Common disease of the pilosebaceous glands presenting as either:

• non-inflammatory comedones (blackheads) and closed comedones (whiteheads); or

• inflammatory papules, pustules, and cysts, also termed "pimples" and "zits" 

Other important causal factors include:

• immune compromise (eg. Colds, flus, allergies)

• oil-based cosmetics

• improper diet and digestive issues (eg. Constipation)

• assorted compounds (eg. corticosteroids, halogens)

• industrial pollutants (eg. coal tar derivatives, chlorinated hydrocarbons)

• oral contraceptive agents and xenoestrogens (eg. plastics, hormones in meats)

• fatigue and stress

• poor skin hygiene

• chronic irritation (e.g. football helmet straps, backpack straps)

• acne in females is related to low pituitary function and low progesterone at mid-cycle

Acne vulgaris is commonly treated with antibiotics but it has been more than a decade since Anne Eady showed that therapeutic failure in acne may be related to bacterial resistance to antibiotics. There has been a global increase in antibiotic resistance in Proprionibacterium acnes.  In research by Leeds and others, results showed that P. acnes strains were resistant to Erythromycin, Tetracycline, Clindamycin and a variety of related antibiotics found in Europe, USA, Australia and Japan (Leeds, et al, Br J Dermatol, 2001;144).  The author recommends that local microbiology laboratories should culture P. acnes and report antibiotic sensitivities and that multiple courses of antibiotic therapy for acne should be reconsidered ("Antibiotics in Acne: Time for a Rethink," Simpson N, Br J Dermatol, 2001;144:225-228).

Diet and Nutrition

Dairy Products Excess

•"Got Milk? Got Acne? New Research Suggests Link," Mahoney D, Family Practice News, June 1, 2004:54

Simple Carbs Excess

•"A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial," Smith RN, et al, Am J Clin Nutr, 2007; 86(1): 107-115

•"The effect of a low glycemic load diet on acne vulgaris and the fatty acid composition of skin surface triglycerides," Smith RN, Braue A, et al, J Dermatol Sci, 2008; 50(1): 41-52

Comments: Other studies suggest that high carbohydrate diets lead to increased outflow of monounsaturated fatty acids in follicular sebum, and may be the reason acne problems are worsened by high sugar diets.

Omega 3 Fatty Acid Deficiency

•"Omega-3 Fatty Acids and Acne," Logan AC, Arch Dermatol, July 2003;139:941-942

•"Essential Fatty Acids and Clinical Dermatology", Wright, S., M.D., Journal of Nutritional Medicine, 1990;1,301-313

Vitamins A and E Deficiencies

•"Does the plasma level of vitamins A and E affect acne condition?" El-Akawi Z, Abdel-Latif N, et al, Clin Exp Dermatol, 2006; 31(3): 430-3




Vitamin B5 Deficiency

•"A Stone That Kills Two Birds: Pantothenic Acid in the Treatment of Acne Vulgaris and Obesity," Leung, Lit-Hung, M.D., Journal of Orthomolecular Medicine, 1997;12(2):99-114

Zinc Deficiency

•"Serum Zinc in Acne Vulgaris," Amer M, et al, Int J Dermatol, October, 1982;21(8):481-484

•"Serum Zinc and Retinol-Binding Protein in Acne," Michaelsson G, et al, Br J Dermatol, 1977;96:283-286

•"Low Doses of Zinc Gluconate For Inflammatory Acne", Dreno, B., et al, ACTA Derm. Venerol Stockh, 1989;69:541-543



Herbs

Topical Aloe Vera

•"Aloe Vera: Its Chemical and Therapeutic Properties," Shelton RM, Int J Dermatol, October 1991;30(10):679-683

•"Herbal Therapy in Dermatology," Bedi MK, Shenefelt PD, Arch Dermatol, February 2002;138:232-242

Topical Green Tea

•"Outcomes of 3% green tea emulsion on skin sebum production in male volunteers," Mahmood T, Saeed T, et al, Bosn J Basic Med Sci, 2010; 10(3): 260-4

Tannin-containing Herbs

•"Phytotherapeutic Approaches to Common Dermatologic Conditions," Brown DJB and Dattner AM, Arch Dermatol, November, 1998;134:1401-1404

•"Herbal Therapy in Dermatology," Bedi MK, Shenefelt PD, Arch Dermatol, February 2002;138:232-242

Allicin from Garlic 

“Antimicrobial properties of allicin from garlic.”  Ankri S, Mirelman D. Microbes Infect, February 1999; 1(2):125-9

Other Herbs

• Vitex agnus castus (Chaste Tree) – balances hormones, especially when associated with premenstrual syndrome

• Arctium lappa (Burdock root) – stimulates excretory systems and helping them rid the body of toxins

• Berberis aquifollium (Oregon Grape) - antihistamine, antibacterial, active on the immune system, anti-inflammatory, anti-fungal, anti-ulcer, and immuno-modulatory, powerful liver stimulants to cleanse the blood

• Taxacum officinale (Dandelion root) – purifies blood, increases flow of bile, cleanses wounds or dead tissue

•“Study of psychological stress, sebum production and acne vulgaris in adolescents.”  Yosipovitch G, Tang M, Dawn AG, Chen M, Goh CL, Huak Y, Seng LF. Acta Derm Venereol. 2007;87(2):135-9.

