Acne - usually needs a combined approach - don't give up

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Acne vulgaris is the common form of acne, it is driven by male sex hormones (present in both sexes from the menarche onwards). In the early stages there is excess keratin which blocks the cysts at the base of hairs, later these become inflammed and infected by propionibacteria. This has a markedly pro-inflammatory effects which I can only think are allergy driven. It explains why acne responds well to antibiotics because they reduce this infectious/allergic drive. I suspect much of this comes from the upper fermenting gut (see Fermentation in the gut and CFS) but some will be from presence of these bacteria on the skin. Anything to reduce the allergic/infectious load on the skin will be helpful such as sunshine and salt water - a beach holiday is often excellent for clearing acne.

Treatment of acne

All of these will help -

The following help the immune system fight infection and allow skin to heal more quickly:

  • Zinc 30mg daily.
  • Vitamin A in high doses eg 50,000 iu daily. Do not continue this for more that a few weeks as high vitamin A may cause headaches. Vitamin A can cause damage to the unborn foetus in early pregnancy and all patients of child-bearing age need to be aware and reminded regularly.
  • Pantothenic acid (vitamin B5). There are many studies demonstrating benefit. High doses of up to 10gms daily need to be used (the highest strength I can find is 500mg: so maybe 20 tabs a day). B5 is extremely safe with no known side effects and no toxicity. As an example of one such study, see A Randomized, Double-Blind, Placebo-Controlled Study of a Novel Pantothenic Acid-Based Dietary Supplement in Subjects with Mild to Moderate Facial Acne which concluded that:
    • "The results from this study indicate that the administration of a pantothenic acid-based dietary supplement in healthy adults with facial acne lesions is safe, well tolerated and reduced total facial lesion count versus placebo after 12 weeks of administration. Secondary analysis shows that the study agent significantly reduced area-specific and inflammatory blemishes."
  • Azelaic acid 20% cream has been shown to be very effective. Here is an example of a UK prescription cream Skinoren Azelaic acid Cream 20%
  • Sunshine and UV light. Sunshine is an excellent treatment and very helpful for killing propionibacteria on the skin. I usually recommend patients get themselves a UV lamp.
  • Topical antimicrobials are also useful such as neem or teatree as soap or lotion. Coconut oil on the skin feeds the friendly bacteria.
  • Creams and lotions
    • Zinneryt: a mix of zinc and erythromycin to reduce bacterial contamination and improve healing.
    • Retin A: a topical vitamin A cream which dries the skin and reduces sebum formation.

This combination of two products works well to prevent acne. They will not get rid of a mature spot.

  • Antibiotics: again these undoubtedly work. Part of the reason is they kill bacteria on the skin, but part may be to treat the fermenting upper gut. My guess is that this is more of a problem in rosacea. See Fermentation in the gut and CFS
  • Do not be tempted to use roaccutane (isotretinoin). This drug is isotretinoin, metabolised in the body to tretinoin, which is used for cancer chemotherapy. It permanently destroys "moisture producing" cells on cell surfaces and may lead to permanently dry skin, eyes, mouth etc. I have seen several patients with severe long term ill health as a result of this drug. See Suicidal risk with isotretinoin treatment – a never-ending story

Finally acne can be a detox reaction - the first description of this was chloracne - associated with organochlorine poisoning. The skin cannot tell if chemicals are on the way in or out, so a similar reaction may ensue with detoxification in the sauna. Some people develop acne with B12 injections and again I suspect this is a detox reaction as chemicals are mobilised. See StatPearls - Chloracne

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