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Picture this:  You’re fighting your way through traffic when you begin to feel a tingling sensation on your cheek.  You brush the spot with the back of your hand thinking a stray hair must be tickling you, but the irritation is persistent.  Finally, you inspect the suspicious spot in the rear view mirror and your worst fears are confirmed.  A zit larger than a breadbox has reared it’s ugly head when you least expected it and when you needed most to look your best.  But, only teenagers get pimples, right?  Well, no…adults can suffer from acne flare-ups too.  The only difference in this scenario is that you’re on your way to an important business meeting instead of the prom. 

Most people equate acne as the consequence of being a teenager, as though it were a rite of passage marking the ascent into adulthood.  But, the fact is that as much as 20% of the adult population are affected by acne, most of them women. Let’s face it – acne doesn’t look good on anyone of any age and it can be socially immobilizing and disfiguring as well.  While teenagers can usually blame the hormonal roller coaster that ushers in puberty as a source of their skin troubles, adults are left wondering why they’re in the same condition long after the ride is over.  But, while hormonal activity is certainly an important factor in causing acne, there are other contributing sources that remain plentiful in the grownup world. 

Acne 101 

Acne formation is a 3 step process, regardless of age.  First, the sebaceous glands surrounding the many hair follicles produce excess sebum, an oily substance geared to lubricate skin and hair and retain moisture. Next comes the involvement of dead skin cells that become trapped in the sebum in the follicle canal or comedo. Nearby cells that produce keratin, a fibrous protein that is an integral component of hair, nails and outer skin, can also be stimulated into overproduction and can join forces with dead skin cells to form a blockage of the follicle canal.  We recognize a blackhead as an open comedo, where the blockage is visible in the pore.  A closed comedo, or white head, occurs when the blockage is complete.  In either case, the follicle canal balloons, but in the latter it does not rupture.  Finally, if the bacterium Propionibacterium acnes is present, the blocked follicle canal encourages its overgrowth and it begins to break down sebum and cause inflammation.  And, there you have it -  a zit is born. 

Since male hormones dictate sebum and keratin production, and are particularly active during puberty, acne is generally accepted to be a hormone-dependant condition.  But, elevated blood testosterone levels may not be the only culprit.  Studies have shown that acne patients also evidence an increased activity of 5-alpha-reductase, an enzyme that converts testosterone into the concentrated form of dihydrotestosterone.  This suggests that how an individual metabolizes testosterone may be another factor to consider in adult acne. Adults are also susceptible to other causes, such as environmental toxins found in the workplace, stress, poor diet and certain medications, such as steroids and oral contraceptives.  Older adults may experience pimples in addition to a form of adult acne known as rosacea, characterized by blotchiness and flushing. 

Diet Matters 

Let’s dispel some myths.  Chocolate and French fries do not necessarily lead to the overproduction of sebum.  It seems likely that these foods in particular have been labeled as pimple-producers because they’re usually considered dietary staples by teens, but there is no scientific confirmation that they specifically cause acne.  However, moderation of anything is always the rule and it is wise to generally limit consumption of refined sugar and foods high in trans-fatty acid content, such as milk products, synthetically hydrogenated vegetable oils and oxidized fatty acids (fried oils).  A diet high in these substances and low in fiber and essential vitamins can result in intestinal toxemia.  Since your skin is the greatest organ of elimination, the consequences of toxin overload may quickly become evident there.  (Note:  Kelp, a sea weed sold as a dietary supplement, and iodized foods, such as salt, have shown a direct link to acne and should be limited or avoided.) 

Several studies indicate that Vitamin A reduces serum and keratin production and, therefore, their buildup in follicle comedos.  Sufficient intake of vitamin A can be obtained by eating at least 5 servings each day of fresh fruits and vegetables. However, high-dose supplementation for the treatment of acne should be closely supervised by a qualified health care practitioner since a toxic condition can develop.  If it is possible for pregnancy to occur, vitamin A supplementation should be limited and administered by a physician. 

Selenium is involved in the action of gluthathione peroxidase, an enzyme that prevents inflammation of the hair follicle and that has been found to be lacking in many acne sufferers.  Vitamin E is a partner in this mechanism and plays a critical role in the action of both selenium and vitamin A. 

