Skin Problem/Acne. Papules inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch

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1 Skin Problem/Acne What Is Acne? Acne is a disorder resulting from the action of hormones and other substances on the skin's oil glands (sebaceous glands) and hair follicles. These factors lead to plugged pores and outbreaks of lesions commonly called pimples or zits. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Although acne is usually not a serious health threat, it can be a source of significant emotional distress. Severe acne can lead to permanent scarring. How Does Acne Develop? Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the body, PSUs consist of a sebaceous gland connected to a canal, called a follicle, that contains a fine hair. These units are most numerous on the face, upper back, and chest. The sebaceous glands make an oily substance called sebum that normally empties onto the skin surface through the opening of the follicle, commonly called a pore. Cells called keratinocytes line the follicle. The hair, sebum, and keratinocytes that fill the narrow follicle may produce a plug, which is an early sign of acne. The plug prevents sebum from reaching the surface of the skin through a pore. The mixture of oil and cells allows bacteria Propionibacterium acnes (P. acnes) that normally live on the skin to grow in the plugged follicles. These bacteria produce chemicals and enzymes and attract white blood cells that cause inflammation. (Inflammation is a characteristic reaction of tissues to disease or injury and is marked by four signs: swelling, redness, heat, and pain.) When the wall of the plugged follicle breaks down, it spills everything into the nearby skin sebum, shed skin cells, and bacteria leading to lesions or pimples. Other troublesome acne lesions can develop, including the following: Papules inflamed lesions that usually appear as small, pink bumps on the skin and can be tender to the touch Pustules (pimples) papules topped by white or yellow pus-filled lesions that may be red at the base Nodules large, painful, solid lesions that are lodged deep within the skin Cysts deep, painful, pus-filled lesions that can cause scarring. 1

2 What Causes Acne? Hormones- Common acne in teenagers starts with an increase in hormone production. During puberty, both boys and girls produce high levels of androgens, the male sex hormones that include testosterone. Testosterone signals the body to make more sebum, a waxy substance that helps the skin retain moisture. Androgens also boost the production of keratin, a substance used by the body to make hair and nails. Hormonal changes related to birth control pills, menstrual periods, and pregnancy can trigger acne. Bacteria - Excess sebum clogs the openings to hair follicles -- especially those on the face, neck, chest, and back. Bacteria grow in these clogged follicles. This makes blackheads or whiteheads form on the skin's surface -- a condition called non-inflammatory acne. Sometimes the follicle wall breaks under the pressure of this buildup. When this happens, sebum leaks into nearby tissues and forms a pustule -- this is called inflammatory acne. This can create cysts. Ruptured cysts leave temporary or permanent scars. Other external acne triggers include heavy face creams and cosmetics, hair dyes, and greasy hair ointment -- all of which can increase blockage of pores. Steroids taken by some bodybuilders and other athletes can also lead to severe outbreaks. Clothing that rubs the skin may also worsen acne, especially on the back and chest. So can heavy sweating during exercise, and hot, humid climates. Stress is known to trigger increased oil production, which is why many teens have a new crop of pimples on the first day of school or just before that big date. 2

3 Stress Worsens Acne Although heredity, viruses, bacteria, allergies and chemical irritants play a central role in skin problems, stress and emotions do cause some skin problems and trigger or heighten others. In a study, published in the Swedish journal Acta Dermato-Venereologica, researchers looked at the relationship between stress levels and acne severity in 94 teenagers in Singapore with an average age of 15. Most of the teenagers had mild to moderate acne. Researchers measured the teens self-reported stress levels and acne severity at a time of high stress (just before midyear exams) and at a time of low stress (two months after the end of exams). At the same time, they also measured levels of sebum, the oily substance that coats the skin and protects the hair and plays a major role in acne. Researchers say sebum production is known to fluctuate with variations in temperature and humidity, and Singapore was chosen for the study because its temperature and humidity are consistent throughout the year. The results showed that sebum production did not vary significantly during low or high stress periods. But acne severity was significantly related to the teens stress levels. Researchers say acne is an inflammatory disease, and previous studies have shown stress can trigger inflammation in the body. What Are the Symptoms of Acne? While the symptoms vary in severity, you will notice these signs on areas of the body with the most oil glands (the face, neck, chest, back, shoulders, and upper arms): Clogged pores (pimples, blackheads, and whiteheads) Papules (raised lesions) Pustules (raised lesions, with or without pus) Cysts (nodules filled with pus or fluid) The least severe type of acne lesion is the whitehead or blackhead. This type is also the most easily treated. With more extensive acne, prescribed medications are often needed to reduce the inflammation, bacterial infection, redness, and pus. 3

