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Acne-Real Causes and Treatments

Updated on March 3, 2014
Purple Falcon profile image

An experienced integrative healthcare professional & Member of the International Alliance of Holistic Therapists

Acne-What causes it?

Factors that cause acne & Treatment strategy to reduce severity of acne; Summary of Acne

All acne is principally an obstructive disease caused by the blockage of the pilo-sebaceous unit opening due to oil, debris and dead skin cells [1].

Factors that cause acne include the following [1]:

  • Sebum over-production
  • Excessively adherent and proliferative skin cells/keratinocytes
  • Bacterial overgrowth that occurs after the obstruction (bacteria associated with acne are commensals i.e. living on or within another organism, and deriving benefit without harming or benefiting the host)
  • Inflammation and in some cases the formation of pus

The sequence to acne is as follows [1]:

  • Primary overgrowth of skin cells and excessive sebum production
  • Secondary obstruction of the pilo-sebaceous unit which provides ideal growing conditions for commensal bacteria
  • Tertiary development of infection
  • Inflammatory response to infection and release of lipids into the dermis

Factors that initiate increased sebum and increased keratinisation [1]

These factors increase the risk of developing acne and are as follows:

  • Pilosebaceous unit only responds to androgens (e.g. testosterone, progesterone and dihydrotestosterone)
  • There is no biofeedback mechanism for skin oiliness and regulation of production of oil is only reliant on pressure effects
  • Anything that increases free testosterone and free dihydrotestosterone will cause increased sebum production by increasing sebocye proliferation

The following hormones if in excess can increase the risk of acne development [1]:

  • Free Testosterone
  • Both Testosterone and Dihydrotestosterone
  • Insulin;

- Insulin decreases Sex Hormone Binding Globulin levels hence increases the levels of free testosterone and dihydrotestosterone

-insulin increases in response to carbohydrates (both simple sugars and complex starches)

  • IGF-1 (Insulin Like Growth Factor) levels rise with rising Insulin

-there are IGF-1 receptors in keratinocytes and sebocytes

-IGF-1 stimulates growth of sebocytes, thus increases sebum production

-IGF-1 stimulates keratinocyte growth

-IGF-1 stimulates synthesis of androgens in testes and ovaries

-IGF-1 makes the sebocytes more responsive to androgens

-free IGF-1 is also a potent mitogen for virtually all body tissues and promotes acne through kertanization and can also cause other diseases like diabetes and cancer

-IGF-1 causes normal loose keratinisation to change to dense kertainisation

Excess Sebum Production Causing Acne[1]

  • Due to increased androgens during puberty
  • Androgens come from adrenals andgonads and may also be synthesised within the pilo-sebaceous unit itself
  • Oxidation of sebum lipids activate inflammatory mediators such as interleukins and lipooxygenases
  • Oxidation can also stimulate hyperproliferation of kertaniocytes and comedone formation

Pathophysiology of Acne [1]

  • Acne is an obstructive disease involving occlusion of the ostium of a hair follicle
  • Genetic predisposition seems to be important however lifestyle changes can help shift this predisposition to acne to a decreased risk of getting it
  • Aggravating factors include diet, clothing, skin care products, personal habits and stress

Aggravating Factors

Aggravating Factors to Acne [1]:

  • Personal habits/environment
  • Excessive sweat, high humidity, tropics
  • Excessive scrubbing of skin (friction) and increasing TEWL (Trans Epidermal Water Loss); Gentle exfoliation is beneficial
  • Pollution, Oils, Picking, Squeezing pimples
  • Oil, Greases (check Occupation)
  • Detergents and Soaps-high pH diminishes effectiveness of Chymotryptic enzyme
  • Occlusive clothing (e.g. turtlenecks, bra straps, baseball caps); acne mechanica

  • Cosmetics
  • Some skin care ingredients are comedogenic
  • Any cream contains oils of some sort thay may be comedogenic
  • All ointments are comedogenic (e.g. Vaseline)
  • Water based and alcohol-based products are generally safe
  • Mineral based powders are generally safe (loose powders applied with a brush are better than compact powders)

  • Genetics
  • Twins Study 2002 suggested that Genetic predisposition seems to be important however lifestyle changes can help shift this predisposition to acne to a decreased risk of getting it

  • Drugs/Medications
  • Steroids, Biphasic oral contraceptives or Progestogen only
  • Anticonvulsives especially Dilantin, Anti-TB drugs, Imuran and Anti-thyroid drugs such as Thiouracil

  • Stress
  • Stress causes increased release of cortisol from the adrenal cortex
  • Cortisol is metabolised in the same way as androgens which can lead to higher levels of testosterone
  • There’s also some suggestion that sebocytes may have cortisol receptors