Summary and Suggestions

The skin eliminates wastes from the body through sweat pores. For that reason, constipation or irregular bowel movements can aggravate the problem and need to be taken care of while dealing with acne. If you need more information on constipation, you can learn more by referring to that topic.

Dietary Suggestions

• Follow a well-balanced diet, low in fat and sugars, high in fiber and high in omega 3 oils such as chia, hemp and flax seeds

• Avoid inorganic iron, which includes mineral supplements and white bread and cereals reinforced with iron, since inorganic iron combines with and inactivates vitamin E

• Drink plenty of filtered water: aim for 2 litres a day

• Avoid extra iodine, including iodized salt and kelp, since iodine can aggravate acne

• Avoid commercial soft drinks, since some contain brominated vegetable oils as stabilizers and bromine can aggravate acne

• Avoid trans-fatty acids and hydrogenated oils (margarine, vegetable shortening, imitation butter spreads, most commercial peanut butters), and oxidized fats (deep fried foods, fast food, barbequed meats)

• Avoid consumption of all dairy products, since they contain hormones which may aggravate acne

• Avoid food intolerances and allergens, along with simple carbohydrates, fried foods, fatty foods, rich foods, chocolates, nuts, coffee, alcohol, sugar, smoking, red meats, shellfish, bamboo shoots, white mushrooms

• Consider elimination diet to rule out allergens or do an Elisa test for food allergens with your physician

Food Suggestions

• Plant foods high in Vitamin A  to correct defect in keratinization of sebaceous follicles – eat more carrots, beets

• Plant foods high in B-vitamins to increase lipid metabolism, support adrenal function which will reduce inflammation – eat more shiitake or crimini mushrooms, avocado, corn and sweet potatoes

• Plant foods high in Vitamin C to improve collagen formation, prevent scars, adrenal support – eat more fresh fruits 

• Plant foods high in Vitamin E to prevent lipid peroxidation of sebum and to maintain Vitamin A levels – eat more sunflower seeds, almonds, turnip greens, spinach, and Swiss chard

• Plant foods rich in Zinc reduce excess hormones – eat more sesame seeds, pumpkin seeds, and oats

• Plant foods that cool the heat in blood and lungs (TCM) including all spices, squash, cucumbers, watermelon, winter melon, celery, carrots, cabbage, beet tops, dandelions, aloe vera, mulberry leaves, carrot tops, lettuce, potato, cherries, papaya, pear, persimmon, raspberries, buckwheat, alfalfa sprouts, millet, brown rice, mung beans

Smoothie Suggestions (serves 1)

Ingredients

• 1 cup filtered water
• 1 heaping tbsp Purefood A-Z (10 g)
• 1 scoop Purefood B (1.5 g)
• 1 scoop Acerola C (2.5 g)
• 1 tsp organic raw chia seeds (6 g)
• 2 tsp organic raw sesame seeds (11.2 g)
• 1 medium organic apple (125 g)
• 1 heaping twp raw cacao (5.8 g)

• Organic fruit juices to replace water for taste
• Organic raw flaxseed to replace chia seeds (omega 3)
• Organic raw pumpkin seeds or walnuts to replace sesame seeds (zinc)
• Fresh organic pear or banana to replace apple ( fiber, nutrients, and flavour)

Ingredients                                                                        

• 2 medium organic carrots (256g)                                                    
• 1 medium organic apple (125 g)                                                     
• 2 leaves organic turnip greens(27g)

Directions                                                                        
Wash produce well. Cut carrots and apples in small enough peices to feed through your juicer. Juice, combine, drink slowly and enjoy!

• Organic beets to replace carrots (vitamin A and other carotenoids)
  
• Organic pear to replace apple (nutrients, and flavour)
  
• Organic spinach or Swiss chard to replace turnip greens (Vitamin E)

Ingredients                                                                        

• 2 medium stalks organic green leafy lettuce (65g)                                  
• 1/2 medium stalk organic Swiss chard (50g)                                         
• 1/4 cup chopped raw organic walnuts (34g)                                          
• 1/4 cup raw organic pumpkin seeds (52g)                                            
• 1/2 medium organic avocado (110g)

Directions
Wash greens well and tear into bite size pieces. In a medium bowl toss greens, nuts and seeds, and avocado. You may use an organic salad dressing of your choice or select one to make from our recipes section. See substitutions box for other ingredient options.