4 SELF CARE Nutritional Therapy According to the American Academy of Dermatology, A healthy diet is important for improving raw materials for healthy skin, There are a number of nutrients found in everyday foods that are known to promote a healthy body and therefore healthy skin. Get wise to these substances, and you ll increase your chances of conquering your acne. Vitamin A. Naturally occurring Vitamin A, or retinol, is found in fish oils, liver and dairy products. The Vitamin A produced by plants is known as Betacarotene, and is found in yellow/orange fruits and vegetable such as carrots, yams, apricots and cantaloupe, as well as green vegetables like parsley, kale and spinach. Extremely high doses of Vitamin A are toxic, so don't overdo it. Betacarotene is used by the body to make vitamin A and helps to heal the skin. Vitamin B may help for premenstrual or mid-menstrual-cycle acne. Because the B vitamins should be taken together, take a supplement that supplies 100 milligrams of each of the major B vitamin daily. The antioxidant vitamins C and E, zinc, and selenium, are important to combating free radicals, therefore, the inflammation in the skin. Vitamin C also helps to strengthen connective tissue and thus help skin stay blemish-free. Zinc is also important in maintaining normal blood level of vitamin A, aids in the normal functioning of the oil-producing glands, and to heal skin and mucous membranes. Omega-3 essential fatty acids (EFAs). Flaxseed and primrose oil are good sources of omega-3 essential fatty acids (EFAs). Acne may be a manifestation of EFA deficiency. Take 2 teaspoons of flaxseed or primrose oil daily. Calcium and magnesium relax a stress nervous system and are helpful for those who experience flare-ups due to nervousness. These minerals also reduce sugar cravings, which may perpetuate acne. Take 750 milligrams of calcium and 375mg of magnesium twice daily, between meals. Chromium helps decrease sugar cravings and keeps blood sugar balanced so you are not driven to consume loads of sugary junk food. Acidophilus and bifidus restore the friendly bacteria in your intestines, cleansing and strengthening your digestive system to function more efficiently. This results in the presence of fewer toxic metabolites that can show on the skin. 4

