Adult Acne

I had mild acne until i got pregnant with my second daughter, since then it got moderate to severe. I was prescribed roacutane for it, but after researching about it I decided not to take it...since then I've been trying different things, all natural, supplements, diet, etc...overall it got better but I still have some and got the scars from my previous breakouts. About 6 weeks ago I started a meditation class and now I'm getting into the habit. Just wondering what else can I do? Thanks :)

Posted Answers

SUMIT BHARDWAJ's picture

A:

JUST KEEP DONIG MEDITATION , YOU WILL GET ALL U WANT .


 Answer by SUMIT BHARDWAJ

A:

Several articles that I dug up:

Section: DERMATOLOGY

The quest for perfect skin is almost as elusive as the search for eternal youth. For most of us, the blackheads and pimples of adolescence aren't entirely a thing of the past; they can erupt premenstrually, flare during pregnancy, and return in full force during menopause. And for 10-20% of women, acne persists for decades.
Acne's origin

Common acne, or acne vulgaris, like most other medical conditions, has a broad spectrum of symptoms. (Although often confused with acne rosacea, which is usually accompanied by flushing and tiny broken vessels, it has a different cause.) Generally, common acne is classified as mild, if it consists exclusively of blackheads or whiteheads; moderate, if it includes closed, pus-containing pockets; and severe, if large nodules or cysts have formed.

Acne begins in pilosebaceous units, which consist of sebaceous glands and a single hair follicle. The sebaceous glands produce a clear, oily liquid called sebum that has two roles: to lubricate the skin and to flush out the debris that results when cells within the follicle die and are replaced. The follicle is home to microscopic organisms, particularly a bacterium, Propionobacterium acnes, which breaks sebum down into fatty acids.

When sebum is overproduced and the rate of cell turnover increases, as is often the case in adolescence, a sticky debris builds up in the follicle. The pore is blocked and P acnes proliferates. What we see is a blackhead or whitehead, or in medical terms, an open comedo or closed comedo.

If the pocket of sebum, bacteria, and debris becomes too large, the follicle will rupture, spilling its contents into the surrounding tissue. As the body's immune system tries to clean up, chemicals are released that damage these tissues. Pimples (also called papules and pustules) as well as cysts and abscesses--all of which contain dead white blood cells, bacteria, sebum, and blood serum--are byproducts of inflammation. Eventually, fibrous tissue is laid down to replace damaged cells, often forming a scar.

It isn't clear precisely what initiates this process. Sebum production is thought to be stimulated in puberty by androgens--hormones that in women are released by the adrenal glands--and there is some evidence that in older women acne results from a drop in estrogen levels.
Treatment

Acne treatments are usually directed at destroying P acnes and other bacteria, slowing the cellular turnover inside the follicular canal, and reducing the production of sebum. Regardless of the form of treatment, it usually takes at least 2-3 months to have any effect, and in some cases, the condition may worsen before it improves. The following techniques are commonly used.

* Salicylic acid, sulfur, or resorcinol: These nonprescription lotions, creams, or gels are used to treat mild acne. Although they can't prevent new blackheads or whiteheads from springing up, they can cause existing ones to dry and peel.
* Benzoyl peroxide: This is probably the most effective nonprescription topical preparation. Available in several strengths as a lotion or gel, it inhibits the growth of P acnes and slows the development of new lesions. It is sometimes used in conjunction with topical antibiotics because it helps to prevent skin bacteria from becoming resistant to their effects. Because benzoyl peroxide can irritate the skin, it's best to start with the weakest preparation and progress to stronger ones as needed.
* Retin-A (tretinoin): This topical vitamin A derivative is very effective in the treatment of comedones, papules, and pustules. It increases the production of slick-surfaced cells along the follicle walls, which dislodge the impacted sebum and allow it to flow to the skin's surface. Retin-A can trigger a proliferation of blemishes, which subsides after the first few weeks of treatment. It also causes peeling, redness, and an increased sensitivity to sunlight. Because of a theoretical link with birth defects, it may not be advised for pregnant women.
* Topical antibiotic solutions or lotions: Available by prescription, preparations such as clindamycin, erythromycin, or tetracycline can not only inhibit bacterial growth, but can also decrease the number of inflamed papules. A combination of topical erythromycin and benzoyl peroxide (Benzamycin gel) may be more effective than either alone.
* Oral antibiotics: Tetracycline, minocycline, and doxycycline, which inhibit the growth of P acnes, are the preferred treatments for moderate acne. Because antibiotics don't slow sebum production or reduce the number of comedones, it's also necessary to use topical preparations as well. All have some side effects: they make the skin more sensitive to the sun and pave the way for vaginal yeast infections. Because they discolor forming teeth, they shouldn't be used during pregnancy. Erythromycin, another antibiotic, may be a good alternative, but it isn't as effective and can cause abdominal cramping.
* Accutane (oral isotretinoin), which shrinks the sebaceous glands to curtail sebum production, is the treatment of choice for severe acne that hasn't responded to very high doses of tetracycline or erythromycin. About 40% of patients treated with Accutane are cured after one or two 4-5 month courses of treatment; another 21% require only topical medications to keep the condition under control; the rest may need oral antibiotics.

