Differin

YO, HAS YOUR FACE gone, like, totally retro? Is your skin a zit pit? Acne isn't just for teenagers anymore--and there's a special misery to breaking out when you're 37 and fretting about crow's-feet. "The vast majority of people once outgrew adolescent ache, except for an unlucky few," says Richard Fried, M.D., a dermatologist and clinical psychologist in Yardley, Pa., and author of Healing Adult Ache. "Now about half of adults deal with ache in some form, and many who never had significant ache develop it for the first time."

So what's responsible for the jump in grown-up ache? Pollution, new medications, and hormone-fed meats are among the irritants cited. "The one common denominator we see among adult ache patients, however, is stress," says Linda K. Franks, M.D., assistant clinical professor of dermatology at New York University School of Medicine. "People are juggling work and family, and generally have busier lives."

Women get the worst of it: About 54 percent of adult females are afflicted with ache, compared to 40 percent of adult males. Chalk up the difference to age-related hormonal changes (which are exacerbated by stress), more oil production, birth-control use, pregnancy, stress, and menopause.

To add inconvenience to injury, the pimples may act the same, but the skin does not. Drier and less resilient, an adult woman's skin can be easily damaged by some of the treatments she may have relied on during her adolescence.

taking root

ALL ACNE ORIGINATES in hair follicles, which either become inflamed and produce pimples, or plug up with whiteheads and blackheads. Male hormones called androgens (present in both genders) trigger ache by raising levels of sebum, or oil, produced by sebaceous glands at the base of these follicles. Hair is normally softened and lubricated by oil, but excess amounts paired with dead-skin-cell buildup cause blockage. When bacteria are present, the follicle becomes irritated, forming pustules.

Some people simply produce more sebum and have greater numbers of sebaceous glands. Others have a poorer rate of skin-cell turnover and are more sensitive to hormones. And ache is partly tied to genes: If your parents battled ache, odds are, so do you.

Only 7 percent to 14 percent of adults suffer from chronic, "clinically significant" acne. Yet even sporadic outbreaks have a high emotional cost. "Studies show that a person can be as profoundly depressed with one zit on her chin a month as someone with a face full of acne," says Fried. "We've seen women who feel burdened, imperfect, and unattractive in their 40s and 50s because of acne, and data show that those with ache suffer from higher rates of divorce, unemployment, suicide, and sexual dysfunction. Acne is not trivial."

The most common form of acne is ache vulgaris, but there are other types caused by irritants such as heat and humidity or exposure to certain pesticides. In the worst cases, cysts can form deep beneath the skin and result in scarring.

Nancy, a 45-year-old medical biller from Massachusetts, had to cope with painful cystic ache throughout her teens and 20s. She went on and off oral antibiotics, which slow bacteria growth. "But it never permanently went away," she says.

At 29, she enrolled in a six-month plan of supplements and balanced meals devised by Georgianna Donadio, Ph.D., founder and program director of the National Institute of Whole Health. "After six months," Nancy says, "I was pulling the hair away from my face for the first time, and people were saying how much my complexion had improved."

the food factor

"A POOR DIET really affects the liver," says Donadio. "The liver dampens and tempers the intensity of androgen hormones, which trigger oil production in the sebaceous glands."

While a 1969 landmark study seemed to prove there is no causal link between diet and acne, a 2002 study at Colorado State University suggested that a diet high in refined carbohydrates boosts insulin, which elevates hormones and stimulates sebaceous glands. Investigators noted that islanders in Papua New Guinea and Paraguay, whose diets were similar only in that they were free of typical Western refined carbs, remained untroubled by acne.

The research isn't conclusive, yet many dermatologists won't argue with those who peg outbreaks to diet. "When a patient comes in and says, 'Every time I eat peanut M&Ms, I break out,' I tell them to stay away from that particular food," says Tina Alster, M.D., director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C.

For a proactive approach, add flaxseeds to your diet. They contain lignans, phytoestrogens that are believed to stabilize a woman's ratio of estrogen and progesterone. Flaxseeds also contain essential fatty acids, which have anti-inflammatory actions, among other benefits.

The recommended daily dose of lignans varies per person, though a rounded tablespoon of ground flaxseeds is commonly prescribed. (Some flaxseed oils lack the lignans component, so check labels and look for certified flaxseed.) A standardized lignans extract now exists, and is used in products like Jarrow Formulas Flax Essence, Nature's Life Golden Flaxseed Lignans, Spectrum Organic Enriched Flax Oil, and Swanson Health Products LinumLife High Lignan Complex.

Other methods to attain hormonal harmony include increasing complex carbohydrates (whole grains, vegetables, legumes) to maintain blood sugar levels; getting enough sleep and exercise; controlling stress; taking calcium, magnesium, and vitamins C and B complex; and utilizing bio-identical hormone treatments.

