Acne - Naturopathic MedicineNaturopathic Medicine Summary

Naturopathic Medicine

Naturopathic Summary

Acne is the most common skin disorder in adolescents and is also the most common skin disorder seen in dermatology practice.[1] People are most affected on the face, though the arms/shoulders, back and upper chest are often involved.[1] A naturopathic approach involves the inclusion of dietary, herbal, and lifestyle based choices in the management of acne. In some states, a naturopathic approach may involve the use of some pharmaceuticals and procedures.

Treatment Philosophy

Treatment of acne is typically based on the severity of acne and can vary between those with mild, moderate, or severe acne. The goal of each form of treatment against acne is generally targeted against at least one of the four “pillars” of acne.

  • The pore: Normalize keratinization to unclog pores
  • The oil: Reduce oil production and improve oil quality
  • The bacteria: Antibacterial control, natural or pharmaceutical
  • The inflammation: Reduce inflammation through reduction of triggers and dietary modification.

Symptoms

Acne consists of both inflammatory and non-inflammatory lesions.[2] Inflammatory lesions are red bumps, pus-filled bumps, and deep red lesions known as inflammatory nodules.[2] Non-inflammatory lesions are not as red and tend to be skin-colored.[2] Non-inflammatory lesions are known as whiteheads and blackheads.[2] In those with darker skin, acne can lead to dark spots on the skin.[2] In many cases, acne can lead to permanent scarring.[2]

Causes

Acne is summarized as four “pillars” that include: 

  • The pore: A combination of large amounts of oils and increased shedding of cells called keratinocytes cause the pores to clog. The clogged pores increase in size and lead to the formation of [2]
  • The oil: Increased oil (also called sebum) is commonly a response of high levels of steroid hormones which are greater during puberty and are increased just before the start of the menstrual cycle in women.[2]
  • The bacteria: Clogged pores offer a perfect environment for an unhealthy overgrowth of bacteria that is normally found on the skin.[2] The most common strain of bacteria implicated in the formation of acne lesions is called Cutibacterium acnes previously known as Propionibacterium acnes.[3]
  • The inflammation: The increase in bacteria and oils lead to inflammation in and around the clogged pore.[2]

These four pillars combine to create what is known as acne.[2] The severity of symptoms varies from person to person, and treatment is often dependent on the severity of those symptoms.[2]

Risk Factors

Your body 

  • Age: Studies show that over 90% of adolescents may experience acne, [1] and it is commonly seen around the time of puberty. Infants and neonates also commonly develop acne, and although acne is primarily a disorder of adolescence, it can be found in any age group.[4]
  • Hormones: Sex hormones, such as testosterone, are correlated with acne development.[5] During puberty these hormones are found in higher concentrations throughout the body, and during the female menstrual cycle these hormones vary in concentration throughout the month.[5]
  • Stress: Stress can be both a cause and a symptom of acne.[6] The psychological effects caused by acne can be remarkable, and reducing the symptoms of one often benefits the other.[7] 

 

Diet

  • Diet: Acne is more prevalent in westernized societies,[8-10] though it is suggested that this may be due to diet rather than environment. High glycemic-load diets, high carbohydrate diets and milk/dairy intake have been correlated with acne.[11-14]

 

Medications and products

Some of the commonly implicated medications include: anabolic steroids, corticosteroids, bromides and progestins.[15] 

 

Environment 

  • Climate: Climates with high heat or humidity tend to promote acne development.[16] In addition, occupations requiring exposure to high heat, such as furnace workers or smelters, and occupations with exposure to petroleum-based products, cutting oils, or coal tar have increased rates of acne. [15]

Naturopathic Therapies

  • Detoxification: Detoxification is a common practice in the naturopathic approach to skin treatment.[17] The skin is one of the detox organs, and this happens generally through sweating.[18] Saunas can help to increase the mobilization and release of toxins through the skin.[19] The liver is also an organ of detoxification, and most naturopathic practitioners will include liver support through the use of herbs like Milk thistle (Silybum marianum) as part of the treatment plan.[20]
  • Azelaic acid: Azelaic acid is an organic substance found in some foods and is also naturally produced by yeast that reside on normal skin.[21] It causes a breakdown of oleic acid, which is the most abundant fatty acid in human body fat.[21] Azelaic acid is commonly used as acne treatment and many different acne products contain Azelaic acid.[21]

Botanicals and Herbs

  • The pore: Turmeric is one herb that has been shown to have a beneficial effect on the keratinization of cells in the pore.[22]
  • The oil: The hormonal control of acne using herbs is common in naturopathic medicine. Herbs like Chaste Tree (Vitex agnus-castus),[23] Green Tea (Camellia sinensis)[24] and Saw Palmetto (Serenoa repens)[25] are known to have effects that reduce the common hormones associated with acne.[26]
  • The bacteria: Herbs such as Oregon Grape (Mahonia aquifolium), Usnea (Usnea spp.), and Purple Coneflower (Echinacea angustifolia) can be helpful against the acnes bacteria of acne.[27] Other commonly used herbal remedies shown to inhibit of C. acnes include: Mangosteen (Garcinia mangostana), Hops (Humulus lupulus), Tea Tree (Melaleuca alternifolia),[28] as well as Green Tea (Camelia sinensis) and Pomegranate (Punica granatum).[29]
  • The inflammation: The herbal control of inflammation is common with herbs such as Turmeric (Curcuma longa),[30-32] Aloe (Aloe vera), and Licorice (Glycyrrhiza glabra) are shown to have anti-inflammatory properties.[28]

Diet and Lifestyle

Nutrition and diet

Diet is typically one of the first methods of acne treatment used in naturopathic medicine. The ideal diet would closely resemble a Paleolithic diet, [33-35] which focuses on increased vegetable, fruit and fish intake, and avoidance of sugars and symptom causing foods. Low glycemic-load diets may improve acne. [12,36] Additionally, reduction of milk and dairy intake has been correlated with improved acne.[9,36]

 

Supplements

  • Zinc: Though not necessarily correlated with the formation of acne, a decreased blood level of zinc has been shown to worsen acne,[37] and the inclusion of zinc may help to reduce symptoms.
  • Vitamin B6: This vitamin has been shown to be beneficial for premenstrual acne flares,[38] but is also believed to cause acne.[39]
  • Omega-3 Fatty Acids: These healthy oils are found in many types of food, including: fatty fish, flaxseed, and walnuts.[40] Several studies show the benefits of using these healthy oils for acne.[41-44]
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