However, relief doesn't come without a price. Accutane has several noteworthy side effects. Because it has been linked with birth defects, women of childbearing age must have a negative pregnancy test before beginning treatment and use reliable contraception for a month prior to therapy, during treatment, and for 2 months afterward.

Most patients taking Accutane experience some or all of the following, most of which are reversible: conjunctivitis (pink eye), inflamed lips, nosebleeds, and abnormally dry skin, eyes, and mouth. Less common adverse reactions include difficulties with night vision, elevated blood lipids, abnormal liver function, and increased numbers of platelets, which are involved in blood clotting.

* Estrogen: High doses of ethinyl estradiol can treat severe acne by suppressing sebum production.
* Comedo extraction: The technical term for picking one's face, comedo extraction involves squeezing, pressing, or gouging the blemish, either with the fingernails or with commercially available instruments. Mother was right when she warned us against the practice because it can trigger inflammation, turning a relatively benign blackhead or whitehead into a pustule, which can leave a scar. Unfortunately, comedo extraction has been incorporated into many professional facials. If you're going to treat yourself to a salon session, ask the cosmetologist to skip this feature. If a lesion won't drain on its own, have a doctor do it.

Treatments for scars

While moderate acne can leave some scars, most red or brown discolorations eventually diminish without treatment in a few months to several years. However, scarring from more severe acne is usually permanent. In most cases, treatment can only reduce scars; it can't eradicate them.

The most common approach to superficial skin damage is collagen injection, which raises shallow scars to the level of the surrounding skin, and chemical peels, in which glycolic acid removes the top layer of skin to reduce pitting.

Deeper scars may require a type of plastic surgery called dermabrasion, in which the patient is sedated and the affected skin is frozen with a refrigerant spray. The skin is then planed with a hand-held device consisting of rotating wire brushes or stainless steel wheels to which industrial diamonds are bonded. If scars are very deep, the surgeon may need to remove the fibrous tissue and fill the depressions with skin taken from behind the ear. Once these skin grafts have healed, dermabrasion can be used to smooth the surface.
Caring for your skin

Medicine has yielded no sure ways to prevent acne, but these measures may help:

* Washing the affected areas once or twice a day with a mild soap recommended by your dermatologist. Avoid abrasive cleansers and masks.
* Reading product labels. Use only make-up and moisturizers labeled "noncomedogenic."
* Shampooing. Use an antiseborrheic shampoo to wash your hair and scalp; wear hair away from your face.
* Eating well. Research has not demonstrated a connection between acne and chocolate or any other food, but eating a balanced diet and eliminating any items you believe will trigger outbreaks could help.
* Sunning. Some doctors recommend limited sun exposure to help clear up acne. However, those who use Retin-A or are taking Accutane or certain antibiotics should avoid it altogether.


SKIN FITNESS

You? acne? no way. you're over 30 and you've never had problem skin. Still, there are those little bumps you've been noticing. They seem to take forever to disappear, and when they do, others appear someplace else. You like having things in common with your teenage daughter, but this was not what you had in mind.

