Acne

 

Acne

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Acne, also called acne vulgaris or acne conglobata, is an inflammatory disorder of the pilosebacous, or sweat, glands. The disease is caused by an increase in both keratin and sebum (oil) production within the gland.

Acne Factors: Hormones, allergens, friction from garments, excessive cleaning, bacteria, skin irritation, and excessive picking are among the many factors that contribute to the onset and severity of acne. Acne can be superficial—blackheads and whiteheads. It may also be deep, characterized by pustules and cysts. Acne is worst when bacteria are involved with excessive picking; a habitual process which often leads to life long scarring. [1]

Acne affects 85% of individuals between the ages of 12 and 24. [2] It commonly begins during puberty as a result of the increased hormone production. Androgens (testosterone) are the primary hormones that affect acne by causing increased sebum production. [3]

In the majority of cases, acne usually resolves by the 3rd decade of life. It does, however, have a guided misconception in older adults. Persons in this age demographic generally view the condition as a “disease” of adolescents and young adults. Many older adults fail to realize that it can affect them well into their 40’s and 50’s. [4]

Acne Symptoms

Acne is the most common of all skin problems/disorders. The lesions are mainly on the face, but can also present on the back, shoulders, and chest. There are several different types of lesions.

  • Open comedones - called blackheads; these are enlarged follicles filled with dark plugs
  • Closed comedones - often referred to as whiteheads if no inflammation is present; called papules if inflammation (redness) is present
  • Nodules - deep collections of pus in the dermis (layer under skin) with no opening or ‘head’
  • Cysts - nodules that fail to discharge the pus
  • Large deep pustules - nodules which have caused breakdown of adjacent tissue [5]

Acne is usually worse in the winter and better in the summer. This is believed to be a result of the sunlight drying out the surface of the skin. In addition, It can cycle with the menses and often will get better or worse with pregnancy.[6]

Conventional Acne Treatment

Conventional treatment of acne is largely dependent on topical and oral treatments with antibiotics and/or retinoic acid. Topical antibiotics, such as clindamycin and erythromycin, are effective against superficial forms of acne. Benzoyl peroxide is another commonly used topical agent for acne prevention as well. It can be found over-the-counter in a 5% solution or prescribed by a doctor in stronger solutions.

Oral antibiotics such as tetracycline are effective against the more severe, or deeper forms of acne. Retinoic acid can be applied topically or given orally in the form of isotretinoin. There are side effects associated with both the long term use of antibiotics and retinoic acid. [7]

Supplements helpful for Acne Treatment

Herbal Acne Treatments:

Melaleuca alternifolia (tea tree oil) and Ocimum gratissiumum (basil species) are two herbal supplements that have been affective in the topical treatment of acne.

  • Tea tree oil - The oil is harvested from the leaves of a native tree species in Australia. The oil has certain antiseptic properties and is effective in combating a wide range of organisms, including most of the natural skin bacterium that contribute to severe acne. Tea tree oil also exhibits antifungal properties and is used as an astringent. A 5% tea tree oil concentration is best effective against superficial forms of acne, and concentrations of 15% may be used for deep acne. [8]

Studies have shown that tea tree oil solution is effective at the concentration of 5%. Research indicated that it may even be as effective as 5% benzoyl peroxide; though the study found that the tea tree oil was slower than benzoyl peroxide in showing positive results. However, the study group did report a lower frequency of skin discomfort with the tea tree oil in comparison to the benzoyl peroxide preparation. [9] In another study, tea tree oil was shown to be equally effective at reducing inflammation caused by histamine release in the skin.[10] This study indicates that tea tree oil could be useful for reducing the redness caused from extraction of the comedones or nodules.

  • Oil of Basil - Another topical herbal preparation that is useful for the treatment of acne, oil of basil has similar properties to preparations containing tea tree oils. Interestingly, it is often effective in a lesser percentage solution - 2% and 5% concentrations. In one particular study, oil of basil was shown to be significantly more effective than 5% benzoyl peroxide. However, the 5% solution of ocimum (basil) was too irritating to use regularly on the skin. [11]

Supplements for Acne Treatment:

Vitamin A

Vitamin A is essential for the treatment of acne. Retinol, a bioactive component of Vitamin A, reduces sebum and keratin production from the sweat glands. In clinical application, this water-soluble vitamin has proved effective in treating acne at an oral dose of 150,000-400,000 IU per day. However, it is important to note that doses ingested in this elevated range are considered toxic and should only be taken under a physician’s care. When females supplement with Vitamin A, it is important to avoid higher dosages if there is possibility of pregnancy. Vitamin A is harmful to the unborn fetus.

Vitamin A is also a very potent anti-oxidant and possesses anti-inflammatory properties. One aspect of the inflammatory process of acne is the presence of reactive oxygen species (ROS) on the surface of the skin. The high amount of daily sunlight exposure to the face may cause high levels of ROS, leading to lipid peroxidation of the sebum and other natural oils found in the skin. Via antioxidant activity, Vitamin A decreases the levels of ROS on the surface of the skin, thereby supporting a decrease in inflammation. [13]

Azelaic acid

Azelaic acid is a naturally occurring antibiotic. It is primarily dispensed in a 20% cream. It has been found to be as effective as benzoyl peroxide, erythromycin, tetracycline, and tretinoin. The only conventional treatment proven to be more effective is oral isotretinoin, though azelaic acid has fewer side effects and produces little or no irritation and toxicity to the body. [14, 15] It is most effective when applied to the affected area for one week. This initial dosing phase is then increased to twice daily for 2-3 months. Azelaic acid treatments may be used for up to one year.