  • Extrinsic Influences
  • Friction and manipulation
  • Occlusive products
  • Close-fitting sports equipment
  • Medications (steroids, antiepileptics and Progestin only contraceptives)
  • Progestin only contraceptives

Treatment Strategy to reduce the severity of Acne [1]:

  • Common Full treatment For Women
  • Cleanse with an allmedic cleanser in the morning
  • Apply allmedic lotion in the morning
  • Use alcohol based sunscreen as needed in the morning
  • Apply Epiduo once at night (Adapalene which has a kertaolytic effect on follicular ostium and BPO which is bactericidal) after scrub
  • Bactrim DS 2 tablets daily
  • Yasmin oral contracepticve
  • Consider using Aldactone 100-200mg daily (anti-androgen)

  • Common Full treatment For Men
  • Cleanse with an allmedic cleanser in the morning
  • Shave as needed with high quality razor using cleanser
  • Apply allmedic lotion in the morning
  • Use alcohol based sunscreen as needed in the morning
  • Use allmedic scrub at night
  • Apply Epiduo after scrub
  • Bactrim DS two per day
  • No hormonal manipulation; however some evidence suggest that 5-Alpha reductase inhibitor e.g. finasteride which is used in male pattern baldness may be useful in male acne)

  • Acne Management in Pregnancy [1]:
  • Avoid all sorts of Vitamin A products (use of retinoid like topicals including Adapalene is not recommended)
  • Use of tetracycline antibiotics specifically not recommended (stains the teeth)
  • Use of hormonal manipulation is contraindicated
  • Photodynamic therapy should generally not be used in pregnancy (unknown side effects and risk of miscarriage)
  • Skin care containing AHAs and BHAs can be used throughout pregnancy
  • Microdermabrasion, AHA and BHA based peels can be safely used
  • Bactrim DS is okay to use in the first and second trimester provided that the patient is on Folic Acid supplements
  • Allclear lotion from allmedic is safe to use in pregnancy
  • Benzoyl peroxide is safe to use in pregnancy

Other treatments:

-Blue Red light therapy

-TCM therapy addressing excess heat, dampness, wind and heat in lungs, dampness and heat of the spleen and stomach, stagnation of qi, blood stasis and phlegm accumulation as well as menstrual disorder syndromes

  • Dietary and Lifestyle Factors [1]
  • Avoid or minimise milk intake and dairy products from pregnant cows as this exposes us to the hormones produced by the cow’s pregnancy and we are not designed to consume these in our adult years
  • Data indicates that a low glycaemic load diet comprising of high levels of protein and low GI foods significantly decreased the mean number of facial lesions and alleviate the severity of acne lesions
  • Restrict intake of refined carbohydrates
  • Some nutrients to assist with the treatment of acne include:

*Increasing Omega 3 and 7, Potassium, Pyridoxine (B6), Vitamin A (shark oil is best), B3 , Selenium 400mcg daily combined with 20IU of Vitamin E and Zinc. Monitor hydrochloric acid levels as these are often low. Increase folate.

  • Decrease or eliminate food sensitivities and triggers such as Almonds, Malt, Refined carbohydrates, Inorganic iron, HRT, and test for B12 levels
  • Address leaky gut syndrome which Is basically due to inflammation of the gut lining (usual causes include antibiotics, alcohol and caffeine, foods and drinks contaminated by parasites like giardia lamblia, cryptosporidium, blastocystis homninis etc, foods and drinks contaminated by hel;icobacter pylori, lebsiella, citrobacter, pseudomonas and others)
  • Consuming a Paleolithic/the hunter gatherer diet (which comprises of fruits, vegetables, nuts, seeds, wild meats and enriched consumption of vegetables and fish with reduced intake of sugar, hyperglycaemic grains, milk and milk products) as prevention and management. This diet attenuates increased mTORC1 activity.
  • Herbal treatments for Acne : Burdock root, Witch Hazel and Fruit acids (e.g. gluconolactone has been beneficial in acne treatment by reducing number of lesions like benzoyl peroxide but with fewer side effects)
  • Guggulipid treatment proven more beneficial in reducing inflammatory lesions compared to tetracycline (both given twice daily for 3 months)
  • Reduce Chocolate intake as it is hypothesised that chocolate may exacerbate acne by production of more comedogenic sebum, increases blood lipid levels/produce less fluid sebum which lead to greater obstruction of pilosebaceous follicles and secondary inflammatory changes. This may also be due to hyperinsulinaemia and changes in the HPA axis


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    • Purple Falcon profile image

      Nat Holistic Health Professional IAHT IANLPC 3 years ago from Australia

      Thanks Jasmeetk! Happy to help and thanks for your appreciation!

    • Jasmeetk profile image

      Jasmeet Kaur 4 years ago from India

      very informative hub!! thanks for sharing!!