Well, my friend, wake up and smell the benzoyl peroxide ... acne can pop up at any age. But you're not alone. And you can fight back.
THE INSIDE STORY

The first step to getting your complexion cleared up is clearing up confusion about what acne is and how to prevent it. At age 40 or at age 20, acne is caused by the same thing: A hair follicle pore becomes plugged with dead skin from the follicle itself. If the plug is exposed to air, it changes color and becomes an open comedo (blackhead). If it stays closed, it's a whitehead.

To become an inflamed pimple, the process is a little more complicated. The normal skin bacteria living in the follicle proliferate and come to the attention of the immune system. Infection-fighting white blood cells decide they need to be on the scene. Already you can see that you have the makings of a rumble.

Usually, however, it's not until the night before your driver's-license photo session that the follicle walls deep in your skin decide they can't take the pressure anymore. They break and let the whole shebang travel out into the surrounding skin. And you know the rest of the story: Red. Inflamed. Painful. The deeper under your skin the follicle wall has crumbled, the more severe the pimple.
PIMPLE FALLACIES

Researchers have a couple good theories about why that great skin you had as a teenager (when your friends were breaking out) didn't come with a lifetime guarantee. But first, they want to clear up three favorite myths about the causes of these cutaneous outbursts.

1. French fries and chocolate cause acne. There are lots of good reasons to avoid fatty foods, and we applaud all of them. But as far as acne is concerned, studies simply haven't indicated that diet is directly involved. "Your body is pretty sophisticated. It doesn't work as simply as, 'If you eat greasy food, it'll come out on your skin,'" says Guy Webster, MD, PhD, associate professor of dermatology at Jefferson Medical College, Philadelphia.
2. Dirt clogs pores. Cleanliness plays almost no role in acne. The plug that you see in the follicle is not dirt from outside, and you can't scrub it away, contrary to what most teens like to believe. "It would be like scrubbing away the tip of an iceberg," says Dr. Webster. What you can do by all that scrubbing and popping and poking is rupture any comedo lurking under the skin. This can encourage inflammation and set the scene for possible scarring.
3. Stress can cause your face to break out. "Stress can indeed raise certain of your internal adrenal hormone levels," says Dr. Webster. "And this could be a contributing factor for some cases of acne." Or you may rub your forehead or chin when you're stressed out, which can aggravate your skin by actually rupturing follicles. But stress does not play a central role in most adult acne. The problem with the stress theory, says Dr. Webster, is that there are a zillion people who have a tendency toward acne. Yet when they're under a lot of stress, most don't get adult acne.

So what can trigger this unwanted late blooming? One theory that holds promise is that you may have inherited a sensitivity to acne that shows up later in life. "We're beginning to think that inflammatory acne could be a lot like hay fever--it's an inherited, inappropriate sensitivity to a benign thing," says Dr. Webster. In this case, you're oversensitive to the harmless bacteria in the follicle.

Another theory has to do with hormones. At different stages of your life, as various hormones change, they may either stimulate or improve acne. (Hormone-replacement therapy, however, seems to have no effect on acne.) "In some cases, acne associated with irregular menstrual cycles and excessive facial hair growth (known as hirsutism) may indicate a hormone imbalance or ovarian problems," says Tabitha Henderson, MD, senior director, dermatology research, Ortho Pharmaceutical, Raritan, NJ. "These women require a gynecologic and hormonal evaluation."
SPOT REMOVAL

When you're looking to get rid of the red, remember that squeezing might say goodbye to a pimple only to say hello to a scar. Squeezing is the surest way to rupture an oil gland and set the pimple up for infection.

So the best thing to do is dab a spot remedy on the offenders, right? That's been his personal solution, but it's not the optimum one, says Dr. Webster. "Yes, it helps," he says. But dabbing some benzoyl peroxide here and there is exactly the wrong way to use it. "You can prevent the pimples from showing up in the first place by using that compound twice a day, every day. Mainly it works to kill the offending bacteria.

"Put the product everywhere you don't want pimples--meaning your whole face or back. Eventually pimples will stop raising their ugly heads," he says. One caution: Fair-skinned people should keep the cap on the bottle and see a doctor first. Pimples may signal a problem relation of acne called rosacea, and home treatments could make rosacea worse.

