Acne: More Than Skin Deep

Words: Dr Rajgopal NIDAMBOOR

Acne is as old as civilisation. If King Tut carried acne scars to his grave, the ancient Romans believed that acne could be treated with sulphur baths — in circa 753 BC.

Acne is a common, distressing disorder — when it is severe it can leave perpetual scars, leading to depression, and gloom, including suicidal tendencies in certain individuals.

  • Acne presents with clogged pores, pimples and lumps, or cysts, on the face, neck, chest, back, shoulders and upper arms
  • Girls and boys are equally affected, though there may be a few variations
  • Age is no bar. Interestingly, young men are sometimes more likely to be affected than young women
  • Acne tends to ease in one’s early twenties; it can, however, affect adults in their forties, no less.

Acne develops from the sebaceous glands that are ‘connected’ to hair follicles — viz., on the face, external auditory meatus, back, chest, and ano-genital area. This is, of course, dependent on a host of factors — from increased sebum secretion to inflammation around the sebaceous glands.

Causes

There are a variety of factors that cause acne — viz., puberty, hormonal imbalance, personal hygiene, dietary errors, stress, certain medications, chemical cosmetics and lifestyle.

It is also likely that acne in some individuals may be made worse by chocolate, nuts, coffee, carbonated, or fizzy, drinks.

The premenstrual worsening of acne is suggested to be caused because of fluid retention. This may often lead to increased hydration and swelling of the duct. Sweating also makes acne worse, primarily because of the same mechanism.

You’d do well to remember that acne isn’t an illness; it is a cosmetic problem. Yet, it can cause ripple effects. Chronic acne can not only lead to low self-esteem, depression, stress and social withdrawal, but also tell-tale scars.

  • Some conventional medications can ‘up’ acne outbursts — anti-depressants, anti-anxietals, and steroids. Other causes may include: oily cosmetics, abrasive cleansing and scrubbing of the skin, pressure from helmets, backpacks, and tight clothing
  • Environmental contaminants, and chemicals, may also cause acne surges, while long-term contact could ‘jam’ the skin pores, or annoy the skin
  • Smog may have just as much effect on the skin, ‘choking’ the pores and leading to acne eruptions
  • What’s most worrying, or a big ‘no-no,’ is picking, or squeezing, the eruption. This can cause the acne blemish to move deeper into the skin, leading to unpleasant scarring.

Types

  • Acne vulgaris primarily affects adolescents; it may persist and become severe as one enters adulthood
  • Adult acne is a form of acne vulgaris that can affect individuals over age 30, who may have not experienced the problem in their teens
  • Acne mechanica is caused by constant pressure, repeated friction, tight clothing, covered skin and excess heat. Certain repetitive tasks, common in sports, may irritate the skin and lead to acne breakouts. Extreme temperature changes can also complicate existent acne with fresh breakouts. Wearing helmets and head bands that rub the forehead, or irritate the skin, including undergarments made with synthetic materials, can trigger acne
  • Acne cosmetica. This form of acne is generally caused by certain forms of strong, powerful cosmetics
  • Pomade acne. Some heavy oils used in pomades can clog the skin, setting the stage for acne. In addition, chemicals in certain pomades may irritate the skin, resulting in acne outbreaks
  • Excoriated acne. When a person picks and scrapes at every pimple, or skin blemish, on their skin, the ‘fingered’ or ‘nailed’ intrusion can trigger this form of acne
  • Infantile acne. This occurs in the new-born, most likely due to hormonal changes when the foetus is developing in the mother’s womb. Typically, infantile, or baby, acne clears up in a matter of weeks without treatment. If the ‘pimples’ don’t clear up, one should consult a doctor to determine whether there are any underlying causes for acne.

There are extreme forms of acne that can affect more than just the body; they may affect every aspect of a person’s life, including emotional and psychological indices, while undermining one’s quality of life [QoL], leading to low self-esteem. They are: acne conglobate, acne fulminans, gram-negative folliculitis, and pyoderma faciale — a type of severe acne that affects women, usually between age 20 and 40. It is typified by large painful nodules, pustules and sores with scarring. It may also occur in women who have never had acne before.

Course 

Acne vulgaris disappears by age 23-25 years in 90 per cent of individuals; however, about 5 per cent of women and approximately 1 per cent of men may yet need treatment — in their 30s and also 40s. 

Investigations 

None are usually required. Cultures may be needed, at times, to discount pyogenic, or anaerobic infection, and gram-negative folliculitis. 