5 10 Foods That Nourish Your Skin & Prevent Acne Prevent Acne From The Inside With These Foods: 1. Organic Green Tea - This is rich in anti-inflammatory chemical called catechins, which helps to combat free radicals and prevent fine lines. 2. Olive oil - good monounsaturated fats like olive or sesame oil contain essential fatty acids that are needed for good health. Fats are an integral part of cell membranes and will help to nourish the skin and give it an inner glow. 3. Walnuts - They are rich in omega-3 oils, another powerful antioxidant that helps to keep the skin plump and flexible. Omega-3 oils are also found in oily fish such as salmon, or in flaxseed oil. 4. Berries - Blueberries, raspberries, cranberries are all rich in phytochemicals that are protective of skin cells. You can't get the same results though, from frozen or preserved fruit. 5. Lemon Juice - It's natural bleach and can be used to fade sunspots and freckles. Put a slice of lemon over the spot and leave it for 10 minutes everyday for a week, or exfoliate by rubbing a cut lemon and half a teaspoon of granulated sugar over the skin for a few minutes. Be careful not to get any lemon in your eyes and stop immediately if you get a bad reaction as some people have extremely sensitive skin. 6. Watermelon - Some people believe that rubbing their faces with the rind of a watermelon will give them beautiful skin. There is plenty of truth to this, as the pulp of the fruit is a good exfoliant and watermelon is rich in vitamins A, B and C. The fruit contains a lot of water which serves to hydrate the skin and the gentle massaging action will stimulate lymphatic drainage. 7. Low-Fat Dairy Products - One the most important components of skin health is vitamin A. One of the best places to get it is low-fat dairy products. In fact, experts say that the health of our skin cells is dependent on dietary vitamin A. 8. Whole-Wheat Bread, Cereals and Brazil nuts - Dietary selenium comes from nuts, cereals, meat, fish, and eggs. Brazil nuts are the richest ordinary dietary source. The mineral selenium connects all these foods for healthy skin. Experts say selenium plays a key role in the health of skin cells. Some studies show that even skin damaged by the sun may suffer fewer consequences if selenium levels are high. 9. Yogurt - Yogurt is a very important natural beauty aid. Apply yogurt on the face every morning. Wash it off after a few minutes with cold water. This will keep the complexion smooth, healthy and fresh. A mixture of yogurt and lemon juice is ideal for softening hands. 10. Water - While the exact amount you should drink each day varies, no one disputes the role good hydration plays in keeping skin looking healthy and even young. When that hydration comes from pure, clean water - not liquids such as soda or even soup - experts say skin cells rejoice. 5

6 Diet High carbohydrates/high GI It has been suggested that there is a link between a diet high in refined sugars and other processed foods and acne. The theory is that rapidly digested carbohydrate food such as white bread and refined sugars produces an overload in metabolic glucose that is rapidly converted into the types of fat that can build up in sebaceous glands. According to this hypothesis, the startling absence of acne in non-westernized societies could be explained by the low glycemic index of these cultures' diets. Others have cited possible genetic reasons for there being no acne in these populations, but similar populations shifting to these diets do develop acne. Note also that the populations studied consumed no milk or other dairy products. Further research is necessary to establish whether a reduced consumption of high-glycemic foods (such as soft drinks, sweets, white bread) can significantly alleviate acne, though consumption of high-glycemic foods should in any case be kept to a minimum, for general health reasons. Avoidance of 'junk food' with its high fat and sugar content is also recommended. On the other hand there is no evidence that fat alone makes skin oilier or acne worse. Milk A recent study, based on a survey of 47,335 women, did find a positive epidemiological association between acne and consumption of partially skimmed milk, instant breakfast drink, sherbet, cottage cheese, and cream cheese. The researchers hypothesize that the association may be caused by hormones (such as several sex hormones and bovine IGF- I) present in cow milk. Though there is evidence of an association between milk and acne, the exact cause is unclear. Most dermatologists are awaiting confirmatory research linking diet and acne but some support the idea that acne sufferers should experiment with their diets, and refrain from consuming such fare if they find such food affects the severity of their acne. Seafood Seafood often contains relatively high levels of iodine. Iodine is known to make existing acne worse but there is probably not enough to cause an acne outbreak. Still, people who are prone to acne may want to avoid excessive consumption of foods high in iodine. 6

