Acne 101: the good, the bad and the answer to beautiful skin

Acne 101: the good, the bad and the answer to beautiful skin

What is acne?
Acne vulgaris is one of the most common, (and frustrating!) skin conditions. It occurs when hair follicles become clogged with dirt, skin cells, and excess sebum, an oily substance produced by the skin. Bacteria, Propionibacterium acnes (P. acnes), grow in clogged pores, they release lipases that breakdown sebum, and this leads to an inflammatory cascade causing redness, swelling and pus. The visible result? Acne.

What causes acne?
Sex hormone fluctuations are largely responsible for acne, however diet, in particular food sensitivities, stress, certain medications, cosmetics and lotions may all contribute to or worsen acne.

Natural approaches to acne
The goals of a holistic natural approach involve…

1. Removal of known food sensitivities and dietary triggers
2. Balancing hormone levels to decrease excess oil production in the skin
3. Increasing healthy skin nutrients
4. Enhancing immune system function to prevent excessive bacterial growth

Diet
Several studies have confirmed that glycemic load plays a substantial role in the pathogenesis and treatment of acne, where in low-glycemic group subjects demonstrated significant clinical improvement in their number of acne lesions.(6) More recent evidence shows that dairy enhances inflammatory insulin/IGF-1 signaling pathways leading to acne aggravation. An increase in the insulin/IGF-1 signaling axis has also been shown to be associated with obesity, type-2 diabetes and cancer. (5) Accordingly, a low-glycemic and dairy free diet may benefit those suffering from acne.

Hormones
One of the most important targets in the development of acne involves balancing sex hormone levels, most commonly, counteracting the effects of elevated androgens.

Conventional therapies such as oral contraceptive pills work to correct elevated androgens by decreasing ovarian synthesis of androgens and by increasing sex-hormone binding globulin (SHBG) to reduce free circulating testosterone. Controversy persists with the use of birth control pills in women with acne; although these agents improve the severity of acne lesions, their potential for adverse effect on insulin resistance, glucose tolerance, and vascular health remain a concern.(2) Spironolactone, a 5-alpha reductase inhibitor, blocks the conversion of testosterone to its more potent form dihydrotestosterone (DHT) and increases testosterone clearance. Although spironolactone possesses moderate anti-androgenic effects, it can cause postural hypotension, dizziness, fatigue and menstrual irregularity.

The use of botanical anti-androgens as alternatives to pharmaceutical intervention shows considerable promise. Glycyrrhiza glabra, commonly known as Licorice root, has been shown to reduce serum testosterone levels, and Serenoa repens, also known as Saw Palmetto, inhibits 5-alpha reductase activity.(1) Flaxseed, Linum usitatissimum, consumption has been shown to stimulate SHBG synthesis, thus lowering free testosterone levels. (7)

Vital skin nutrients
Vitamins A and E are necessary antioxidants for skin health, and zinc, an essential mineral, possesses anti-inflammatory activity in the body. In its retinol form, vitamin A has been shown to have inhibitory effects on sebaceous gland activity and sebum secretion, subsequently leading to a reduction in P. acnes population.(8) Data from several studies show that acne severity is intensified in patients with low levels of vitamin A, vitamin E and zinc. (8) These findings support the use of these nutrients in the prevention and treatment of acne.

Gut health
Recent studies have shown an increase in intestinal permeability in acne sufferers.(3) Intestinal permeability leads to systemic inflammation, and has been found in patients with irritable bowel syndrome, small intestinal bacterial overgrowth, and other digestive disturbances. The investigation and management of digestive dysfunction in acne patients is therefor warranted; specifically, the use of probiotics and antimicrobial herbs such as Berberis vulgaris (Barberry) has been shown to be of benefit to acne patients. (4)

Conclusion
There are many effective natural treatments for acne vulgaris. A successful strategy addresses the cause of the acne (hormonal, dietary, digestive etc.) while using a holistic, comprehensive treatment approach.

Dr. Alaina Overton, ND

References
1. Armanini D1, Mattarello MJ, Fiore C, Bonanni G, Scaroni C, Sartorato P, Palermo M. Licorice reduces serum testosterone in healthy women. Steroids. 2004 Oct-Nov; 69(11-12): 763-6.
2. Azziz R. Up To Date Clinical Reference Library; 2006. Use of combination oral contraceptives in the treatment of hyperandrogenism and hirsutism
3. Bowe, W. and A. Logan. “Acne vulgaris, probiotics and the gut-brain-skin-axis—Back to the future?” Gut Pathogens Vol. 3, No. 1 (2011): 1.
4. Fouladi, R.F. “Aqueous extract of dried fruit of Berberis vulgaris L. in acne vulgaris: A clinical trial.” Journal of Dietary Supplements Vol. 9, No. 4 (2012): 253–261.
5. Kwon HH, Youn JY, Hong JS, Jung JY, Park MS, Suh DH. The clinical and histological effect of low glycémie load diet in the treatment of acne vulgaris in Korean patients: a randomized, controlled trial. Acta Derm Venereol 2012; 92: 241-246.
6. Melnik, B.C. “Diet in acne: Further evidence for the role of nutrient signalling in acne pathogenesis.” Acta Dermato-Venereologica Vol. 92, No. 3 (2012): 228–233.
7. Nowak DA1, Snyder DC, Brown AJ, Demark-Wahnefried W. The Effect of Flaxseed Supplementation on Hormonal Levels Associated with Polycystic Ovarian Syndrome: A Case Study. Curr Top Nutraceutical Res. 2007;5(4):177-181.
8. Ozuguz, P. and K. Dogruk. “Evaluation of serum vitamins A and E and zinc levels according to the severity of acne vulgaris.” Cutaneous and Ocular Toxicology Vol. 33, No. 2 (2014): 99–102.