Acne! Not just about Skin
Acne is a disease of the skin most commonly affecting both males and females between the ages of 15 - 25. It generally begins during puberty, however acne can also occur in adulthood and be triggered by such things as hormones, genetics, digestion and stress. Acne can appear on the skin in the form of blackheads, whiteheads, papule, pustule and cysts which may not just affect the appearance; it can also have an impact on quality of life.
What is acne?
Acne is a result of blocked pores in the skin. The skin produces sebum (oil), which keeps the skin moisturized and acts as a protective barrier against pathogenic bacteria. Infection can occur from excess commensal bacteria, pathogenic bacteria and fungus.
Acne can appear on the face, neck and trunk (chest and back) and be classified as mild acne (whiteheads and blackheads), moderate (inflamed papules) and severe (cystic acne). Acne sufferers may feel embarrassment and suffer from low self-esteem.
Triggering factors for acne development
Acne can be triggered by many factors such as hormonal imbalances, stress, diet, genetics and lifestyle. In most cases, it is irregularities in the hormonal system (such as at puberty and menopause) which result in an excess production of sebum and it is this sebum which causes blocked pores.
The skin microbiome
Propionibacterium acnes (P. acnes) is a commensal skin bacterium - a bacteria which normally resides on human skin, but in excess P. acnes has been associated with the progression of acne.
Hormones
Hormonal imbalances are the most common reason for acne. Adolescents tend to have higher levels of androgens (male hormone) due to the maturation of sexual development, making them more susceptible to acne. While it is easy to predict in teens, adults can also suffer from acne. Women are more prone due to hormonal fluctuations which occur during the menstrual cycle, conditions such as polycystic ovarian disease, the use of contraception and at menopause.
Digestive health
There is enough supportive evidence to suggest that gut microbes and the integrity of the gastrointestinal tract are contributing factors in the acne process, its development and severity. When digestive health is compromised it can lead to inflammation, oxidative stress, dysregulated glycaemic control, tissue lipid content and also have an influence on mood.
Commensal microorganisms on the human skin microbiome (friendly bacteria) help fight pathogens and maintain skin homeostasis (balance). One such bacteria, Staphylococcus epidermidis (S. epidermidis) can mediate fermentation of glycerol, which is naturally produced in skin, and can reduce the growth of P. acnes.
Stress
Stress can not only influence digestive health, but also the hormonal system, resulting in hormone changes. Stress can come from many areas of life. Pressure from work and school, financial problems, personal crises and relationship breakdowns are common causes of stress.
Genetics
Genetics have been implicated in acne, with certain genes being associated with a predisposition to its development.
Diet
Probably the most controversial factor often causing debate among healthcare professionals, media and support groups is the effect of diet to acne development. Some people claim that eating certain foods worsen acne or may even contribute to its development. However, such claims have little to no solid evidence.
Research has shown some diets can result in an improvement in skin appearance, such as a low GI (glycaemic index) diet. A low GI diet focuses on eating protein-rich foods such as meat, fish, eggs, milk, nuts and particular whole fruits and vegetables, which results in a slower release of sugar into the body.
A healthy body is generally influenced by a balanced diet rich in fresh wholesome foods eaten regularly.
Lifestyle
An active lifestyle is good for health. Exercise reduces stress and helps with glycaemic control, whilst physical inactivity may cause an increase in insulin.
Other contributing factors
Other contributing factors include: using oil-based cosmetics; hot and humid environments; medications such as steroids, some contraceptive medication and epilepsy treatments.
Supplementing for skin health
Probiotics
Maintaining gut and skin microbial balance is important for the prevention of bacterial infection. The probiotic, L. reuteri, may help control the growth of bacteria involved in acne and help reduce associated inflammation. Probiotics can help with gut permeability, dysbiosis, irritable bowel and constipation. Maintaining digestive microbial balance plays an important role in immunity with many areas of health. Probiotic supplements can be taken with antibiotics, just take at an alternative time, unless otherwise advised.
Zinc
Zinc and Selenium have known antioxidant affects and may be beneficial in reducing oxidative stress. Zinc levels may be related to the severity and type of acne and low zinc level may contribute to the formation of acne. Zinc is a mineral needed at times of growth and development and can often be low in adolescents. Zinc-rich foods include meat, egg yolks, oysters and sea food, whole grains, sunflower and pumpkin seeds. Selenium is found in barley, Brazil nuts, cashews, peanuts, broccoli, eggs, garlic, oysters, tuna, mackerel, crab and onions.
Magnesium
Magnesium deficiency is associated with oxidative stress, inflammatory states, premenstrual symptoms, anxiety and blood sugar irregularities. RDI for adults is 350-450mg/day. Food sources include almonds and cashews, cocoa, (this may be why you crave chocolate) eggs, kelp and leafy green vegetables.