Another possibility for preventing the offenders is alpha hydroxy acids. These help unplug follicles so oil can't build up there. Alpha hydroxy acids work best in higher concentrations--from a minimum of 8%. "This is why most OTC preparations don't work," says Dr. Webster.

"If the bottle doesn't say what percent alpha hydroxy acids are in the product, don't buy it. Salicylic acid (such as Fostex) is also a useful tool. It works the same way as AHAs." You may need to see a dermatologist for higher-strength AHAs.

These remedies are intended for your standard white- or blackheads. But if pimples tend to be large and inflamed, a dermatologist should be your first stop. The best medications for that job, antibiotics and retinoids (such as Retin-A and Accutane) are prescription only. Retinoids act on the cells in the follicles so they're not as prone to break away and stick together, blocking a follicle.

The worst remedy: an over-the-counter cortisone product. While there might be an initial benefit, you're also likely to have lasting problems of worse acne or supersensitive skin. Prescription cortisone is even worse.
THE CLEAREST OF THEM ALL

Even when you do everything right, problem skin does not clear up overnight. Here's what to do in the meantime (and beyond):

Don't become obsessive about your skin. "You don't have to examine your skin with a magnifying glass in search of a possible blemish," says Dr. Hen-derson. People who look too closely can end up picking and gouging their skin, which can lead to more blemishes and possible scarring.

Wash your face gently. We can't stress this enough. You don't need a special scrubber like a loofah. Since acne is not due to dirt, you don't need to wash your skin constantly. "Excessive cleansing and scrubbing with harsh abrasives may actually aggravate acne conditions," says Dr. Henderson. It may be satisfying to think that you're scrubbing that crud out of there but, in fact, you're making it worse.

Look for moisturizers and cosmetics with labels that say either noncomedogenic or nonacnegenic. The same is true of sunscreens. Many acne medications make you extra-prone to sunburn. Always combine these medications with regular sunscreen use.

Don't go on an antiacne oil-free kick. You don't have to insist on oil-free makeup for acne's sake. "Adding extra oil to the top of the skin doesn't affect acne," says Dr.Webster, although there are always a few people who react in an unpredictable way.

DIAGRAM: WHITEHEAD (CLOSED COMEDO)

PHOTO (COLOR): Mother and daughter

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by Pamela Boyer


Section: Vanities

New remedies are making life easier for the millions of adults with acne

When I was a kid, my friends were mad about boys while I was still crazy about Barbie. They were wearing training bras while I was still buying thermal undershirts. Now my friends are bemoaning their first gray hairs and crow's-feet while I'm coping with something they stopped complaining about years ago: acne. Call me a late bloomer.

For years I put off going to a dermatologist. Finally a safe distance from the taunting of eighth-grade girls, I saw myself as a grown woman who would be judged not by the condition of her skin but by the content of her character.

Then one day Mt. Vesuvius erupted on my chin.

"What's that on your face?" my brother asked, gaping. winced. "Is it really noticeable?" "Are you kidding?" he said. "That thing has its own weather system." The time had come to find a cure.

Having a spotty complexion once made me feel singularly unattractive, but it turns out I'm hardly alone. About one in ten adults between the ages of 25 and 44 suffers from acne, according to survey estimates from Galderma Laboratories, which makes skin care products; in fact, many dermatologists think the number may be closer to one in five. And adult women, many of whom enjoyed clear complexions throughout adolescence, are the fastest-growing group seeking treatment.

They won't be disappointed. Acne medicine is undergoing a renaissance the likes of which it hasn't seen since tretinoin--the vitamin A derivative found in prescription remedies such as Retin-A, Renova, and Accutane--came out in the 1970s. In the last two years four new treatments--the topical drugs Differin, Azelex, and Klaron, and the birth control pill Ortho Tri-Cyclen--have arrived on the market.

"When you take people who have horrible skin and make it better, it changes their life," says Diane Berson, an assistant clinical professor of dermatology at New York University Medical Center. "I think it's better than psychotherapy."

