Despite hundreds of years of research and millions of dollars spent on studies and drug trials, treatment options to address acne have remained the same for decades.
All of them come with side effects (some more severe than others). In many cases, they don't offer long-term relief, and often they don't work at all.
This headline is from way back in 2011, “further research is urgently needed for effective non-antibiotic treatments for acne, given the concerns of long-term antibiotic use and bacterial resistance.”
And just last year, in June 2019: “Probably the most alarming research relates to what we are doing to cause massive changes to the microbial landscape of our bodies”.
I hope to provide insights into what might be contributing to your acne problems and provide some suggestions for creating a “healing space”, relieving acute symptoms, supporting the long-term, healthy functioning of your skin, and reducing the chances of complications associated with treatment options.
There are some harsh facts about your acne. The problem isn’t dirt, dead skin cells, poor hygiene, or even sebum. It’s our modern world …
True acne (not whiteheads and blackheads) was once thought to be an infectious disease, today we know true acne is a chronic inflammatory disease.
Acne is the 3rd most commonly reported skin issue.
Conservative estimates: 80% of Americans are affected by acne at least once in their lives.
1/2 of people with acne have a genetic component involved. The numbers are growing.
Evidence suggests acne is on the rise among young people and adults. A 2016 study from the University of Colorado found that between 1990 and 2010 acne rates increased 11% among teens. Recent research on adult acne indicates it’s on the rise for both young women and young men.
One thing we’re certain about now, is that acne is a “modern industrial world” problem rooted in chronic inflammation.
Many people believe wrongly that until the modern era and all of its’ medical miracles - life, for everyone everywhere on the planet was brutish and short.
This is a lie.
What can our ancestors tell us about the widespread increase in acne today?
For the past 20 years, I have been reading the work of researchers who studied healthy isolated, indigenous populations who were still following their traditional foodways early in the last century. “Primitive” people, untouched by the modern world, don’t really exist anymore but the work of the “Nutrition pioneers” sure does! Their work shows us that many “primitive” populations didn’t suffer from modern inflammatory diseases at all, regardless of where they lived on the planet, or their incredibly different diets, environments, and lifestyles.
This research from not too long ago (20 years) surprised a lot of people (but not others, me included): Among the Kitavan people living on isolated islands near Papua New Guinea and the remote Aché people of Paraguay not one person in either population of any age had acne - zero, none, zip, non-existent.
Dr. Weston Price would not have been surprised one bit by the robust health of the
Kitavan and
Aché people!
This is an image of the isolated, primitive Swiss mountain villagers taken in the early 1900s. These people had very little contact with the outside world for hundreds of years. They were shockingly healthy for the time. People all over Europe were dying in large numbers from TB and other infectious diseases at alarming rates. The robust Swiss villagers were studied by Dr. Weston Price. Not only did these hardy people live long, healthy lives, but they also suffered from no modern-world inflammatory diseases, and no poor physical development - or ACNE. These people and their way of life no longer exist.
Not only did these isolated tribal people have ZERO acne, but notice also the perfect teeth and wide, well-developed facial structure, just like the robust Swiss alpineers from the same time, and “primitives” ALL OVER THE WORLD!! Long-lived Healthy people EXISTED and THRIVED. Not anymore.
CURRENT TREATMENTS: What do relevant studies suggest?
Current treatments have remained the same for decades. Very briefly this is from a 2019 review of relevant studies:
“No new clinically meaningful therapies have been approved in more than a decade. Although many acne medications work well if used properly, the complex combination treatment regimens required to target different aspects of acne pathophysiology lead to poor adherence, which undermines treatment success. Side effects of treatments are common. Benzoyl peroxide, for example, causes redness and peeling; oestrogen hormones are unsuitable for boys; the overuse of broad-spectrum antibiotics is thought to lead to antibiotic resistance and to damage microbiota; and retinoids can cause red, sore skin that blisters and becomes sensitive to sunlight. The possible side effects of isotretinoin include hyperlipidaemia, abnormal liver function tests, loss of night vision, depression, and suicidal thoughts. Isotretinoin is also extremely teratogenic (and) taken with great caution.” (note: Isotretinoin (Accutane) is the most potent inhibitor of sebum secretion).
With modern genome sequencing, there is hope on the horizon! In the same report: “scientific advances in the understanding of acne complexity are revealing new targets for development. Many receptors, cytokines, chemokines, and other proinflammatory mediators are implicated, and nutrition, the skin microbiome, and genetics of both the patient AND the bacteria living in the follicle may also be involved”.