Vitamin B6
The B group vitamins are important for many functions in the body. Vitamin B6 is of particular help with acne.
It aids neurotransmitter synthesis (brain chemicals that help with stress and happiness), supports the nervous system, reduces androgen and oestrogen response, aids detoxification, carbohydrate metabolism; is required for the synthesis of essential fatty acids metabolites and improves oxygen to the tissues. Food sources include avocado, bananas, carrot, chicken, egg yolk, fish, sunflower seeds and walnuts.
Fish oil
There is some evidence that fish oil supplementation is associated with an improvement in ratings of overall acne severity, especially for those with moderate and severe acne. Fish oil acts on prostaglandin levels in the body which help with inflammation. A suggested dose of EPA to 3–6 grams daily is recommended.
Chaste Tree
Chaste Tree (Vitex agnus Castus L) - a study has found that the chaste tree herb taken for at least 3 months resulted in improvement of both female and male patients with acne. This is believed to be due to its anti-androgenic effect. Vitex has been traditionally used for the regulation of hormonal conditions.
- Chaste Tree can interact with other hormonal drugs such as HRT, progesterone drugs or the contraceptive pill and is contraindicated in the first stage of pregnancy. Discuss with your health care provider before supplementing.
Turmeric (Curcuma longa) - the active ingredient from turmeric (curcumin) has been shown to reduce inflammatory mediators.
Tea Tree oil (Melaleuca alternifolia) essential oil used topically - has antimicrobial and anti-inflammatory properties. Use products containing tea tree to help reduce bacterial and fungal growth.
Skin CARE
A good skin care regime is beneficial for helping reduce infection. Excess sebum (oil) on the surface of the skin will attract dirt and encourage bacteria growth.
Gentle cleansing morning and night and particularly after exercise and sport.
Use a skin mask instead of aggressive exfoliants that can damage the skin surface and promote bacteria. Alternatively, if using an exfoliant, gentle pat the skin rather than scrub.
Use products suitable for your skin type that also contain antimicrobial ingredients.
Change pillow slips regularly to limit bacterial spread.
Cosmetic and cosmetic brushes can be a breeding ground for bacteria. Regularly replace products and wash brushes after use.
Avoid touching skin as much as possible.
Common prescriptions
Topical retinoids are derived mainly from Vitamin A. They are widely used to treat and prevent blackheads and whiteheads by causing the skin to peel, unblocking the pores. Using topical retinoid may have a possible side effect on pregnant women or those who suffer from skin irritation and sun sensitivity.
Antibiotics are used to reduce acne bacteria in the skin. They are to be used on mild to moderate inflammatory acne that hasn't improved from other treatments. Antibiotics are available applied directly to the skin or taken orally. Antibiotics applied on the skin contain active ingredients clindamycin or erythromycin, which have minimal irritation but takes longer to be effective. Antibiotic tablets/capsules include doxycycline, tetracycline and erythromycin and can sometimes cause upset stomach, light-headedness or dizziness. Moderate to severe acne, when not treated immediately, can leave a permanent scar. Your GP will recommend the most suitable treatment.
References
- http://www.acne.org.au/
- https://au.news.yahoo.com/thewest/lifestyle/a/31702536/solutions-to-pimples-and-adult-acne/
- http://www.healthdirect.gov.au/acne
- Skin Microflora and Bacterial Infections of the skin https://www.sciencedirect.com/science/article/pii/S0022202X15529011#:~:text=Sk
- Acne vulgaris, probiotics and the gut-brain-skin axis - back to the future? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3038963/
- Correlation between the Severity and Type of Acne Lesions with Serum Zinc Levels in Patients with Acne Vulgaris http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135093/
- Effects of fish oil supplementation on inflammatory acne http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543297/
- Effect of Lactobacillus reuteri on the proliferation of Propionibacterium acnes and Staphylococcus epidermidis http://www.ncbi.nlm.nih.gov/pubmed/22367948
- Staphylococcus epidermidis in the human skin microbiome mediates fermentation to inhibit the growth of Propionibacterium acnes: implications of probiotics in acne vulgaris http://www.ncbi.nlm.nih.gov/pubmed/24265031
- Melaleuca alternifolia (Tea Tree) Oil: a Review of Antimicrobial and Other Medicinal Properties http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1360273/
- Mills,S;Bone, K;Principles and Practices of Phytomedicine Medicine,2009,Churchill Livingstone, Sydney Aust ,p.332
- Osiecki,H;The Nutrient Bible 9th Edition, Bio concepts publishing QLD, Aust
- Sarris, J; Wardle, J; Clinical Naturopathy 2e,2014 Churchill Livingstone, Sydney Aust,Pg.529
This article is for informational purposes only and does not provide medical advice, diagnosis, or treatment. Any information published on this website or by this brand is not intended as a substitute for medical advice. If you have any concerns or questions about your health you should consult with a health professional.