Acne occurs in the skin's tiny sebaceous follicles, each consisting of a minute hair shaft connected to a gland which produces the skin oil, sebum. An acne pimple is like a stool supported on four legs: blockage of the follicle (typically by accumulated skin cells deep inside the shaft), oil production (controlled by the hormones known as androgens), bacterial activity and inflammation.
All acne medicines are, in effect, specialists, adept at knocking out one supporting leg or another. Prescription antibiotics and over-the counter benzoyl peroxide, for example, fight bacteria. Topical retinoids, such as Retin-A, clear follicular blockages. Treatments containing sulfur and other anti-inflammatory ingredients, reduce the redness and swelling of pimples. Hormonal therapies, such as the birth control pills sometimes prescribed for acne-prone women, regulate oil-stimulating androgens.
While complementary remedies tend to be less potent and predictable than standard pharmaceutical agents, many possess similar therapeutic properties, and can be incorporated into acne treatments, either as alternatives to conventional medicines or as supporting players. Antiseptic tea tree oil, for example, is a potential substitute for benzoyl peroxide or antibiotics because it eradicates the elusive acne bacteria, P. acnes. Many topically applied ingredients (alpha lipoic acid, green tea extract, allantoin, arnica and chamomile, to name just a few, have anti-inflammatory qualities. Others, taken orally, influence the hormones that control sebaceous glands. The tropical berry, saw palmetto, is an anti-androgen; vitex, a fruit extract, helps regulate hormones that stimulate the ovaries and can be effective in treating pre-menstrual acne.(Neither should be taken by pregnant or nursing women).
Although many acne patients believe diet contributes to their breakouts, numerous studies dating back over 40 years have consistently failed to establish a convincing link between acne and any single nutritional culprit such as chocolate, soft drinks or French fries. However, researchers taking a fresh look at nutrition today, speculate that while sebaceous glands (which do not excrete dietary fats) may not react directly to the foods you eat, the hormonal mechanisms that control them are very likely to.
Accordingly, many alternative practitioners and some dermatologists now recommend that acne patients avoid processed breads, sugars, cereals and other refined carbohydrates that can cause blood sugar levels to soar and stimulate the body to produce excess insulin. This in turn creates a hormonal imbalance that may cause the sebaceous gland to produce excess oil and acne. There is also some evidence that controlling blood sugar through diet may also help keep destructive inflammation at bay, as may consuming foods high in anti-inflammatory Omega-3 essential fatty acids (found in cold-water fish, especially salmon, some nuts and olive oil).
While there has been surprisingly little research into the biological connections between acne and stress, it is now also increasingly recognized that managing stress can also help manage acne. Both emotional and physical stress can send the adrenal glands into overdrive, pouring out the "fight-or-flight" hormones, cortisol and epinephrine (also called adrenaline). Along with these chemicals come other adrenal hormones, including androgens that promote oil production and cellular buildup in sebaceous follicles. Chronic, long-term stress can make skin oilier than usual and create new pimples in previously clear complexions. Heightened levels of cortisol provoke irritation, inflammation and itchiness, which can aggravate existing blemishes and incite an intense inflammatory reaction in follicles that contain small, previously undetected blockages, transforming them into angry pimples.
According to experts, one of the most effective antidotes to acne-inducing stress is regular exercise, even if it is just a daily walk. A stressed-out body is chemically primed to fight or flee; exercise will release those chemicals and improve the environment inside acne-harboring sebaceous follicles. Formal stress reduction techniques such as meditation, prayer, Tai Chi, yoga, progressive muscle relaxation, similarly act to modulate adrenal hormones.
Will managing stress (or eating salmon and avoiding sugar, for that matter) eliminate your acne once and for all? Probably not. There is no single surefire for acne. "But these are skills that help your body overall," notes dermatologist and clinical psychologist Richard Fried, a specialist in psychodermatology, "I tell patients, 'If you weren't doing this, you would have more acne and be using more medicine. So it is by no means a wasted effort."
Lydia Preston is author of "Breaking Out: A Woman's Guide to Coping with Acne at Any Age" (Simon & Schuster; 2004; $13.00). An award-winning medical journalist, she leads the Washington Acne Scar Support Group. For more information, visit: www.simonsays.com or www.acnescarsupport.org