Most people have experienced acne. For some it is merely an occasional nuisance while others find it to be a seriously embarrassing and frustrating issue that seems to defy all logical treatment. And for a few it can leave emotional scars that are more than just skin deep. Successful acne treatment requires getting to the root cause of the acne and fixing it at the source. We need to address issues with skin turnover, bacteria and fungal infections, inflammation and hormone imbalances. And yes … diet, stress, and sleep also play a role.
Acne is the result of clogged oil glands in the surface layer of skin, with or without inflammation and infection. The oil glands secrete a waxy oil called sebum and can become plugged, leading to whiteheads, blackheads, and eventually red, inflamed and infected pustules or boils. The boils can be severe enough to damage underlying collagen layers leading to scarring.
The simplest form of acne is caused when the oil glands are plugged by the normal outer layer of dead skin, called keratin. Certain hormones increase oil production while inflammation or infections are often driving forces for acne.
Topical Acne Treatment
Good skin care involves twice daily washing, moisturizing, and sun protection. We recommend cleansers that gently and effectively rejuvenate the skin by dissolving surface oil, bacteria and impurities without harmful over drying, leaving your skin feeling fresh and clean. A good moisturizer should be oil free and provide nutrients that encourage healthy skin. By combining a sunscreen with moisturizer it makes for a very simple step in your daily regimen. We recommend medical-grade product lines for basic skin care with outstanding results.
When it comes to make-up, avoid heavy, pore-clogging, high-fragrance foundations. We suggest mineral make-up, which does not clog pores.
Control of acne requires an effective and convenient way to control sebum production and gently exfoliate dead skin cells. This can be done with daily topical treatments, such as glycolic and salicylic acid topicals, retinoids, and fruit peels. A photosensitizing chemical peel called Levulan is great for the most resistant cases. Microdermabrasion can be very helpful in preventing keratin build-up, but it can worsen acne during a flare up. Manually removing sebum-plugs from clogged pores by extraction is an essential part of a comprehensive regimen and should be done by an experienced esthetician.
Internal Acne Treatment
For many people acne is a sign of underlying inflammation or problems with the immune system as a whole. Everything from diet, stress, poor sleep, infections and allergies might be playing a role in acne due to inflammation.
Certain foods cause acne due to the effects on various hormones in the body that deal with inflammation. High sugar and high glycemic diets will cause spikes in insulin and with it our stress hormone cortisol will rise. Cortisol will directly stimulate the sebum glands and cause acne. Too much saturated fat in the diet will cause inflammation and high cortisol. Stress and lack of sleep will both cause high cortisol, and again, this can lead to more acne.
Conditions such as delayed food allergies or “leaky gut” can cause acne due to the resulting inflammation and increased cortisol hormone production. We see numerous cases where acne just disappears as patients eliminate certain foods they are allergic to such as gluten or dairy products. It takes week to months for inflammation from delayed food allergies to resolve, and it takes a targeted treatment plan to heal leaky gut, so patience and knowledgeable help are usually required.
Underlying infections in the gut or bloodstream, such as the yeast Candida, can cause inflammation and acne. The “good” bacteria in the body, especially in the gut, play a big role in keeping the immune system strong and helping to keep “bad” microbes and inflammation under control. When the immune system is weakened it allows the otherwise harmless microbes to take over — and this can happen in the skin. The beneficial bacteria in the gut also play a role in removing toxins and excess hormones from the body, both of which may help acne.
The skin is often a tell-tale sign of an underlying hormone imbalance. Similar to cortisol, the androgens or “male hormones” such as DHEA, Testosterone, and its byproduct DHT, all increase oil production in the skin and stimulate hair growth. When the androgens are in excess relative to the “female hormones” such as estrogen and progesterone then the skin can become oily, hairy, or both.
Women commonly have pre-menstrual breakouts due to hormone imbalances. During and after menopause many women experience a flare up of acne not seen since their teens or at all due to the falling levels of estrogen and progesterone. Other hormonal conditions such as low thyroid and polycystic ovarian syndrome can affect the skin. A hormone analysis is a very important step in acne treatment and correction of hormone imbalances will improve skin and overall health.
A crucial part of successful acne treatment is to understand the role of infection. “Propionibacterium Acnes” is a common bacteria that inhabits oil glands, causing a worsening of the size and inflammation of plugged glands. Once acne moves beyond whiteheads or blackheads into pustules or boils then additional treatment for infection is indicated. For milder cases, prescription topical antibiotics often work well. For more intensive infections systemic antibiotics are helpful. Specialized blue light therapy effectively kills the P. Acnes bacteria, without the side effects and risk of antibiotics.
Finally, we have very good success using a type of immunotherapy call Low Dose Immunotherapy, essentially turning off an immune attack on bacteria or fungii that reside in the skin. This a very inexpensive and amazing treatment that has helps many of our patients with stubborn acne.
For really tough cystic lesions injections we may inject about with Triamcinolone 2.5mg/mL and Lincomycin 75mg/mL to “cool off” the inflammation and infection. About 0.1mL in 1cm cyst does the trick. Accutane is another last resort medication that reduces sebum production and levels of P Acne bacteria. Both treatments carry higher risks but are usually very successful.
An integrated medical-aesthetic approach is the “cure” for difficult to treat acne. At our clinic, Bellezza Laser Aesthetics, we specialize in acne treatment by addressing the skin directly while evaluating the whole person beneath. Proper skin care and aesthetic procedures can do wonders for reducing acne and improving skin health, but it usually requires working on medical or lifestyle issues to really get at the root cause of acne.
Scott Rollins, MD, is Board Certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement for men and women, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado (www.imcwc.com) and Bellezza Laser Aesthetics (www.bellezzalaser.com). Call (970) 245-6911 for an appointment or more information.