Acne is the most common skin disease and is a dysfunction of the skin pores. Hair follicles become plugged with sebum, a mixture of oils and waxes that lubricate the skin, and kerarin, a protein that comprises the outermost layer of skin. When these substances build up, acne is the result. Acne can occur on the face, neck, chest, shoulders, or back. Myths abound regarding the causes of acne, from diet to uncontrolled sex drives, but heredity and hormones are the primary causes. The mild forms of acne will eventually go away on their own. But the more severe forms can cause permanent scarring of the skin if left untreated.

Common Symptoms

Lesions that may have one or a combination of

• Blackheads (dark spots with open pores).
• Whiteheads (bulging under the skin without openings).
• Pustules, nodules, and cysts, all of which are fluid-filled lumps.

What You Need to Know

The best approach to treating acne is to do what you can to prevent flare-ups. Try to avoid medications that can cause acne-like lesions, including steroids, drugs that contain bromides or iodides, Dilantin (for seizures), and lithium carbonate (for bipolar disorders). If you are taking any of these medications, do not discontinue them without your doctor’s advice! Some forms of oral contraceptives worsen acne, while others improve it (check with your gynecologist for guidance). Avoid or minimize exposure to pollutants that cause acne-machine oils, coal tar derivatives, and chlorinated hydrocarbons. Cosmetics, over­ washing, or rubbing your face can cause flare-ups.

General Recommendations

It is a common myth that eating greasy, high-fat foods causes acne. It is generally accepted that foods do not cause acne, and they probably don’t aggravate it either. However, your diet can affect the health of your skin, which in turns allows acne treatments to work more quickly and effectively. For the healthiest skin, I recommend that you limit refined and simple sugars as well as high-fat foods in your diet. Avoid fried oils and processed foods with trans fats; these are the most unhealthy for your skin and your health overall.

Your balanced healing action plan for acne

• For mild acne, start with Step 1.
• For moderate acne, begin with Step 6, and then return to Step 1.
• For severe acne, start with Steps 6 and 7, then return to Step 1.

Step 1: Use Acupuncture First

I recommend starting with acupuncture, which can be very effective in controlling acne for long periods. Principal points are found on the arms, legs, and feet. Ear acupuncture is also very effective, either alone or with body points. Principal points usually include lung, endocrine, testis, skin, and cheek. Always seek evaluation and treatment from a practitioner certified in acupuncture. With acupuncture, you should notice improvement within six treatments.

Step 2: Use Topical Tea Tree Oil, Azelaic Acid, or Benzoyl-Peroxide Solution

Topical tea tree oil is the best topical solution (that is, a solution that you put on your skin) to use for acne because it kills skin bacteria and has the fewest side effects. Start with the 5 percent solution if you have mild acne. If you have moderate or severe acne, start with the 15 percent solution along with Step 6.

If you don’t see the results you want after one to two months, it’s time for a change. Switch to a solution containing 20 percent azelaic acid, another topical antiseptic. Apply this twice a day for at least a month, and then go to once a day for six months.

And if neither of these topicals is effective, then change to benzoyl-peroxide solution (5 to 10 percent concentration) or gel (12 percent). If you find that each of these topicals has some partial benefit, you can use them together, but apply them at different times. These products can dry the skin, so it is better if you use only one or two of them.

Step 3: Take Chromium, Selenium, Vitamin E, Zinc, Pantothenic Acid, and/or Chasteberry

If you find that step 1 is only partially effective, take these supplements all together, once daily:

• Chromium (200mg to 400mg/day)-Helps break down sugars.
• Selenium (200mcg/day)-Helps inhibit acne inflammation.
• Vitamin E (400 IU/day)-Helps inhibit acne inflammation.
• Zinc (45mg to 60mg/day)-Improves skin health; use the effervescent sulfate or gluconate forms (identified on the package label).

If these four nutrients do not help completely, add 2.5mg of pantothenic acid four times a day. This compound reduces the production of sebum, the substance that plugs the skin pores. You should see improvement within one to three months. Another helpful herb is chasteberry, (solid extract, standardized to 0.5 percent agnuside, 175mg to 225mg daily), which has antibacterial properties and can help reduce acne in 70 percent of patients (but it may take six months to do so).

Vitamin A has been found to be effective in reducing sebum production as well, but only in high doses that can be dangerous, so a physician should monitor its use. Do not use vitamin A unless your physician recommends it and provides regular follow-up care and monitoring.

Step 4: Take Appropriate Chinese Herbal Remedies

There are several Chinese herbal formulas, usually containing cnidium seed and honey­ suckle, that are effective for acne. I recommend Cai Feng Zhen Zhu An Chuang Wan or Wu Wei Xiao Du Yin. Consult a practitioner qualified in Chinese herbal medicine to determine which herbal formulas are the best for your particular syndromes (See Appendix A, under “Chinese Herbs.”)

Step 5: Take Appropriate Homeopathic Remedies

If your acne continues, Corynebacterium acnei is one of the homeopathic remedies that may be beneficial, and you can use it with the previous steps. Consult a qualified homeopathist for guidance on which remedies and dosages will be most beneficial. You should see benefits within one to two weeks.

Step 6: Take a Prescription Antibiotic

If your acne persists, or is moderate to severe initially, your doctor can prescribe oral antibiotics such as tetracycline, erythromycin, or a cephalosporin (such as Ceclor) . You can usually take these antibiotics for extended periods of time. Clindamycin, erythromycin, and metronidazole are antibiotics that come in topical solutions or gels, if you prefer to apply the medication to your skin rather than take a pill.

All these antibiotics are effective; your physician needs to determine which one and what dosage is best for you. But taking antibiotics for several weeks can cause vaginal yeast infections in some women. Antibiotics can also cause stomach problems because the antibiotic kills beneficial digestive bacteria as well. You can avoid both of these problems by taking probiotics. (See Appendix B, under “Supplements,” for more information on probiotics,) It usually takes up to three months for antibiotics to deliver maximum benefit.

Step 7: Use Prescription Topicals

If Steps 1 through 6 fail to relieve your acne, or if your acne is severe, your physician might prescribe 0.025 percent to 0.1 percent Tretinoin (retinoic acid), a vitamin A derivative. Benzoyl peroxide (Step 2) may inhibit the healing effects of Tretinoin, however, so you must use them at different times if you are using both.

Step 8: Take Other Prescription Medications

For severe cases and cystic acne, isotretinoin used to be the treatment of choice. It may be taken off the market, however, because in some people, it may trigger depression and suicide, so many doctors have stopped prescribing it. If you are taking it or would like to explore the possibility of taking it, talk to your doctor and make sure you are closely monitored.

If you have acne scars

A dermatologist or plastic surgeon might be able to remove scars using one of two cosmetic surgical methods: dermabrasion or chemical peeling. Both are effective.

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