Other novel treatments that warrant more study are Bee Venom topical treatments:
What are these treatments targeted at?
Well, I am going to skim over this for now. Why? First, because it is a long and complicated list. And second, by understanding just a little about how skin functions, you’ll have a better understanding of your acne issues a lot better. You might also gain some intuition as to how to authentically nourish your vital, hardworking skin organ! Because your skin does love you, learn how to love it back!
So, let’s jump right in.
THE ACID MANTLE: aka our Moisture Barrier
You might have heard the term “moisture barrier”? This is the Acid Mantle. It goes by other names too; protective barrier, hydro-lipid film, etc.
Our skin is made up of layers. The very top is our Stratum Corneum. On top of our SA lies a thin, protective hydro-lipid film.
"Hydro" for moisture and "lipid" for sebum.
This is the Acid Mantle: an anti-bacterial and fungicidal biofilm. It’s created by the skin organ itself with natural skin oils, water from the underlying tissue, and naturally occurring skin compounds including lactic acid, cholesterol, ceramides, amino acids, hyaluronic acid, etc.
The very foundation of strong, resilient skin depends, in large part, on the continuous renewal of this protective film. We can not replicate it, but we can support its creation, or impair it!
The Acid Mantle is our front line of defense, protecting us from invading bacteria, viruses, fungus, mold, toxins, pollutants, dust, pollen, sun damage.
When the Acid Mantle is damaged, weak or impaired, the skin microbiome will become unbalanced and acne causing bacteria can easily proliferate.
Preserving and nurturing the Acid Mantle also nurture’s and supports our skin's native flora, the Skin Microbiome, which in turn impacts our immune health. MILLIONS if not BILLIONS of microscopic creatures reside in the Acid Mantle where they perform vital biological functions. And just like in our guts, many things can shift the balance of from the good bugs to the bad bugs living on us.
THE SKIN MICROBIOME
Skin bugs may determine who gets outbreaks and who doesn’t. One particular strain of acne-causing bacteria living on the skin of people without acne was the subject of a recent study.
The results were surprising. When they sequenced the genome of the bacteria from those with active acne and those without, they discovered two unique strains of P. acnes found in 20% of participants with pimples, but close to non-existent among those with healthy skin. They found something else of interest, 1. another strain of P. acnes was found among the volunteers with healthy skin, and 2. this strain of P. acnes was quite rare in participants with acne.
So is there “good” and “bad” p. acnes??
It sure looks like it! The study authors think that the "good" strain has a natural defense mechanism able to target and eliminate bad bacteria before they can infect the cell. UCLA study could explain why some people get zits and others don't.
In this study, 13,000 adolescents were evaluated. Those with acne were more likely to have constipation, bad breath (halitosis), acid reflux, and bloating (highly correlated with acne, 37% of kids with acne report bloating).
We’re just starting to understand the many roles these beneficial creatures play in protecting us from our often hostile environment and informing our immune system beyond the skin through immune system modulation. LEARN MORE ABOUT OUR SKIN MICROBIOME. I go into more details there.
And for relevant research, check out: Potential Role of the Microbiome in Acne: A Comprehensive Review, 2019 “It is increasingly believed that the interaction between skin microbes and host immunity plays an important role in this disease, with perturbed microbial composition and activity found in acne patients”.
So, there is hope for better therapies in the (hopefully) not to distant future!
why skin pH is so important
The Acid Mantle and Skin Ph have been hot topics on skin care blogs recently. You’re learning WHY.
OPTIMAL SKIN PH
An appreciation for an optimal skin pH is not only vital in understanding how to support healthy skin, simply addressing the factors which disrupt. Maintaining optimal skin pH can actually resolve mild skin issues including mild acne, and help restore the Acid Mantle.
The Acid Mantle must remain within a certain, slightly acidic pH range to perform its vast array of functions. This is somewhere between 5.4 and 5.9 on most parts of our body.
The difference between 5.5 (a skin-friendly pH) and 7 (neutral) may seem small but it’s quite significant. Even our tap water, which is generally neutral, is not desirable from your skin’s perspective.
If the skin pH increases to 6.5 or higher it becomes vulnerable to damage and penetration by pathogenic bacteria which cause acne, and those associated with eczema and rosacea to name a few. An alkaline substance often called for in DIY recipes to help those with acne include baking soda! Please, don’t ever put baking soda on your skin in any form or any concentration!
More bad news? 31 moisturizers ranged in pH from 3.73 to a damaging 8.19 and another recent study found only about 1/3 of moisturizers had a pH “appropriate for barrier protective basic therapy.”