Vitamin B3 (niacin, nicotinamide, niacinamide, NADH)

Vitamin B3 has been shown to be a legitimate treatment for acne. As an effective antioxidant, it is protective to the cell membrane and prevents cellular breakdown by free radicals and lipid peroxidation. In one study, the B vitamin coenzyme NADH was used in a 1% concentration added to Vaseline. [16] Other studies, highlighting different B-complex vitamins, have researched their effectiveness at treating inflammatory acne as well. When applied to the affected area twice daily in a 4% cream, niacinamide was shown to be as effective as topical clindamycin for treating various forms of acne. [17]

Vitamin B6 (pyridoxine)

Vitamin B6 is involved in hormone metabolism in the body. A deficiency of Vitamin B6 can lead to an increase in uptake of androgens, as well as increased skin sensitivity. Vitamin B6 is effective at improving the metabolism and excretion of androgens and other steroid hormones from the body. [18] Several studies on women who suffer from premenstrual ‘flare-ups’ of acne have shown that Vitamin B6 can effectively reduce the occurrence and severity of the flare-up. The dosage employed in study was 50 - 200 mg/day, this is the recommended dosage and can be taken over the duration of the cycle. [19]

Zinc

Zinc is an important mineral and aids in retinol metabolism in the body. It also supports tissue regeneration and wound healing. Zinc is an important co-factor for many biochemical processes in the body; existing as an integral component of immune system function. It is equally essential for healthy skin. [20]

One study showed that 30mg of elemental zinc, given 1-2 times daily for 3 months, had a 31.2% cure rate when compared with the wide spectrum antibiotic monocycline; which had a 63.4% cure rate. These results proved significant. There was a 2/3 reduction in lesions and fewer side effects reported within the zinc group than the group taking monocyline. [21] After the initial treatment and resolution, a lower dose can be given for maintenance.

Green Tea

Centella asiatica, green tea, is a very potent anti-oxidant. Particular constituents of green tea, catechins, are well known for there anti-oxidant capabilities. A recent study discovered that catechins are also capable of modulating the production and action of androgens. [12] This aspect makes green tea an effective treatment for acne when the cause is hormonal imbalance.

Acne References

[1] Beers M and Berkow R. 2004 Merck Manual 17th Ed. Chapter 116.

[2] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml. Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 30, 2004.

[3] Beers M and Berkow R. 2004 Merck Manual 17th Ed. Chapter 116.

[4] http://www.pdrhealth.com/drug_info/nmdrugprofiles/herbaldrugs/101840.shtml. Acne. National Institute of Arthritis and Musculoskeletal and Skin Diseases. September 30, 2004.

[5] Pizzorno J, Murray M, and Joiner-Bey H. Clinician’s Handbook of Natural Medicine. Pp1-5. 2002 Churchill Livingstone New York.

[6] Beers M and Berkow R. 2004 Merck Manual 17th Ed. Chapter 116.

[7] Beers M and Berkow R. 2004 Merck Manual 17th Ed. Chapter 116.

[8] Pizzorno J, Murray M, and Joiner-Bey H. Clinician’s Handbook of Natural Medicine. Pp1-5. 2002 Churchill Livingstone New York.

[9] Martin K and Ernst E. Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials. J Antimicrobial Chemo. 2003; 51: 241-246.

[10] Koh KJ et al. Tea tree oil reduces histamine-induced skin inflammation. Br J Dermatol. 2002 Dec; 147(6):1212-1217.

[11] Martin K and Ernst E. Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials. J Antimicrobial Chemo. 2003; 51: 241-246.

[12] Liao S. The medicinal actions of androgens and green tea epigallocatechin gallate. Hong Kong Medical Journal. 2001 Dec; 7(4): 369-375.

[13] Briganti S and Picardo M. Antioxidant activity, lipid peroxidation, and skin diseases: what’s new? J Euro Acad Dermatol Venereol. 2003 Nov; 17(6): 663-669.

[14] Pizzorno J, Murray M, and Joiner-Bey H. Clinician’s Handbook of Natural Medicine. Pp1-5. 2002 Churchill Livingstone New York.

[15] Krautheim A and Gollnick HP. Topical treatment in acne: current status and future aspects. Dermatology 2003; 206(1): 29-36.

[16] Wozniacka A et al. Topical application of NADH for the treatment of rosacea and contact dermatitis. Clin Exp Dermatol. 2003 Jan; 28(1): 61-63.

[17] Gaby A. Nutritional Protocols. 2001 Nutrition Seminars. P84.

[18] Pizzorno J, Murray M, and Joiner-Bey H. Clinician’s Handbook of Natural Medicine. Pp1-5. 2002 Churchill Livingstone New York.

[19] Gaby A. Nutritional Protocols. 2001 Nutrition Seminars. P84.

[20] Pizzorno J, Murray M, and Joiner-Bey H. Clinician’s Handbook of Natural Medicine. Pp1-5. 2002 Churchill Livingstone New York.

[21] Dreno B et al. Multicenter randomized comparative double-blind controlled clinical trial of the safety and efficacy of zinc gluconate versus monocyline. Dermatology. 2003; 203(2): 135-140.