And cheaper, too. So I went to see Portland, Oregon, dermatologist Paul Russell, who won me over at our first meeting when he told me that my bumpy skin had nothing to do with my love of chocolate (diet has little or no role in causing breakouts) and everything to do with my hormones, stress levels, and father (heredity plays a big part).

The problem begins in the sebaceous glands, oil-secreting sacs attached to the base of hair follicles (pores) on the face, chest, and upper back. These glands produce sebum, a sticky oil that keeps the hair and skin from drying out. When sex hormones called androgens kick in around puberty, they can prompt the skin cells in the follicle to shed abnormally, in clumpy, flaky sheets.

At the same time, androgens cue the sebaceous glands to step up their output of sebum, which pushes bacteria, pigment, and dead cells through the opening of the follicle and out to the skin's surface. If too much sebum and dead skin are rushing toward the narrow opening at once (picture the crush at a general seating concert), they create a plug called a comedo. A closed comedo is a whitehead; an open comedo, in which the follicle's dark plug is visible, is a blackhead. When clogged follicles fill with bacteria and infection-fighting white blood cells, they may rupture and cause severe acne.

Though raging hormones are mostly to blame for teen breakouts, other hormonal surges--premenstruation, giving birth, going on or off birth control pills--often trigger bouts of acne in women. Anxiety and strong emotions can also raise hormone levels, which is what many dermatologists believe explains the rise in acne among adult women. "Stress plays a major role in exacerbating acne, and women are certainly under more stress now than they were a generation ago," says Berson. "They're not only carrying on responsibilities at home, they also have careers. It's a lot to balance."

Since it's impossible to eliminate stress and hormones from your life, you have to treat acne by controlling the other things throwing your skin out of whack--mainly overproductive glands and abnormally shedding skin cells. Since these combine to cause acne, treatment counters with a similar one-two punch. For example, a dermatologist might prescribe either an oral antibiotic (like tetracycline or minocycline) or an antibiotic cream (like the new sodium sulfacetamide lotion, Klaron) to kill the bacteria that live in hair follicles, along with the vitamin A-derivative tretinoin, which helps reduce the stickiness of sloughing skin cells and brings plugs to the surface.

When specialists suspect a hormonal imbalance--signaled by premenstrual breakouts, irregular periods, even hair growth on the face or breasts--they sometimes prescribe birth control pills with low progesterone levels. Though the Pill wasn't designed for acne treatment, in January the Food and Drug Administration approved one brand, the low-dose Ortho Tri-Cyclen, for treating acne in adult women--a one-pill approach to skin care and family planning.

For severe cases of inflammatory acne (large cysts that can scar and pit the skin), dermatologists rely on Accutane, an oral retinoid--Retin-A's relative--that brings skin shedding under control and shrinks the sebaceous glands. Though Accutane cures severe acne for about 65 percent of sufferers, it appears less helpful at preventing breakouts that begin in adulthood. And since the drug has serious side effects (it can cause birth defects if a woman becomes pregnant), dermatologists often regard an Accutane prescription as a last resort--only for people whose acne doesn't respond to antibiotics or whose blemishes are causing pockmarks.

For my skin, Russell prescribed Retin-A and tetracycline and told me to keep my fingers away from my face. (Most pimples heal on their own; squeezing them just increases the chance of scarring.) He also told me not to expect a miracle, noting, "Everyone wants to be well by tomorrow." Unfortunately, he explained, the life of a comedo lasts about eight weeks, which means that as the medication acts on unseen blemishes and forces them to the surface, skin may appear to get worse before it gets better.

He wasn't kidding. Six weeks later I still faced the mirror each morning armed with a tube of concealer. And while I consoled myself with the thought that this would all end at menopause, it's not entirely certain. "We like to think acne will be over for most women in their forties, but I still have some patients in their sixties and seventies," admits Jonathan Weiss, assistant clinical professor of dermatology at Emory University School of Medicine in Atlanta.