Dissolved minerals and chlorine in tap water, combined with overwashing in general, take a toll over time.
Anyone with skin issues at all should take a look at their tap water. Follow this link: Tap Water: how it impacts skin health. I provide more info and a map with links to finding more information about your water source so that you can take action.
Try this simple hack, Acidified with Dilute Apple Cider Vinegar, I’ll discuss this in the “suggestions” that follow. but first …
WHAT DAMAGES OUR ACID MANTLE
The vast majority of things on this list have to do with skin pH - most of them can be mitigated to some degree or another.
I strongly suggest that everyone tune into these factors and do what they can to address them from the very start to the end of life!
How, and if, addressing every one of them helps your situation depends on many factors. That said, they WILL help you get relief, support healthy skin, and help you heal. But just as important, is that by taking steps to minimize damage you are supporting long-term skin health, which is a must for many reasons.
This is a long list: Please follow the links for relevant research on these topics for further study:
Harsh dry climates, very cold or hot weather.
Exposure to chemically treated hot tubs and pools
Irritants in synthetic soaps and fragrance
Anything with a basic pH:
Tap water discussed above: has a neutral pH of 7 pH or higher, contains chlorine, and often has high levels of dissolved minerals that accumulate on the skin.
Overexposure to UV Radiation causes oxidative stress, cell damage, and free radical formation. (a moderate amount of sunshine is beneficial)
Skincare habits: over-cleansing, over-exfoliating, use of strong acids, laser peeling, clay masks, over-cleansing, over-reliance on and prolonged use of steroid creams.
Contact with HOT water.
Occlusive topical applications esp. heavy makeup and thick creams and seed butter (shea, mango, etc) provide food for bad bugs.
Not allowing enough time for the Acid Mantle to be restored after washing it away.
Emotional and physical stress.
Hormone imbalances
Nutrient density of the diet
Gut health: the Gut - Skin Connection
Medications, skin disorders, underlying disease: diabetes, hypothyroidism, Histamine intolerance MAST Cell Activation Syndrome, etc (all beyond the scope of this conversation).
Sleep disorders
Did I miss anything?
This discussion is not complete without looking more deeply into nutrition. The author of this study linked here provides a somewhat technical introduction to some 2015 research.
Linking diet to acne metabolomics, inflammation, and comedogenesis: an update.
Required reading
Nutrition and Physical Degeneration A Comparison of Primitive and Modern Diets and Their Effects
Written in 1939 by the once renowned researcher and “the Darwin of Nutrition”, Dr. Weston Price, it should be required reading for every high school student in America. Dr. Price was president of the National Dental Association (precursor to the American Dental Assoc.). His 25 years of study and research are foundational evidence of which the recent rise in ancestral-based diets.
Ok we are finally here …
Here are some of my recommendations for creating a “healing space” to address acute symptoms and support overall skin health. Please reach out with questions, and follow the links for more!
PAIN RELIEF: ICE AND COLD COMPRESSES
Direct Ice:
The fastest, most effective way to relieve pain and swelling is with ICE: Wrap a piece of ice in a paper towel and hold on the blemish for 5 - 10 minutes.
Cold Compresses:
Soak a clean washcloth in water with ice in it, press the cloth to the inflamed areas for 5 minutes, soak the rag in the ice water again, and repeat for 20 minutes.
Add healing compounds to the ice water by steeping herbs in hot water, straining, and cooling before adding ice. Make your ice with herbal-infused water. (green tea, comfrey, calendula, lavender, witch hazel, rosemary)
Soaked chamomile tea bags can also be used for compressing.
Instead of water, use Aloe juice for your “water”.
Sat: Dissolve 1 T of salt into 1 cup of water. It will sting a little, discontinue if unbearable.
Oat water: make some oatmeal with a lot of water, strain, and use the cooled water for your compress.
Add honey to the water: Honey is anti-inflammatory and can help calm the skin.
ORAL ANTI-INFLAMMATORIES (NSAIDS)
Reduces pain and swelling. However, these drugs can cause further gut microbiome imbalance.
ANTIHISTAMINES:
They can help too, allergic reactions can be initiated by the irritation caused by the disease process. 2 studies show histamine reduces sebum production and improves acne symptoms. Antihistamine: A Useful Medication with Minimal Adverse Drug Reactions t Reactions to Improve Acne Sympt e Acne Symptoms and Reduce Sebum oms and Reduce Sebum Production
DON’T PICK OR POP YOUR PIMPLES:
You already know this but it bears repeating - you're just causing more damage, and inflammation, spreading the pathogenic bacteria to other cells, forcing the pus even deeper. Repeated popping and squeezing increases the likelihood of scarring.
