How to Deal with Acne

Acne is a very common skin disorder in the USA. It affects about 85% of adolescents, and comedos, an early stage of acne that may or may not develop into acne, affects practically all teenagers. Getting older is not a guarantee either: the number of older people suffering from acne is increasing, affecting 8% of 25-34 year-olds and 3% of 35-44 year-old. This means that acne is normal, at least at some stage in our lives, but this does not make it any less painful and it is important to know that acne can be controlled and how.

What is acne?
Acne is a disease of the follicles, the pore where the hair is formed and sebum is secreted. Keratinocytes, which would normally be "shed", accumulate and plug the pore with the sebum acting as glue, and the result is a a microcomedo. Continued accumulation of materials will distend the pore, forming an open comedo, a blackhead. Oxidized lipids and melanin give blackheads their color.

Inside the comedo there is little oxygen and lots of sebum, an ideal medium for the acne bacterium, Propionibacterium acnes, to grow and multiply. The activity of the bacteria leads in turn to inflammation and irritation.

Cysts can develop when the contents of the sick follicle (keratinocytes, sebum and bacteria) spills into the surrounding dermis, producing a pustule (superficial), or, deeper papule or nodule.

What can we do?
First, remember that acne is not a trivial matter. Besides the psychological suffering, acne can leave scars, keloids andchanges in pigmentation, so it is important to control acne before it leads to permanent changes in the skin. Second, serious acne should be taken seriously and this means visiting your M.D. Some genetic problems show themselves as acne, and only tests ordered by your doctor can tell you whether your acne is “normal”, i.e. caused by the hormonal turmoil of adolescence or the menstrual cycle, or whether it is a symptom of polycystic ovarian syndrome or other health problems that cause an excess in the production of male hormones by the young woman.

To control acne:

1) Keep sebum secretion under control using sea kelp bioferment, niacinamide and EGCG from green tea.
2) Normalize keratinization and prevent the exfoliated keratinocytes from sticking together, closing the pore. Go for white willow bark extract, which will also reduce inflammation. Other helpful actives are sulfur, retinyl acetate (or other retinoids). Chemical peels will also help but make sure that the glycolic and other acids are not neutralized using bases like sodium hydroxide, a common ploy used to impress consumers with high concentrations of acid that will do nothing because they have been converted into (useless) salts.
3) Decrease inflammation with actives like white liquorice extract. Avoid steroids, anti-inflammatories that everybody likes because they are so fast. With prolonged use they may cause skin atrophy and steroid acne.
4) Kill acne bacteria: tea tree oil, Coleus essential oil. Propolis should also work but many of our clients do not like the smell. Avoid benzoyl peroxide, which will kill bacteria but will also age your skin and increase the probability of skin cancer.
5) For men and women: inhibit the activity of the enzyme 5-alpha reductase using saw palmetto and wild yam extracts, this active will reduce skin androgens, reducing the frequency of acne lesions.

What NOT to do
Don't use benzoyl peroxide. This chemical is a strong oxidant, and the idea is to use it to kill the acne bacteria. The problem is, you are killing your own cells too. There must have been a time when benzoyl peroxide seemed like a good idea, but with what we have learnt about the effect of oxidant on cells, and how the are a major cause of skin aging, it is time to forget about it and go for more sophisticated tools. Sophisticated does not mean more expensive. Skin Actives Scientific is now selling a kit for under $30 that will help control sebum production (and sebum is the bacteria's favorite food!), skin renewal (so that pores are kept open and do not turn into comedos) plus anti-inflammatory actives.

So, before you go for benzoyl peroxide, think long-term and give your skin a chance.