstrate the ability to stave off breakouts.
Dairy Products: One food connection that has gained lots of attention is cow's milk, which is produced when pregnant cows pass on high levels of hormones into the dairy products we drink and eat. The theory is that these hormones "turn on" the oil glands in humans, causing them to over-secrete sebum, which then mixes with the shedding keratin cells in the hair follicles, creating a plugged pore or pimple. The rationale is that the hormones responsible for causing an overproduction of sebum and "lining cells" come from three sources: androgens (or sex hormones), the adrenal glands, and dairy products.
The acne and milk connection is a theory embraced by many experts, including Dr. C.A. Adebamowo, who published an article on the subject in the Journal of the American Academy of Dermatology in 2005 and has posted his work on www.acnemilk.com. This website, also co-authored by several physicians, including the head of the Harvard School of Public Health's School of Nutrition, advises acne sufferers to stop consuming all milk and other dairy products or find dairy- like substitutes.
Refined Carbohydrates: Another hypothesis links refined carbohydrates as a possible contributor. One study found that native people living near the coast of Papua New Guinea and the Aché hunter-gathers of Paraguay do not have acne, which researchers attribute to their low-glycemic diets rich in fresh fruits, vegetables and lean protein. While the studies are compelling, more research is needed.
Zinc: The mineral zinc reduces the severity of acne by primarily regulating oil gland activity and reducing inflammation. Zinc is involved in the body's metabolism of testosterone, a principal hormone involved in acne formation. Some studies suggest low levels of zinc can lead to acne, according to the Mayo Clinic. Zinc also plays a role in wound healing to help prevent scarring. Common food sources include oysters, red meat, poultry beans and fortified cereal.
Selenium: Selenium helps regulate glutathione peroxidase, an enzyme critical to preventing inflammation in acne. When the body is low on this trace mineral, inflammatory conditions, including acne, can flare.
Chromium: Another trace mineral, chromium enhances the body's insulin sensitivity, which can be a key concern for acne patients who do not metabolize sugar properly.
Natural Remedies and Herbs: Some herbal remedies, such as burdock, Oregon grape, yellow dock and dandelion help detoxify and cleanse the skin from within. Bromelain serves as an anti-inflammatory, while methylsulfonylmethane (MSM) offers a natural anti-microbial. The Mayo Clinic reports that a specific strain of brewer's yeast, CBS 5926, seems to help decrease acne, though it may cause migraines and intestinal upset in some people.

Rosacea
Affecting about 14 million people in North America alone, rosacea continues to mystify researchers with a cause that is still being debated. Demodex folliculorum mites, which are found in large concentrations in rosacea patients' skin, is one prevailing theory. Others postulate that rosacea occurs when blood vessels expand too easily.
The National Institutes for Health (NIH) has funded new research into rosacea, yielding insights from Dr. Richard Gallo of the University of San Diego, who along with his colleagues, have found that some rosacea sufferers have high levels of inflammation-causing chemicals in their skin.
Often confused with acne, rosacea causes reddening of the cheeks, nose and forehead, spider-like blood vessels (telangiectasia), and sometimes pimple-like blemishes and inflamed eyes.
Although there is no known cure for rosacea, conventional treatments include antibiotics, such as doxycycline, minocycline or tetracycline. Topical anti-microbials include prescription metronidazole or azelaic acid. Without a prescription, azelaic acid can help by offering an anti-inflammatory effect. There are also vaso-endolethial growth factors (VEGF) inhibitors that help reduce telangiectasia and attenuate
skin redness.
Topical treatments based on herbs like magnolia and astragalus root may also have some inhibitory effect by reducing redness and supporting the skin's immunity system.
One study involving 246 rosacea patients found that a cream containing an extract of Chrysanthellum indicum significantly improved facial redness compared to placebo. Researchers theorize that the compounds in the extract strengthen the skin's capillaries.
Another study, presented as an abstract at the 2005 American Academy of Dermatology annual meeting, found evidence that a green tea cream may help ameliorate red bumps and pustules associated with rosacea.
Often used to improve the skin barrier and reduce inflammation, niacinamide (B3) improved the skin barrier in a small study of 50 participants.3 Researchers are exploring the B3 vitamin as an oral rosacea treatment as well.
Licorice is another useful ingredient to add to your rosacea treatments for its anti-inflammatory properties.
As with acne, azelaic acid slows the growth of bacteria in rosacea patients and appears to demonstrate efficacy in reducing redness, papules and pustules in rosacea patients. A University of British Columbia study found that an azelaic acid 20 percent cream proved comparable to a topical metronidazole 0.75 percent cream in reducing papules and pustules in rosacea skin. Azelaic acid also appears to have a slight edge over the prescription in reducing redness. As a bonus, azelaic acid has some skin-lightening properties (see below).

