Acne is common among adolescents and young adults, usually starting between ages 12-14 and peaking between the ages 16-19. Although acne generally disappears once puberty and growth are over, it may persist into adulthood and may be exacerbated in the premenstrual phase. Diet is critical for skin health.
Rosacea is a condition related to acne but generally occurring in middle aged people. Mild forms initially may present as redness over the face with visible spidery blood vessels. More advanced forms involve pimples, pustules, nodules, and even swelling of the nose (rhinophyma).
One type of Rosacea, "Perioral dermatitis", is more common in women often erupting around the mouth and nose. Lesions manifest as pinpoint papules and/or small blisters (vesicles). Another more serious type of acne, "Hidradenitis suppurativa", is associated with deeper cystic lesions occurring in the axilla, groin, under the female breast and anogenital areas. There are many other types and locations of acne. These few are offered here just as an introduction.
Chinese and Western Recommendations
Chinese Medicine views acne as an imbalance in which excess heat, damp, toxins and/or blood stasis are manifested in the skin. Acne is treated with dietary modifications correlating to Western biomedical diet recommendations. Acne is an inflammatory process of the “pilosebaceous unit of the skin” which includes the hair follicle and associated sebaceous glands.
The formation of acne is caused by complex interactions between hormones increased during stress (cortisols and catecholamines), menstrual cyclic increases of androgens, keratin producing cells, sebum and bacteria. Dietary factors which affect the overall health of the body ultimately result in better skin health. Research evaluating molecular chemical processes occurring in normal skin uncovered the interaction of trace elements (chromium, zinc, selenium), vitamins (B 6, D,C, A, beta carotenes), amino acids and essential fatty acids in maintaining skin integrity. An imbalance in natural functioning of the pilosebaceous unit can result in inflammation with the formation of acne lesions. Reducing inflammation on a cellular level may be helpful in preventing acne. Potentially useful substances include anti-oxidants, essential fatty acids, and amino acids in quality protein sources. Below you'll find a few simple recommendations.
Maintain a diet with a preference for unrefined whole foods. Avoid simple carbohydrates which elevate blood sugar levels quickly, often leading to lack of satiety and ongoing hunger. Foods with high glycemic index contribute to heat and dampness in the body, worsening acne.
Maintain good hydration. Drink plenty of water - at least 1 ½ quarts a day in additional to other beverages. Ideally, drink non chlorinated water sources when possible. Drinking water at room temperature is preferred which maintains temperature balance in the stomach.
Avoid constipation which contributes to a “backing up” of wastes and potentially toxic end products of digestion. Eat a high fiber diet keeping the digestive processes moving smooth and regular. Magnesium in the diet at 300-600mg per day helps keep bowels regular.
Spicy hot, pungent or aromatic foods are best avoided along with colas, caffeine, and alcohol. These foods cause blood vessel dilation and heat in the blood and a worsening of acne. Within Chinese Medicine dietary understanding these foods strain the body's ability to balance temperature and humidity thus promoting the accumulation of damp heat.
Avoid overeating that results in “retention of food” that, in turn, slows the digestive transit time through the body and may contribute to damp heat and constipation. If you have the discipline, it may help to avoid eating immediately under conditions of high emotional stress (which contributes to poor digestion). Emotionally heightened states contribute to increased risk for many disease states including acne.
Acne associated with PMS may respond to Vit B 6 (100mg three times per day for the week preceding the menses).
Not surprisingly, foods containing trans-fatty acids (margarine, shortening) or oxidized fatty acids (fried oils) are best to avoid. Animal derived oils can generate the body's inflammatory response to sebum, skin bacteria and plugging of pores. On a positive note, do increase intake of essential fatty acids -linoleic acid (omega 6 and omega 3) which reduce inflammatory conditions in the body. These inflammatory processes occur within the pilosebaceous unit of the skin, including inflammatory acne lesions.
Vitamin A supplementation can reduce sebum production and hyperkeratosis resulting in significant reduction of acne . Average doses of 100,000- 300,000 iu/day for 3 months can result in toxicity and birth deficits in pregnant women. This method is not recommended unless liver function tests can be monitored by your primary care physician. Early recognition of Vitamin A toxicity is important. Headache is usually the first symptom followed by fatigue and joint or muscle pain.
Zinc supplementation (30mg 3 x per day for 8-12 weeks) can reduce acne in people who are deficient due to severely restrictive diets or requiring increased nutritional demands. Pumpkin seeds, nuts, seeds and soybeans are a good source of zinc.
Vitamin C (1000mg), Selenium (200mcg) and Vitamin E (600iu), Chromium (400mcg per day) may improve acne in some people. The intake of these supplements would require at least 8-12 weeks to give an adequate trial to determine effectiveness.
Eliminate foods high in iodine if you notice an increase in acne after eating seafoods or salty foods.
Reduction of milk products might reduce acne. Avoid non-organic milk products which might contain exogenous hormones.
If you are taking antibiotics for acne control consider supplementing your diet with Lactobacillus acidophilus (½ tsp 3 x per day ), Superdophilus, or Myco-Gard (2 caps 3 x day) to protect the normal flora in the intestines and reduce yeast infections.
Western Recommendations
There are many popular over the counter acne treatments which incorporate exfoliants, resorcinol, alcohol, benzoyl peroxide, retinoic acid, salicylic acid, or sulfur. Many of these products are effective for mild to moderate acne. For more severe acne, prescription medications that may be prescribed include tretinoin (Retin A) oral and topical antibiotics such as tetracycline or cleocin. For women of childbearing age, birth control pills may control acne which seems to flare prior to the menstrual period. In severe cystic acne, isotretinion (Accutane) may be the last resort but is only prescribed with strict adherence to the FDA protocols.
If you would like to discuss the possibility of treatment, please call me at (503) 943-9842. You can also reach me via email.