Difficult cases of acne are generally referred to a dermatologist for management and treatment, suggesting that this is a skin problem. However integrative or holistic medical doctors believe that acne, which appears on the face and sometimes the neck and shoulders, is only the outer manifestation of a much deeper problem.
Acne is also not just a hormonal problem despite the fact that it occurs predominantly during adolescence. There is no correlation between hormonal levels and the incidence of acne. Like all disease, acne is multi-factorial, meaning that many factors play a role. While some factors may predominate in individual cases it is the particular combination of underlying metabolic pressures from a number of sources that results in the typical lesions of acne. Each acne case has its own unique characteristics and each case requires an individual approach.
Dietary factors are probably important. Some studies have shown that the Western diet is associated with an increased incidence of acne. Research shows there is far less acne among the black population in Zambia eating a traditional diet than among young blacks in the United States. Eskimos who changed to Western diets after World War II developed a number of new diseases, including acne. This may be related to the use of refined vegetables oils, margarines and refined carbohydrates and sugar.
Naturopathic practitioners generally think of acne as a condition due to (a kind of) poisoning arising from the intestines, secondary to chronic constipation and indigestion or the poor digestion of food. Foreign bacteria may also be present causing fermentation. These poisons arising within the intestine are then absorbed into the body, giving rise to acne or other diseases in some people.
Poisons are also produced in the body as by-products of metabolic processes and are constantly being removed by organs of detoxification. Lactic acid is a simple example of a poison produced by prolonged and excessive exercise causing muscle soreness. Excess fermentation processes or an abnormal bacterial flora in the intestines may generate ammonia or ethanol molecules, which are poisonous if absorbed. The liver is the primary organ of detoxification, and if this malfunctions, in addition to intestinal disturbances, this aggravates acne and can be an underlying factor in its development.
• Diet: It is essential to follow a healthy diet consisting of raw and lightly cooked vegetables, especially green leafy vegetables that contain valuable trace minerals and that are rich in fibre. In addition there should be sufficient lean protein and complex carbohydrates. Sugar is not a food and all processed foods should be eliminated. Drink plenty of water and eliminate or limit animal fats, hydrogenated oils (margarines) and fried foods.
- Probiotics such as lactobacillus acidophilus and bifidus should be used especially in people who have taken antibiotics for a prolonged period of time. Buy only those probiotics, which have been kept refrigerated. Take between meals rather than with meals.
- Vitamin A: When used in high doses vitamin A has been shown to reduce sebum production and the build-up of keratin. Many of the drugs used by conventional doctors such as Roaccutane and Retin-A were derived from vitamin A research. They are not bio-identical but synthetic chemicals and should not be confused with vitamin A. In these high doses vitamin A can be toxic if used for prolonged periods of time and usage should therefore be monitored by a practitioner. Vitamin A in high doses is poisonous to the fetus and should not be used by pregnant women. In doses less than 25 000 IU a day it is safe to use (if not pregnant) especially if combined with zinc and vitamin E.
- Other supplements that are useful in managing acne include vitamin C and bioflavanoids, which strengthen connective tissue and act as natural anti-inflammatories. The dose is 250 mg three times a day for each until symptoms have cleared up and then reduce to once a day. Vitamin E 400 IU twice a day is useful and supports the functioning of vitamin A and selenium. Vitamin B6 (pyridoxine) is useful in women with premenstrual aggravation of acne because of its role in the normal metabolism of steroid hormones.
- Zinc: In some but not all double-blind studies zinc supplements were found to be effective in the treatment of acne. Some studies have shown it to be more effective than the antibiotic tetracycline and also vitamin A. Start with a dose of 25 mg of zinc chelate or picolinate twice daily for 2 weeks and then decrease to once daily for 2 months.
- Low-energy laser treatment: High-energy laser treatment is used as a surgical tool or for burning lesions. On the other hand, low-energy laser appears to have anti-inflammatory properties without any burning or sensation. It is possibly the best single treatment for severe cases of acne. The more severe, the better the results are. Treatment is once a week for 2 – 3 months.
- Chinese herbal medicines have also been used successfully. A Chinese herbalist must be consulted because there are various patterns according to Chinese traditional diagnosis and each pattern requires a different combination of herbs.
- Toxic bowel: As indicated at the beginning of the article, some natural medicine practitioners believe that acne is due to the internal generation of poisons in the bowel which are inadequately removed. Management requires treating constipation, increasing roughage in the diet, saunas to facilitate sweating, and herbal medicines to stimulate liver and kidney-cleansing processes.
- Local applications: Tea tree oil (5 – 15% concentration) and azelaic acid (20% concentration) are natural skin antiseptics and have been shown to lower the bacteria level and inflammation of acne as effectively as benzoyl peroxide or Retin A without these drugs’ negative side-effects. Other aromatherapy oil creams may also be used.
Acne can be a major problem because of its psychological effects in young adolescent girls and boys. It can occur in adults in their 20s and 30s, and they too find it difficult to cope with. One needs to keep in mind that even acne has responded to placebo treatment, showing how powerful the mind is. If placebos, which have no medicinal properties, are able to help with acne, then it is possible that acne may also be caused by self-image problems. Psychotherapy may be helpful in these cases.