7 Dietary Advices Your digestion is not what it could be, and that this is having a knock-on effect on your skin. In this case, you may want to seek the advice of a qualified nutritionist to take you through a full nutritional program or any changes you wish to make. Because of the diverse nature of skin disorders and all the different underlying causes it is impossible to give blanket dietary guidelines which apply to everyone. So below are broad guidelines for an optimum diet: Dos Water: Have six glasses each day Colorful fruit and vegetables: Have five daily servings, including red/orange/yellow vegetables and fruits, purple foods, green foods, onions and garlic, and seed foods such as peas. Fresh seeds: Each day have one tablespoon of mixed fresh seeds, e.g. pumpkin, sunflower, sesame or ground hemp/linseed. Essential fats: Have a tablespoon of cold-pressed seed oils daily and oily fish three times a week. Fiber-rich foods: Eat plenty of whole grains, root vegetables, lentils and beans. Organic foods: Eat organic as far as possible. Alternatives to dairy products: Try sometimes using alternatives to milk and cheese such as Soya, milk and tofu. Vegetable sources of protein: Include some Soya, beans, lentils and sprouted seeds. Yoghurt: Have low-fat, live, organic yoghurt. Alcohol: Avoid completely or limit your alcohol intake. Tea and coffee: Have no more than two cups a day. Vegetable oils: Limit vegetable oils to a little olive oil and/or cold pressed sunflower or other oils. Red meat: limit red meat to no more than three times a week. Have fish, organic chicken or game instead. Grain foods: Limit foods made from wheat, oats, rye, etc. to one or two portions each day. Sugar: Don't add sugar to drinks and cereals, and avoid sugary foods such as soft drinks, sweets, jams, many cereals, biscuits, cakes and desserts. Refined carbohydrates: Don't have foods containing white flour, such as bread, biscuits, cakes, pastries and pasta. Fried foods: Don't have fried foods. Boil, steam, bake or lightly grill them instead. Chemicals: Don't have foods containing chemical additives. This includes most canned, preserved or processed foods. Fatty foods: Don't have foods like butter, cream and ice cream. Processed fats: Don't have processed foods as most of them contain trans-fats. Smoking: Don't smoke at all. 7

8 Following these guidelines, a day s meals might look like this: Breakfast: Natural, live yoghurt with chopped fresh fruits and a handful of pumpkin seeds or a muesli made from oats, fresh hazelnuts, sunflower, pumpkin and sesame seeds and raisins with natural yoghurt and some apple juice. Lunch: A baked potato with tuna fish, tomato, celery and spring onion, with olive oil and lemon juice or a big rice salad with many types of fresh vegetables, cottage cheese, pumpkin seeds, olive oil, lemon juice and freshly ground black pepper. Dinner: Grilled fresh fish, chicken or lean meat or a vegetarian alternative made from beans, lentils or Soya. Serve with a large helping of freshly steamed or lightly stir-fried vegetables. You can also 'steam-fry' vegetables by using just the tiniest drop of oil and adding a couple of tablespoons of water, to, in effect, steam them. Snacks: Fresh fruit, raw nuts and seeds (e.g. almonds, hazelnuts, Brazils, pumpkin and sunflower seeds); raw vegetables (e.g. carrots, broccoli, celery) with hoummous. Drinks: At least six glasses of water, herbal and fruit teas (beware of artificially flavored or sweetened ones), fresh fruit and vegetable juices, occasional 'smoothies' - freshly made with fruits/fruit juices and yoghurt or Soya milk. Common Care Get regular exercise, preferably outdoors in the fresh air. Avoid a Sunburn or Suntan. A sunburn that reddens the skin or suntan that darkens the skin may make blemishes less visible and make the skin feel drier. However, these benefits are only temporary, and there are known risks of excessive sun exposure, such as more rapid skin aging and a risk of developing skin cancer. Get enough restful sleep each night. Use drying astringents no more than once a week, being careful not to irritate your skin and thus worsen acne. Do not squeeze pimples, pustules, whiteheads. This can cause infection and scarring. Do not lean or block acne lesions with your hands or other objects. This will make them worse. If you wear makeup, use oil-free, water based products. Remove any makeup completely every night before going bed. Use flesh-tinted anti-acne lotions such as Clearasil to cover acne instead of covering blemishes with make up. Wash your hand regularly, especially if it is oily. Do not use oily conditioners or hair gels. Try to keep your hair off your face. 8