After five months my condition had improved, but not enough to keep Russell from running me through the gamut of treatments. Each medication I tried had its own unique set of side effects. Retin-A made my skin so pink and sensitive it hurt to lay my cheek on a cotton pillow. Renova, its more potent cousin, went on smoothly but was so drying over time that my cheeks flaked as though I'd been sunburned. A dry-ice and acetone combination, designed to inflame skin mildly so it sloughs off abnormally sticky cells, made my face smell like a burnt marshmallow. Luckily, Russell offered me two new treatments to try.

The first, azelaic acid, or Azelex, is an antibacterial ointment originally used to get rid of brown spots and the skin discoloration some women develop while pregnant or on the Pill. But patients who tried it found that the lotion, which comes from a compound in wheat, was also effective on moderate cases of inflammatory acne. As is the case with many acne drugs, no one knows exactly how it works or why it helps smooth rough, blemished skin. I applied a thin smear of Azelex in the morning; it had a slightly smoky scent and left my skin feeling tingly for several seconds.

At night I used Differin, another topical treatment that some dermatologists are hailing as a major breakthrough in acne treatment. Differin is the first new topical retinoid in 24 years. While it seems to slow the abnormal shedding of skin cells, as Retin-A does, clinical tests have shown that it may be less irritating and better at shrinking acne lesions. Weiss says Differin, another spin-off of vitamin A, may give patients some of the benefits of Retin-A without the redness, peeling, and burning. "Or they might get some of the side effects," he cautions, "without getting some of the benefits."

I immediately understood why dermatologists call Differin "cosmetically elegant." It's a nicely slippery gel that allows you to cover your face with just a pea-size blob. While the initial buzz about the drug prompted patients to call their doctors demanding this latest acne treatment, Weiss says there's no need to try a new drug if you've already found one you like. "I wouldn't recommend that people who get results with Retin-A switch to Differin," Weiss says. "Stick with what works for you."

And after almost four months with this formula--Azelex and Differin--I think I've found what works for me. The lumps and whiteheads that made my chin look like a relief map have finally cleared. Some people's acne disappears almost as mysteriously as it comes; for others, it persists for years. My good fortune may last only as long as I continue treatment, but even so I'm pleased.

"What zits?" my brother asked recently when I told him about my new acne solution. "I can't even see them."

48n1.jpgGETTING CLEAR

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BY LAURA BILLINGS


Section: Health & Beauty Aids

(shhh: not just for teens)

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 an aircraft hanger 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 ache 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 consider acne to be a consequence of being a teenager, as though it were a rite of passage marking the ascent into adulthood. But, the "secret" truth is, as much as 20 percent of the adult population is affected by acne, the majority being women. Let's face it -- acne doesn't look attractive 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. Then, dead skin cells 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.
Acne triggers -- beyond hormones

Since male hormones dictate sebum and keratin production, and are particularly active during puberty, ache is generally accepted to be a hormone-dependent 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, which is 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 seaweed sold as a dietary supplement, and iodized foods, such as salt, have shown a direct link to acne and should be limited or avoided, if you have acne or are acne-prone.)

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 five 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 glutathione 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.

Another important nutrient in the treatment of acne is zinc. 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.

Lactobacillus 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 them. But, facial cleansing merely removes surface dirt and does little to unclog pores or neutralize bacteria. However, proper cleansing is an essential part of maintaining healthy skin. As with anything else, there's a right way and a wrong way to do it.
What you should know about acne treatments

Commercial acne treatments run the gamut in forms and possible side effects. Certain creams and lotions that contain zinc, sulphur, or benzoyl 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 health-food 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 vitamins C and E are potent antioxidants that help reduce infection and inflammation. Other ingredients include fruit acids (AHAs and BHAs) that act as gentle exfoliates.

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.
Do's and Don'ts for Healthy Skin

* 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 overdo 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.

REFERENCES

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

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

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 40(6 Pt l):961-5, Jun 1999.

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By Karyn Siegel-Maier

Karyn Siegel-Maier is a freelance writer who specializes in herbs, alternative medicine, and new-age issues. Karyn is a frequent contributor to national and regional magazines, newsletters, newspapers, and other publications. She is the author of The Naturally Clean Home: 121 Safe and Easy Herbal Formulas for Non-Toxic Cleansers (StoryBooks/Dec. 1999).


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