Acne
& dealing with problem skins 

There are dozens of books and thousands of articles and websites on the topic.  It is a quagmire of information to sort through.  But there is some well tested clinical experience that a person can use for self-help or to find professional guidance. 

Before exploring what can be done to resolve the problem, let’s deal with some of the common misconceptions. 

                                                Acne Myths 

Myth #1: Acne is caused by eating chocolate, greasy foods or junk food.  It is common for acne to be triggered by stress and a poor or imbalanced diet can stress the body.  A healthy balanced diet is important, however an occasional fast-foods lunch or dinner is not apt to trigger an acne outbreak.  For some people there are trigger foods that seem to cause an outbreak.  Keeping a food diary can reveal these.

Tests have been performed by major chocolate manufacturers in which the participants were divided into multiple groups some getting no chocolate, others getting regular chocolate, and others getting double chocolate.  After a month there was no significant difference in their acne conditions.  (The experiment did not address any other side effects of eating the candy such as weight gain.) 

Myth #2: Acne is caused by dirty skin and hair touching the forehead.  First of all, acne cannot be scrubbed away.  Acne impactions extend deep beneath the surface of the skin, and they are not dirt.  Ignorant people may have confused blackheads with dirt, but a blackhead is actually thousands of dead skin cells which have collected in the follicle along with the skin’s own oil and other natural debris.  The dark color comes when this mass pushes to the surface and is exposed to the oxygen in the air.  Since acne impactions develop deep below the surface, cleansing cannot reach acne. Sebum, from the sebaceous glands, is the oil that creates the problem—not the oil from hair.  However, comedogenic ingredients in hair products can cause problems for acne-prone individuals. 

Myth #3. Acne is only a teenage disease.  Because of this myth, too many acne sufferers are not helped as they have been told that acne is just a part of being a teenager and it will go away when they grow up.  Acne can strike at any age, and subside at any age.  Untreated acne can lead to permanent scarring, both emotional and physical.  This myth is a sensitive issue for adult acne sufferers.

Myth #4: It’s not acne, it’s just “complexion problems”, or an allergy, or a blemish, oily skin, etc. Acne is acne, no matter how many or few pimples a person has.  Acne occurs one follicle at a time, and scarring takes place on follicle at a time.  Even if a person only had one bad pimple a month that could amount to sixty scars during a five-year period. 

What causes acne? 

Acne is caused by propionibacterium acnes (commonly called p.acnes bacteria) trapped in the follicle with sticky sebum and build up of dead skin cells.  Some of the key triggers include the following:

1. Hormones (androgens) produced at puberty
   Androgens stimulate the sebaceous glands to enlarge and to produce sebum.
   Monthly breakouts occur when sebaceous glands are sensitive to androgen stimulation.  In adults, hormonal acne is generally located on the lower portion of the face including around the mouth and along the jaw-line.
2. Increased sebum production
   The greater the sebum production, the greater the likelihood for acne because the oily sebum must travel up the hair shaft where it mixes with bacteria and dead skin cells that have been shed from the lining of the follicle.
3. Increased shedding of dead skin cells (hyper keratinization) 
   During puberty, skin cells inside the follicle shed more rapidly and tend to stick together.  Sticky skin cells mix with sebum to form a plug in the follicle.  This plug is called a microcomedone (the beginning of all acne lesions).
4. Bacteria (propionibacterium acnes)
   “Plugged” follicles are a breeding ground for bacteria.  Some p. acnes bacteria are normal but too much will produce chemicals that can cause inflammation in the follicle and surrounding skin.   One of the keys to the problem is that blackheads start as microcomedones 2-3 months before they are visible. 

Combating Acne Problems           

Because the problems start before they are visible it is important to do zone therapy rather than spot therapy to stay in control.  If you tend to have breakouts on the forehead the entire forehead should be treated, etc.  Those who only suffer from occasional or sporadic stress-related acne can more effectively do spot treatment.  When working to bring acne under control keep in mind that it took time to develop and will take time to eliminate the symptoms. If the appropriate acne routine is used daily you should start to see significant changes in about a month.  For some people this happens more quickly and for others it may take two to three months to achieve good control.