RESIST THE URGE TO USE HOT WATER FOR BATHING AND WASHING
SUNLIGHT and ARTIFICIAL LIGHT THERAPY:
There are several very different theories about how sunlight and artificial UV light (e.g. in tanning beds) affect acne. Some people think that UV light improves acne, and others believe that it makes acne worse. There's no evidence that it has any benefits and we know it can cause damage.
Artificial light therapy (red and blue) High‐quality evidence on the use of light therapies to treat acne is lacking. This review of the studies that have been conducted discovered data reporting problems, sample sizes, and notable, conflicts of interest (studies done by makers of light therapy devices). The authors state “Well-planned studies, using standardized outcome measures, comparing the effectiveness of common acne treatments with light therapies would be welcomed”.
REDUCE IRRITATION:
When skin is already irritated and inflamed anything will lead to further irritation. Makeup, sunscreen, lotions, oils, etc. can all cause problems making life hard to live, but it’s the facts. Acne-causing bacteria proliferate by consuming oils, so they thrive on sebum (oils) produced by the skin and those applied topically. So caution is advised. Oil Cleansing can cause problems, and so can the use of oil/butter-rich creams and facial oil.
SKIN FASTING:
Allow your skin to be free of topical applications for as long as possible. 8-12 hours a day - especially makeup. Makeup is a major contributor to acne: it clogs pores, disrupts the skin acid mantle, provides food for bad bugs, and seals in skin oils, as well as food for the bad bugs.
HONEY: PURE RAW OR BETTER YET, MEDICATED:
Nothing soothes and calms the skin like honey - for most people (unless you have an allergy or some other underlying problem). Any pure raw honey brings benefits to our skin but special single-source medicinal grade honey, Manuka and Kanuka, are available. They can be taken internally and also used for topical relief of irritated, inflamed skin. Go ahead and check out my article Beauty and the Bee: Nourishing and Healing the Skin with Honey and HOW CAN THE TOPICAL APPLICATION OF PURE RAW HONEY HELP?
SAFE TONERS:
Most conventional toners contain alcohol which will further damage your skin. When considering the health of the Acid Mantle and what it needs to function properly, the toning step, with a gentle toner is required (remember what I mentioned above about tap water pH). Balanced skin pH is VITAL for the healthy functioning of our skin! When the skin pH is too basic (meaning higher than 6) we are asking for trouble. If skin pH rises to 6.5 or higher it’s vulnerable to penetration by pathogenic bacteria acne-causing bacteria, and bacteria involved in eczema and rosacea, to name 2 more. Tap water has a pH of 7, healthy skin between 4.5 - 5.5
MOISTURIZING: It is very common for those to experience skin that has become “dehydrated at the surface” - we wrongly describe this condition as “dry skin” when in fact the skin produces plenty of skin oils but is unable to retain moisture due to impairment of the Acid Mantle. One of the first signs of an impaired Acid Mantle is, in fact, dehydrated skin, and skin stripped of natural oils and Natural Moisture Factors. Take a peek at my article Dry Skin + Healthy Aging for a lot of insights into this situation.
PRESCRIPTION TOPICALS: If your situation requires help from a dermatologist, remember they’re short on options as spelled out in the introduction above. If you need to resort to prescription products, consider treating just the active outbreaks, and spots that feel like they are developing. Avoid or minimize the use of prescription washes.
NON-PRESCRIPTION OPTIONS: Two to consider
Adapalene .1% topical gel (the Differin brand company website wrongly states that adapalene is a “new” treatment it isn’t new at all .1% adapalene ointments have been over the counter since 1996 (hardly new!) The .3% gel is by prescription only. Worth a try however if you are getting ready to resort to stronger meds.
A completely different approach would be Control Correctives and Salicylic Acid (2%) Acne Spot Treatment.
HOMEOPATHY FOR ACNE: Go out and get some homeopathic remedies!! They will not interact with any drug or herbal supplement, and the results can often be dramatic! I am a huge “believer” in homeopathy! Or seek the advice of a Homeopathic practitioner in your area. Homeopathy options, lists symptoms and 6 different specific remedies for your particular situation. Hylands and Borion are both top brands.
RESIT THE URGE TO GET A FACIAL! They often lead to more problems!! Especially do not seek out facial treatments when you are actively having severe outbreaks! This is the time for cold compresses and honey masks.
ACIDIFY THE ACID MANTLE: HOW TO RE-ACIDIFY THE ACID MANTLE