9 Herbal Treatment Calendula soap, made from marigold flower, is good for helping to clear blemishes. Wash with it twice a day, using warm water alternating with cold water. A combination of calendula and witch hazel also makes an excellent cleanser. Mix equal parts of liquid calendula extract and distilled witch hazel and apply this to the lesions three times a day. Make a goldenseal and tea tree oil paste by mixing ½ teaspoon of powdered goldenseal root with 12 drops of tea tree oil. Apply the resulting paste to the acne lesions and leave it on for twenty minutes before rinsing it off. Repeat twice a day, this has been found to be extremely effective. A combination astringent lotion made by mixing equal parts of liquid marigold and chickweed extracts and distilled witch hazel can be applied to blemishes three times a day. Use a clay masque for deep cleansing. Mix 1 teaspoon of green clay in a little water, until a paste is formed. Apply this to areas of oily and leave it on for fifteen minutes before washing it off with warm water. Lemon juice diluted in water has an antiseptic effect when applied twice a day. The following herbs have been noted to help acne when taken orally: Burdock root. Take 500mg three times a day. Echinacea and goldenseal. Take 500mg of Echinacea with 300mg of goldenseal 3 times a day. Grape seed or pink dark extract. Take 250mg 3 times a day. Blue flag, cleavers, Echinacea, figwort, and poke root. Make a tea containing equal parts of these herbs, and drink a cup three times a day to help support the metabolism of fats and carbohydrates, and to promote healthy elimination. Red clover, Echinacea, nettle, burdock root, dandelion root, licorice root, and ginger. Make a tea containing four parts red clover, two parts each Echinacea, nettle, burdock root, and dandelion root, and one part each licorice root and ginger. Drink one cup 3 times a day to aid in eliminating toxins. Alternative Ways Doing breathing exercises outdoors in the fresh air and sunlight is very helpful. Learn relaxation and/or meditation techniques to reduce stress. Yoga can be helpful, as there are specific poses which increase the blood flow to the face. Lymphatic drainage massage helps to drain accumulated toxins and clear severe acne. Reflexology-massage of the hands and feet focusing on parts that correspond to the liver, kidneys, intestines, adrenal glands, thyroid, and diaphragm is useful in the treatment of acne. 9

10 Exercise Exercise can help acne by increasing the blood flow to the skin and providing oxygen to the skin cells. Moderate sweating will clean the pores from the inside. This in turn will aid skin health and reduce acne by both preventing further outbreaks of acne and helping existing acne disappear. Spots and blackheads will heal quicker and scars will fade. Exercise will improve the fitness of your internal organs so they will be able to work more efficiently. Improved cardio-vascular fitness will mean your heart and lungs will get oxygen round your body more effectively. Your liver, kidneys and bowel will be able to work better to get the right nutrients out of the food you eat and get toxins out of your system more quickly. Exercise rebalances hormones and reduces stress both are precursors of acne. Types of exercise You don't have to overdo it or partake in a sport you don't enjoy. Find something you enjoy doing and practice it regularly. Try and find time to exercise outdoors, the fresh air and sunshine will further reduce your acne. Suitable exercise includes cycling, rowing, swimming, jogging, brisk walking, and team sports. Swimming is especially good for acne as you're in water and are cleaning the skin from the inside and outside. Just make sure you rinse the chlorine (or salt if you're lucky enough to live near the sea) off as soon as you finish. You don't have to get hot and sweaty - you can try exercise like yoga and t'ai chi which also calm the mind. Hygiene Make sure you shower as soon after exercising as possible to wash away the sweat where bacteria can grow. This is especially important if you have acne on you back and chest. 10