To control current eruptions we recommend employing the following tools:

1. ICE – There is nothing that will more quickly take the pain away and reduce redness than icing a lesion directly 3-5 minutes twice daily until the redness and edema abate.  You can freeze some water in a paper cup and then tearing away the top (open) end of the cup to expose the ice employ it like a popsicle to administer cold to the lesions.  This can be done while watching television, studying or doing computer work (just don’t drip onto your keyboard.) 
2. Benzoyl peroxide.  This is a therapeutic agent that has proven its worth over the years as one of the best ingredients for fighting acne breakout.  The peroxide kills bacteria and the benzoyl triggers the sloughing of the impacted material.  It is available both as a stand alone product or incorporated into a day or night cream for those with less problem or more sensitive skin.    Benzoyl peroxide will make the skin more UV sensitive so an SPF protection should be used on a daily basis – year around.  Some ethnic groups such as southeast Asians tend to be reactive to benzoyl peroxide.  Their next best choice is a product with resorcinol in it. As resorcinol can be irritating to the skin it is often combined with sulfur.
3. Salicylic.  Salicylic acid has demonstrated great effectiveness in breaking up clogged follicles without triggering breakout as can happen with other acids. Glycolic and lactic acids can cause breakouts to be worse especially when used straight. Blends of the acids are designed to be less irritating.  Salicylic acid is oil-loving.  This makes it perfect to penetrate the clogged oil glands where the p acnes bacteria is breeding.
4. Sulfur.  While many people may be sensitive to sulfur when taken orally, most people deal well with it as a topical product. Sulfur is healing and soothing.  This combined with the absorbtive properties of a clay work well in a mask to calm acne skin and reduce surface oiliness.  I recommend a sulfur mask be applied upon rising and then removed in the shower with a gentle scrub.  This will often make makeup application easier and the skin will go longer during the day without feeling oily.
5. Supplements. With the hectic pace of our lifestyle today it is sometimes challenging to get adequate nutrients from our food.  Perfectly fresh fruits and vegetables may not be available year around in some climactic regions.  Busy schedules may mean grabbing something quick instead of taking the time to prepare better choices.  While we strongly urge good nutrition, taking supplements can be very helpful.  Acne suffers want to select a vitamin or supplement blend without additional iodine as this can be an acne trigger for many people. The GlyMed Acne Supplement Formula has Burdock for deep cleansing of the blood, zinc and vitamins E and C for anti-inflammatory and healing benefits.

Judith Culp, CEO of Esthetics NW has dealt extensively with acne issues during her nearly 25 years as an esthetician.  Based on research and results in our clinic we offer two different lines of acne products.  These can be selected based on personal preference and the severity of the acne issues.

Circadia by Dr. Pugliese offers a simple line of acne products that work well for mild acne or adult acne.  All of these products contain Dr. Pugliese patented heeps complex of Linoleic Esters to promote healing and thereby minimize potential scarring.

This regime includes:

Cleansing Gel with Salicylic Acid – this product may be used once or twice daily as the skin tolerates.  It is not recommended as an eye makeup remover.  It rinses clean and no toner is required. 

Daytime Control – this gel based product contains 2.5% Benzoyl Peroxide for non-irritating control of acne.  Sensitive acne skins do well on this product as it also contains anti-inflammatory and healing ingredients. UV agents help protect the skin from ultra-violet light.

Nighttime Control – this gel is 5% Benzoyl Peroxide for stronger acne control.  This light lotion also contains anti-inflammatory agents along with the germicides to control acne but not irritate the skin.

Spot Stop – this nearly magic formula does not prevent acne but is instead phenomenal for healing lesions.  If you feel a tender spot emerging start putting Spot Stop on it several times a day.  You will be amazed at the result.  It is appropriate to use regardless of the other skin care products you may be using and a must for every person’s emergency stress repair kit.

GlyMed Acne
GlyMed acne products are perfect for serious acne treatment.  To help you get started with a small investment GlyMed has put together Action Pacs.  Each Pac is designed for a different type of acne situation.  As you run out of these trial products you may reorder the items you need individually. Follow this link to determine which acne kit is best for you.  Which ever kit you select, we suggest you consider the Acne Supplements to best support your efforts.

We also suggest in-salon treatments if there is a qualified esthetician in your area. We do not recommend Microdermabrasion procedures for inflamed acne or any other inflamed condition.  Salicylic peels or peels with blends of acids seem to facilitate exfoliation as do enzymatic peels.  An ultrasonic peel such as with the Dermachine is a great acne treatment to loosen impactions prior to extraction.  Your technician may also use high frequency to kill bacteria after extraction and facilitate healing.  Well trained technicians used a mixed approach to best treat this condition. It’s rather like your fitness trainer teaching you more than one exercise.  A diversity does a better job of conditioning the body.

If you live near Eugene, Oregon come and see us at the NW Institute of Aesthetics. Receive specialty treatments at discounted prices from well trained students.