There’s no denying that first impressions matter. And what’s that “first” in first impressions? Your face! It’s the first thing that people see when you walk into a room.
But when you have acne, it’s easy to feel insecure and even hopeless about your skin. From adolescence to adulthood, acne can have a profound impact on your quality of life. And even after trying every treatment under the sun, you may still feel like you don’t have it under control.
June is Acne Awareness Month, so read on to find out how you can support healthy, blemish-free skin all summer long.
What Is Acne?
Acne vulgaris, a condition affecting the skin, is the result of hair follicles becoming plugged with oil and dead skin cells. Bacteria called Propionibacterium acnes (P. acnes), which live in the pores and proliferate under these conditions and cause inflammation, resulting in a lesion that appears on the skin. It can pop up anywhere on the body, but most often occurs on the face, neck, chest, back, shoulders, upper arms, and buttocks.
Acne is a condition that affects up to 95% of us at some point in our lives, hitting both the young and the not-so-young to the tune of 40–50 million Americans per year!
Types of Acne
All acne lesions begin as a microcomedone, a stage where the pore appears normal but has built up oil and skin cells creating a bottleneck effect that prevents normal sloughing (shedding of dead skin cells).
The resulting lesions can be divided into two categories: non-inflammatory acne and inflammatory acne.
Microcomedones can become unplugged and heal on their own. They can also become non-inflamed skin blemishes called blackheads or whiteheads.
Blackheads occur when the pore opens to the surface and the oil, or sebum, oxidizes and turns dark brown or black in appearance. Contrary to their appearance, they are not filled with dirt and cannot be washed away, and because the substances in the pore drain very slowly, they can remain for a long time.
Whiteheads occur when the sebum and bacteria remain trapped underneath the skin’s surface. They may be so small that they are not visible to the naked eye, or they may appear as small white or flesh-colored bumps.
When blackheads or whiteheads cannot release their contents to the surface and heal, the follicle wall can rupture, resulting in inflammatory acne. This rupture can occur randomly or by touching or picking at the skin.
Papules occur when the follicular wall breaks, white blood cells enter, and the pore becomes inflamed.
Pustules, what we usually call “zits” or “pimples,” form several days later, when white blood cells rise to the skin’s surface.
A papule or pustule can completely collapse or burst, causing severe inflammation of the surrounding skin and affecting nearby follicles and forming lesions called cysts or nodules.
Cysts are large, pus-filled lesions. Nodules occur when the follicle breaks along the bottom, resulting in total collapse, and they appear as large, inflamed bumps, often sore to the touch.
Acne vulgaris is the least severe form of acne, and there are several more severe forms that can be both painful and disfiguring.
Acne conglobata – chronic and severe form of acne vulgaris, often called cystic acne; can cause cyst formation and subsequent scarring.
Acne fulminans – sudden onset of highly destructive inflammation; can cause severe and ulcerating acne, fever, with inflammation and aching joints.
Nodulocystic acne – characterized by large, inflamed cysts; can require surgical drainage, and result in scarring.
Gram-negative folliculitis – follicular inflammation caused by bacterial infection after long-term antibiotic treatment.
Acne occurs when hair follicles become clogged with sebum and dead skin cells, creating the perfect environment for bacteria to flourish.
While we understand the process of acne lesion formation, it’s difficult to pinpoint why this happens in one follicle but not in another. Still, there are many factors that may individually or collectively trigger a breakout.
During puberty, both boys and girls experience increased production of hormones known as androgens, which cause the sebaceous glands to enlarge and produce more sebum. Pregnancy and oral contraceptive use can also affect hormone levels and sebum production.
Acne appears to have a hereditary component, as children of parents who had acne have a greater likelihood of developing the skin condition. Genetics can influence your body’s cellular turnover rate and/or response to inflammation, contributing to acne.
Medications with corticosteroids, androgens, or lithium are known to cause acne because they can affect hormone levels.
Conventional Acne Treatments
If you struggle with acne, there are a number of conventional treatment options available.
These are treatments that are applied to the skin to kill bacteria or reduce oil production. These include both over-the-counter and prescription medications:
Salicylic Acid. Used to treat mild to moderate acne. Helps correct abnormal shedding of skin cells. Can help unclog pores to resolve and prevent acne lesions. Must be used continuously, but may cause dryness and peeling. Found in many products, including cleansers, lotions, creams, and pads.
Benzoyl Peroxide. Includes brands Brevoxyl and Triaz. Used to treat mild to moderate acne. Kills the bacteria associated with acne. Can take up to a month to work. Can cause dryness, flaking, and bleach fabric. Found in creams, lotions, washes, and gels.
Retinoids. Also known under brands Differin, Avage, Tazorac, Avita, Renova, Retin-A. Used to treat moderate to severe acne. Derived from vitamin A, they unplug clogged pores and prevent dead skin cells from clogging pores. Often used with other topical treatments. May cause burning, dryness, flaking, itchiness, and sensitivity to sunlight. Found in cream, gel, and liquid forms.