11 When Should I Call My Doctor? Whether you have a few pimples, or more serious acne, talk to your primary health care provider about treatments. Treating acne early is the key to avoiding permanent scarring. Available treatments There are many products sold for the treatment of acne, many of them without any scientifically-proven effects. Generally speaking successful treatments give little improvement within the first week or two; and then the acne decreases over approximately 3 months, after which the improvement starts to flatten out. Many treatments that promise big improvements within 2 weeks are likely to be largely disappointing. However short bursts of cortisone can give very quick results and other treatments can rapidly improve some active spots, but not usually all active spots. Modes of improvement are not necessarily fully understood but in general treatments are believed to work in at least 4 different ways (with many of the best treatments providing multiple simultaneous effects: normalizing shedding into the pore to prevent blockage killing P. acnes anti-inflammatory effects hormonal manipulation A combination of treatments can greatly reduce the amount and severity of acne in many cases. Those treatments that are most effective tend to have greater potential for side effects and need a greater degree of monitoring, so a step-wise approach is often taken. Many people consult with doctors when deciding which treatments to use, especially when considering using any treatments in combination. There are a number of treatments that have been proven effective: Topical bactericidals Widely available OTC bactericidal products containing benzoyl peroxide may be used in mild to moderate acne. The gel or cream containing benzoyl peroxide is rubbed, twice daily, into the pores over the affected region. Bar soaps or washes may also be used and vary from 2 to 10% in strength. In addition to its therapeutic effect as a keratolytic (a chemical that dissolves the keratin plugging the pores) benzoyl peroxide also prevents new lesions by killing P.acnes. Other antibacterials that have been used include triclosan, or chlorhexidine gluconate but these are often less effective. Topical antibiotics Externally applied antibiotics such as erythromycin, clindamycin, Stiemycin or tetracycline aim to kill the bacteria that are harbored in the blocked follicles. Whilst 11

12 topical use of antibiotics is equally as effective as oral, this method avoids possible side effects of stomach upset or drug interactions (e.g. it will not affect the oral contraceptive pill), but may prove awkward to apply over larger areas than just the face alone. Oral antibiotics Oral antibiotics used to treat acne include erythromycin or one of the tetracycline antibiotics (tetracycline, the better absorbed oxytetracycline, or one of the once daily doxycycline, minocycline or lymecycline). Trimethoprim is also sometimes used (offlabel use in UK). It has been found that sub-antimicrobial doses of antibiotics such as minocycline also improve acne. It is believed that minocycline's anti-inflammatory effect also prevents acne. These low doses do not kill bacteria and hence cannot induce resistance. Oral antibiotics such as Doxycycline have better results on the treatment of acne. [26] and generally will work better if started with at a higher dose. Hormonal treatments In females, acne can be improved with hormonal treatments. The common combined oestrogen/progestogen methods of hormonal contraception have some effect, but the anti-testosterone, Cyproterone, in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels. Diane-35 is not available in the USA, but a newer oral contraceptive containing the progestin drospirenone is now available with fewer side effects than Diane 35 / Dianette. Both can be used where blood tests show abnormally high levels of androgens, but are effective even when this is not the case. Along with this, treatment with low dose spironolactone can have antiandrogenetic properties, especially in patients with polycystic ovarian syndrome. If a pimple is large and/or does not seem to be affected by other treatments, a dermatologist may administer an injection of cortisone directly into it, which will usually reduce redness and inflammation almost immediately. This has the effect of flattening the pimple, thereby making it easier to cover up with makeup, and can also aid in the healing process. Side effects are minimal, but may include a temporary whitening of the skin around the injection point; and occasionally a small depression forms, which may persist, although often fills eventually. This method also carries a much smaller risk of scarring than surgical removal. Topical retinoids A group of medications for normalizing the follicle cell lifecycle are topical retinoids such as tretinoin (brand name Retin-A), adapalene (brand name Differin) and tazarotene (brand name Tazorac). Like isotretinoin, they are related to vitamin A, but they are administered as topicals and generally have much milder side effects. They can, however, cause significant irritation of the skin. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products. Effective topical retinoids have been in use over 30 years but are 12

13 available only on prescription so are not as widely used as the other topical treatments. Topical retinoids often cause an initial flare up of acne and facial flushing (physiology). Oral retinoids A daily oral intake of vitamin A derivative isotretinoin (marketed as Accutane, Sotret, Claravis) over a period of 4-6 months can cause long-term resolution or reduction of acne. It is believed that isotretinoin works primarily by reducing the secretion of oils from the glands, however some studies suggest that it affects other acne-related factors as well. Isotretinoin has been shown to be very effective in treating severe acne and can either improve or clear well over 80% of patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (many of which can be severe). 13