Self-Care 

  1. Wash twice a day; also, after workout, or sweating. Sweating, especially when wearing a helmet, can make acne worse
  2. Use your fingertips to apply a gentle, non-abrasive cleanser. Avoid washcloth, or mesh sponge, that may irritate your skin
  3. Be gentle — use products that are alcohol-free. Say no to astringents, toners and exfoliants. They could worsen your acne
  4. Don’t scrub your skin; it may worsen your acne
  5. Rinse always with lukewarm water
  6. Shampoo frequently. More so, if you’ve oily hair — in which case you should shampoo daily
  7. Never pick, pop, or squeeze your acne; it may delay the natural healing process
  8. Avoid touching your acne spots — this can cause outbreaks
  9. Avoid the sun and tanning beds.
  10. Tanning damages your skin. It may also heighten your risk for melanoma, a dangerous form of skin cancer by 75 per cent.

Treatment 

Ayurveda and homeopathic physicians suggest that acne is a sort of defence response; or, the body’s core ‘riposte’ to combating the prowler [e.g. bacteria]. They contend that acne may heal best when it is engaged from the inside out – i.e., from within the body. Clinical studies suggest that certain Ayurvedic and ‘individualised’ homeopathic remedies — prescribed on the patient’s distinctive configuration of symptoms — can ‘fuel’ a good therapeutic response in acne, as also other skin disorders, without side-effects. It is, however, imperative, that the guidance of a professional Ayurveda, or homeopathic, physician is followed diligently for successful treatment outcomes.

Most complementary and alternative medicine [CAM] physicians may often recommend Curcumin [turmeric] and Zingiber officinale [ginger], along with zinc and vitamin C supplements, for certain forms of acne. For women whose acne spots tend to worsen before their periods [PMS], cobalamin [vitamin B12] with Vitex negundo [Chaste tree], thanks to its anti-androgenic, ‘hormone-balancing’ properties, may, likewise, be prescribed.

Ayurveda:  Ayurveda employs a range of herbs for acne, or mukshadushika in Sanskrit, and other specialised products. The herbs [Zimade mohasa] are primarily irsa [Iris florentina], barghe neem [Azadirachta indica leaves], poste saras [Acacia speciosa bark], ghungchi safaid [Abrus precatorious] and namake sambhar [lake salt], 50gm each. This acts as a topical cleanser, astringent, anti-inflammatory and antibacterial agent.

  • Lone A H, Habib S, Ahmad T, et al. “Effect of a Polyherbal Formulation in Acne Vulgaris: A Preliminary Study. J Ayurveda Integr Med 2012; 3: 180-183.

Homeopathy: Sixty patients with chronic skin disease were included in the study of atopic dermatitis [AD] [n=25], eczema other than AD [n=20], severe acne [n=6], chronic urticaria [n=6], psoriasis vulgaris [n=2] and alopecia universalis [n=1]. These patients received individualised homeopathic treatments in addition to conventional dermatological treatments for a period of three months to two years and seven months. Results: Six patients reported a score of 4 [complete recovery], 23 patients a score of 3 [75 per cent improvement], 24 patients a score of 2 [50 per cent improvement] and seven patients a score of 1 [25 per cent improvement]. A total of 88.3 per cent of patients reported over 50 per cent improvement. Around one-half the patients with AD and eczema reported greater satisfaction in daily life, greater fulfilment at work and greater satisfaction in human relations. Conclusions: The psychological, physical and psychosomatic symptoms and effects of chronic skin diseases are inextricable. Individualised homeopathic treatment can provoke a good response in patients with chronic skin disease; therefore, the holistic approach used in homeopathy may be a useful strategy [alongside conventional treatment].

  • Itamura R. “Effect of Homeopathic Treatment of 60 Japanese Patients with Chronic Skin Disease.” Complement Ther Med 2007; 15: 115-120.

Nutrition: A new study, published in JAMA Dermatology, compared the results of 24-hour dietary surveys of more than 24,000 adults [average age 57] who reported having acne at present, having it in the past but not presently, or never having had it. The researchers found a connection between the likelihood of having current acne and consumption of certain high-fat foods [including milk and meat], sugary foods and beverages, a diet high in the combination of high-fat and high-sugar foods. When equated with subjects who never had acne, respondents with current acne were 54 per cent more likely to consume this type of diet.

  • Laetitia Penso, et al. “Association between Adult Acne and Dietary Behaviors: Findings from the NutriNet-Santé Prospective Cohort Study.” JAMA Dermatol; 2020 Aug 1;156 [8]:854-862.

NB: Put simply, what you may be eating may be causing your acne. You’d do well to know what foods, or diets, may help you to treat your acne, along with medical treatment. The best thing to do is to consult a professional nutritionist too. 

Dr RAJGOPAL NIDAMBOOR, PhD, is a wellness physician-writer-editor, independent researcher, critic, columnist, author and publisher. His published work includes hundreds of newspaper, magazine, web articles, essays, meditations, columns, and critiques on a host of subjects, eight books on natural health, two coffee table tomes and an encyclopaedic treatise on Indian philosophy. He is Chief Wellness Officer, Docco360 — a mobile health application/platform connecting patients with Ayurveda, homeopathic and Unani physicians, and nutrition therapists, among others, from the comfort of their home — and, Editor-in-Chief, ThinkWellness360.

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