Foods in the Red
Like acne, food choices can affect rosacea symptoms but, in this case, the choices are more about what not to eat. Spicy foods, hot beverages and alcohol are some of the biggest triggers of rosacea symptoms. The theory is that these foods may cause the release of chemicals that dilate blood vessels, which lead to the common flushing response.
Conversely, one food that may help the condition is apple cider vinegar, which is thought to stimulate digestive enzymes that help normalize the bacteria in the intestines. Nevertheless, it is best to consult a health practitioner first before introducing apple cider vinegar into the diet as some reports link at least the tablets to esophageal injury.
In addition, a 2008 study by Italian researchers in the Journal of Cosmetic Dermatology reported that silymarin from milk thistle eased rosacea symptoms.4

Hyperpigmentation
The global skin-lightening market is estimated to reach $10 billion by 2015, according to Global Industry Analysts (GIA). Today's brighteners are sought by a world population looking to lighten darker skin tones, as well as counter hyperpigmentation induced by sun exposure and hormonal changes. Tyrosinase inhibitors, such as vitamin C, arbutin, kojic acid and mulberry, have been favored for their ability to inhibit melanin by targeting the tyrosinase enzyme, which converts the amino acid phenylalanine into the melanin precursors.
Chromabright, a newer treatment comprised of a synthetic molecule, has exhibited significant brightening properties in in vivo clinical trials by demonstrating melanin inhibition on par with hydroquinone, an effective yet controversial skin lightener with potential side effects. Chromabright also helps prevent UV-induced skin damage.
In addition, some whitening peptides have demonstrated tyrosinase-inhibiting activity by affecting the proteins in the tyrosinase enzyme.
In 15 to 20 percent concentrations, azelaic acid as a melanin inhibitor may be as effective as hydroquinone yet without the irritation, according to some studies.
Glutathione works a little differently than mainstay tyrosinase inhibitors. Instead, this natural tripeptide competes with melanin's precursors and reduces melanin's ability to
develop pigment.
In addition, hexylresorcinol offers not only skin brightening benefits, but may also increase UV protection and minimize the appearance of fine lines and wrinkles.
Effective topical vitamins include niacinamide and several forms of vitamin C, including L-ascorbic acid, magnesium ascorbyl phosphate (MAP), and tetrahexyldecyl ascorbate, an oil-soluble version.
In addition to having a direct skin-lightening effect, vitamin C can help protect against sun damage by neutralizing free radicals that contribute to hyperpigmentation. Studies have shown that vitamins C and E in combination can improve the efficacy of sunscreen.
A great all-around skin vitamin, vitamin A helps pigmentation problems by treating slight discolorations and evening skin tone. Vitamin A can be taken orally as well as applied topically in the form of a retinol cream or other retinoid.

Foods That Can Change the Tone
Interestingly, psoralens (furocoumarin compounds), a common remedy used to treat vitilago, a skin disorder resulting from lack of pigmentation, has demonstrated an ability to absorb radiant energy and stimulate pigment when photoactivated in the presence of UVA or UVB. When certain psoralen-containing foods, such as parsnips, limes, parsley and celery come into contact with the skin, they can augment the effects of sun exposure and increase the risk of age spots.
Eating these foods will not have the same effect as handling them with the skin, and, according to a 2009 study, pre-treating the skin with psoralens may have a protective effect against UVB by stimulating production of naturally protective flavonoids and carotenoids.5
On the other hand, eating a diet rich in fruits and vegetables might help prevent UV-induced hyperpigmentation by protecting skin with antioxidants. Good examples include berries, kiwi, grapefruit, kale and spinach.
By understanding the effects nutrients and topicals can have on the skin, we can speed results and work in a more positive direction toward treatment.

References:
1 J Clin Aesthet Dermatol, 2008, Nov. 1(4): 48-51
2 Int J Dermatol, 1986 Dec; 25 (10): 664-7
3 Cutis, 2005 76(2); 135-41
4 Journal of Cosmetic Dermatol, Vol. 7, Issue 1, March 2008
5 Ecotoxicol Environ Saf, 2009, 72 (4): 1129-36. Epub 2009 Feb 1

Sam Dhatt was born and raised in India, and from the time of his youth, he pursued his passion for chemistry and invention. His education, therefore, involved years of hard work and dedication, achieving a MS in Chemistry and an MBA in Marketing and Finance. Dhatt's introduction as a leader in innovative technology begins with his work in 1992 with alpha hydroxy acids, which was in its infancy at the time. AHA's are now one of the most popular ingredients found in skincare products today. Then in 1995, he started his own cosmetics research and development company, Allure Cosmetics, Inc., which is especially known in the skin care industry as the leader in creating innovative anti-aging products. In addition, Allure Cosmetics, Inc. also supplies hair care, foot care, spa products, cosmetic accessories and makeup to their 700 clients worldwide. However, his drive for innovation did not stop with Allure Cosmetics, Inc. In 1999, Dhatt opened another company, DermaQuest® Skin Therapy.

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