Zinc is another important nutrient in the treatment of acne.  Zinc supports vitamin A function and contributes to tissue healing and regeneration.  Zinc also interferes with the conversion of testosterone to dihydrotestosterone, a stimulator of sebum production. 

Acidophilus, a “friendly” bacteria, is useful in treating acne in that it checks harmful intestinal bacteria, including yeasts such as Candida albicans.  You can add acidophilus to your diet by consuming yogurt with live culture or by taking supplements in gel-capsule form. 

Give the “All-Clear” to Adult Acne 

If simply washing were enough to eliminate those annoying and embarrassing outbreaks, you probably wouldn’t experience any.  But, facial cleansing merely removes surface dirt and does little to unclog pores or neutralize the bacteria.  However, proper cleansing is an essential part of maintaining healthy skin.  As with any thing else, there’s a right way and a wrong way to do it. 

-         Don’t scrub.  Scrubbing with wash cloths or abrasive cleansers won’t “wear” pimples down, but will exacerbate the problem.

-         Don’t wash with harsh soaps.  Instead, use natural botanical and vegetable oil-based soaps that cleanse gently without “stripping” the skin.

-         Don’t over do it.  Washing your face too often will disturb your skin’s pH balance, leading to more breakouts and adding dry, flaky skin to your troubles.  Twice each day is usually sufficient.

-         Do use herbal extracts and supplements to encourage the renewal of healthy skin.

-         Do use pure, natural cosmetics on your skin, including natural foundation and other makeup essentials. 

Commercial acne treatments run the gamut of forms and of possible side effects. Certain creams and lotions that contain zinc, sulphur or benzyl peroxide may reduce pimples, but they can also burn and leave skin dry and blotchy.  Some oral medications offer help, but with significant risks.  Antibiotics, for instance, do improve acne conditions, but they also interfere with the balance of healthy intestinal flora, making the problem cyclic.  One oral medication prescribed for cystic acne, isotretinoin (Accutane), significantly reduces sebum production but is associated with serious birth defects. As the manufacturer cautions, malformation of the fetal brain, spine, skull and heart are possible if used just before or during pregnancy.  Other side effects include loss of bone density, arthritis and depression.  Fortunately, your natural products store will have a variety of quality brands of cleansers, toners and topical creams that are gentle and effective against adult acne, but without these negative effects. 

What are some of the ingredients found in these products and their benefits?   Some of the most effective treatments contain tea tree oil, green tea extract, azelaic acid, ester- C, tocopherol (vitamin E) and a variety of herbal extracts.  Azelaic acid is a naturally occurring acid that stabilizes keratin production and produces results comparable to that of Retin-A, benzoyl peroxide or oral antibiotics, such as tetracycline.  Tea tree oil has long been known to possess antifungal and antibacterial qualities.  Green tea, and topical vitamin C and E are potent antioxidants that help to reduce infection and inflammation.

Other ingredients include fruit acids (AHAs and BHAs) that act as gentle exfoliates.  One relative newcomer to this list is an algae extract called Phlorogine that has met with great success in several double-blind studies on adult acne. 

Look for products that contain these healing ingredients, cleanse thoroughly and gently and eat a balanced diet consisting of plenty of fresh fruits and vegetables.  It may take a few weeks to a few months, but soon you’ll be feeling good in your skin again.  And, who knows?  Maybe you’ll look even better than you did when you went to the prom. 

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References: 

1.      Leachman SA, et. al. “Bone densities in patients receiving isotretinoin for cystic acne.” Archives of Dermatology 1999 Aug;135(8):961-5.

2.      Maddin S.  “A comparison of topical azelaic acid 20% cream and topical metronidazole 0.75% cream in the treatment of patients with papulopustular rosacea.” Journal of the American Academy of Dermatology 1999 Jun;40(6 Pt I):961-5.

3.      Gibson JR.  “Azelaic acid 20% cream (AZELEX) and the medical management of acne vulgaris.”  Dermatological Nursing 1997 Oct;9(5):339-44.

4.      Murray Michael T, Pizzorno Joseph.  The Encyclopedia of Natural Medicine, 2^nd Edition.  Prima Publishing 1998 (Rocklin, CA).