Antibiotics. Includes erythromycin and clindamycin (Cleocin T). Used to treat moderate to severe acne. Kills the P. acnes bacteria. May cause skin irritation. Found in creams and gels.
These are prescription medications, taken in pill form, that work throughout the body.
Antibiotics. Includes tetracycline (Sumycin), doxycycline (Vibramycin, Oracea, Adoxa, Atridox), cefadroxil (Duricef), and amoxicillin (Amoxil, DisperMox, Trimox). For moderate to severe acne. Kills the P. acnes bacteria. May cause stomach upset, esophageal irritation, and increased sun sensitivity.
Oral Contraceptives. Birth control pills including a combination of norgestimate and ethinyl estradiol (Orotho Tri-Cylclen, Previfem, etc.) used to treat mild to moderate acne. May cause headaches, breast tenderness, nausea, depression, and slightly increased risk of heart disease, high blood pressure, and blood clots.
Isotretinoin. Known under brands like Acccutane, Amnesteem, Claravis, Sotret. Used to treat severe acne when other treatments have failed. Works by unclogging skin pores and shrinking oil glands. Generally taken for 3-6 months. Can cause dry eyes, mouth, lips, nose and skin, as well as itching, nosebleeds, muscle aches, sun sensitivity and poor night vision. May also increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels.
These are in-office treatments performed by a dermatologist or other medical professional. They may include:
Lasers/Light Therapies. Includes Fraxel, IPL, Isolaz, etc. Reach deeper layers of skin surface. Lasers reduce oil production, and light therapies target acne-causing bacteria and inflammation. May cause skin irritation, dryness, peeling, and sun sensitivity.
Chemical Peels. Used to treat blackheads and papules, they remove the uppermost layer of skin to reveal new skin underneath. May cause inflammation, redness, dryness, and peeling.
Acne Removal. Procedure known as “drainage and extraction” can be used to remove large acne cysts. May help alleviate pain and reduce risk of scarring.
Lasers, peels, and injectable dermal fillers such as Restylane, Juvederm, Perlane, etc. can also help diminish the appearance of acne scars.
It’s important to understand that there is no one-size-fits-all approach to treating acne, and what works for one individual may not work for another. In addition, a lifestyle and dietary change may me necessary for long-term improvement. As with any health condition, you should always consult with your physician about what’s right for you.
Acne Nutrition: The Growing Link Between Diet & Acne
Long believed to be a myth, studies are disproving this idea and increasingly indicating that there is a link between diet and acne.
In a 2002 study published in the journal The Archives of Dermatology, researchers found that two different non-western populations living on remote islands in different parts of the world did not suffer from acne. They attributed this to differences in diet, because both groups ate a diet rich in fresh fruits, vegetables, and lean meat but ate little to no dairy, processed foods, or high-glycemic carbohydrate-rich foods like cereals and breads.
Another 2005 study by the Harvard School of Public Health also found that in a group of nearly 50,000 females, those who consumed dairy products were more likely to suffer from acne.
One common denominator between these two studies, as well as numerous other studies on diet and acne, is insulin. High-glycemic foods high in sugar and refined carbohydrates, as well as dairy products can cause blood sugar to rise quickly, triggering a boost in insulin. And like androgens, too much insulin can cause in increase in sebum production, contributing to the development of acne.
Just as certain foods contribute to the formation of acne, there are several vitamins, minerals, and botanicals that promote healthy skin.
Studies have shown that several vitamins play an important role in the treatment of acne: vitamin A and the carotenoids, pantothenic acid (B5), vitamin B6 (pyridoxine), vitamin E, vitamin C and bioflavonoids.
Minerals like zinc, selenium, and chromium taken orally may also help to reduce the severity of acne, help prevent inflammation, and improve skin cell metabolism.
Herbal supplements that support healthy skin include burdock, Oregon Grape, dandelion and yellow dock. They are known for their potent skin and blood cleansing properties to help detoxify the skin.
VitaMedica’s Clear Skin Formula and Healthy Skin Formula natural acne supplements are formulated with these targeted nutrients your skin craves to help cover gaps in your diet and promote a healthy, clear complexion.
Probiotics also hold promise for improving skin. A recent study showed that in young adults with moderate acne, those who took a probiotic drink showed significant improvement in their acne. After 12 weeks, they had 23% fewer pimples in total and 40% less inflammatory lesions. The probiotic improved acne by reducing sebum content and decreasing skin inflammation due to its broad antibacterial and anti-inflammatory activities. There are even topical probiotic products now making their way to the market.
Dealing with acne can be painful, frustrating, and even debilitating. But don’t lose hope! By finding the right balance of diet, lifestyle, nutrition, and treatment, you can manage this condition and have healthy, beautiful skin.
Updated June 7, 2017
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.