Substitutions

• Kale, spinach, collard greens or turnip greens to replace Swiss chard (vitamin A and E)
• Tofu, sprouted soybeans to replace walnuts (omega 3)
• Sesame seeds to replace pumpkin seeds (zinc)
• Additional option, top with lean organic meat , cooked well
• Optional- Add finely chopped onions

Salad Dressing Suggestions (serves 1)

Ingredients                                                                        

• 1 tsp raw organic apple cider vinegar (5ml)                                        
• 1 tbsp (15 ml) organic flax and borage oil combination (see brands below)        
• 1 small garlic clove finely grated (3 g)                                           
• 1 tsp fresh or dried oregano (1g)                                     
• 1 tsp fresh parsley finely chopped (2g)                                            
• Pinch of Himalayan sea salt to taste

Directions                                                                        
In a small bowl, whisk together apple cider vinegar and oil until well combined. Mix in crushed garlic, oregano, parsley and sea salt. You may also combine all ingredients in a blender. Serve on fresh salad and enjoy.

Substitutions

• Only a few companies sell a blend of organic flax and borage oil - the two that we recommend are Barlean's and Spectrum Organics. You can find these in the refrigerated oils section at your health food grocer.
• Substitute apple cider vinegar with fresh lemon juice
• Substitute garlic with  organic chives, finely chopped

Herbal Tea Suggestions

• Burdock root, Dandelion root, Oregon grape: place 1 teaspoon each in 3 cups of water in a pot, bring to boil, simmer for 5 minutes, steep for another 15 minutes, then drink 2 to 3 cups per day 

Topical Suggestions After washing affected areas with non-scented glycerin soap, you may try applying one of the following on waking and before bedtime:

• Dandelion poultice for cleansing
• Aloe vera gel tonifies the skin and tightens pores
• Bentonite mask for oily skin
• Tea tree oil for fungal lesions
• grated Cucumber for cleansing and hydrating
• rub Watermelon rind for cleansing and hydrating
• grated Lemon peel for infectious lesions
• Honey for healing and antifungal and antibacterial properties

Stress Management Suggestions When the body and mind is in a reactive or sympathetic mode, large amounts of excitatory catecholamines (including epinephrine, norepinephrine and cortisol) are released which can aggravate the condition leading to hyperactivity, restlessness, insomnia, anxiety, fear and even panic attacks.  Breathing and breathing exercises becomes very important to shift from reactive sympathetic state to a parasympathetic and calm state.  Being aware of your breathing pattern (especially when you hold your breath or breathing fast), practice slow and regular breathing, having a good sitting or standing posture, avoid multi-tasking and slowing down your pace would greatly reduce your stress hormones and neurotransmitters.

Stress reaction leads to the release of cortisol from the adrenal glands along with sex hormones including estrogen and testosterone.   These fluctuating levels can worsen your condition.  In order to regulate adrenal function:

• Maintain regular sleep/wake cycles; this will coincide with a healthy glandular rhythm (your internal clock)
• Get adequate sleep every night; lack of sleep with lower your stress tolerance and induce stress hormones
• Eat 4 regular meals a day (3 meals and a snack) including a complex carbohydrate and/or protein at each meal
• Exercise only during the day;  exercise in the evening can disrupt your sleep cycle and cause insomnia
• Praying, meditating, reading and taking a bath in the evening helps to slow down your mind and body before bed
• Watching TV, emailing, playing video games, and socializing are not considered relaxation and may disturb sleep
• Staying positive, being grateful and compassionate, and enjoying a good laugh each day also helps

Other Suggestions

• Avoid female hormones, including birth control pills, which have an antagonist effect with vitamin E
• Exposing the skin to sunshine and fresh air is good for the skin.  

Naturopathic Medicine

• Acne usually isn't a serious medical condition. But you may want to see a naturopathic physician for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne and the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask your physician if your acne can be controlled or if your scars can be diminished.  
• Ask your naturopathic doctor about administering Mesotherapy to help heal the skin and reduce scarring.
• Ask your naturopathic doctor for a food allergy test may be important in discovering allergens that may cause or aggravate acne.  See you naturopathic doctor about an Elisa blood test for food allergens.
• Besides the tea, ask your naturopathic doctor about using any of the herbs in tincture or capsule form

Click “Ask the Doctor”

References

www.whfoods.org  
www.nutritiondata.self.com 
www.ndb.nal.usda.gov/ndb/foods/list  
www.vitasearch.com  

This article is for educational purposes only. This information has not been evaluated by Health Canada nor the Food and Drug Administration.  This information is not intended to diagnose, treat, cure, or prevent any disease.