(For more information, see "Natural Balance" in our May issue.)

pills and lotions

MEDICAL STRATEGIES have come a long way since X-rays were used to shrink sebaceous glands. Today, dermatologists employ a variety of techniques to decrease sebum production, kill the bacteria that elicit inflammation, and help exfoliate skin around the pores.

Prescription retinoid lotions (Retin A, Differin, Tazorac) loosen plugs or prevent them from forming, and speed skin-cell turnover.

Benzoyl peroxide kills bacteria, and is often used in prescription lotions with or without an antibiotic (erythromycin, clindamycin). Milder acne may be controlled with nonprescription products like Proactiv that contain lower concentrations of benzoyl peroxide. Similar products use salicylic acid, lactic acid, or sulfur to help control bacteria; these acids are sometimes combined with sage, green tea, and aloe vera.

Glycolic- or salicylic-acid peels, performed by dermatologists, can facilitate the penetration of topical medicines and unclog pores.

A three-to-six-month course of oral antibiotics (tetracycline, doxycycline, minocycline) may be recommended for moderate to severe inflammatory acne. Many antibiotics cause photosensitivity, so avoid the sun, and take acidophilus to replace beneficial bacteria in the digestive tract eliminated by the drugs.

Isotretinoin (brand name Accutane) is a synthetic derivative of vitamin A used for severe nodular acne. While Accutane has a high success rate, its potential side effects include drying, nosebleeds, headaches, joint pain, severe depression, and possible liver damage and birth defects. This July the FDA is launching a centralized registry of isotretinoin patients, prescribers, and dispensers, which will mandate two negative pregnancy tests and the use of two forms of contraception for patients on the drug. To mitigate some risks, doctors sometimes prescribe Accutane at less than the recommended dosage, drawing out the usual course of treatment from five months up to nine months. But even in low doses, the danger of birth defects is not reduced.

lighting the way

FUTURE TREATMENTS may be measured in wavelengths, not milligrams. Laser and light therapies have become popular weapons against treatment-resistant acne. While only small, short-term clinical trials have been conducted, results seem promising. Three to eight monthly sessions are usually administered, each lasting five to 20 minutes. (A complete series can keep skin clear for more than six months.) The cost ranges up to $250 per session, but can go as high as $800 if a multipart treatment, such as photodynamic therapy, is used; in most cases, it's not covered by insurance. Seek treatment from an experienced, board-certified dermatologist, not a neighborhood spa.

FDA-approved blue light therapy is the best-known laser option; it kills acne-causing bacteria with a narrowband, high-intensity light free of damaging ultraviolet wavelengths. In a 2003 study in the Journal of Cosmetic and Laser Therapy, 80 percent of patients responded favorably, with a 59 percent to 67 percent reduction in inflammatory acne lesions.

Diode lasers shrink sebaceous glands and reduce sebum output by creating a mild thermal injury around the glands. In a 2004 report published in Dermatologic Surgery, acne lesions decreased by 83 percent after three treatments.

Photodynamic therapy is the latest in combination techniques that work to kill bacteria and shrink sebaceous glands. An hour session begins with mild microdermabrasion to remove dead skin cells. A solution of 5-amino-levulinic acid is applied, increasing light sensitivity. The ALA is removed after 15 minutes to an hour, and the patient is then treated with a light source of the dermatologist's choosing. "Some lasers, like Smooth Beam and Cool Touch, are known to improve the appearance of scars," says Alster. "They help with new collagen formation." As with many light treatments, avoid sunlight for at least 48 hours following a session.

skin-deep remedies

DON'T CONCENTRATE so much on laser beams that you forget these skin-centric options for clear complexions.

Steam opens up pores and expels toxins. Pour boiled water over a handful of strawberry leaves, eucalyptus, thyme, and wintergreen. Place a towel over your head and lean over the bowl for 10 to 15 minutes.

Tea tree oil is known for its antibacterial, anti-fungal, and anti-viral properties. It can be used on stings, burns, and skin infections, but never on open wounds--skin should be intact. Apply a 15 percent solution to blemishes twice each day.

Calendula is mildly antiseptic; apply an herbal ointment or a tea directly on blemishes.

Natural clay masks loosen blocked pores and draw out toxins. Form a paste by combining a tablespoon of kaolin clay or Fuller's Earth with rose water; spread it over your face, leave it on for 10 minutes, and rinse with tepid water.

Finally, good habits and a gentle touch can help minimize acne and return your complexion to pimple-free adulthood: Wash your face twice a day, not more. (Acne is not caused by dirt.) But never scrub harshly with lotions or loofah sponges.

Don't pick or squeeze pimples, which can cause scarring. And don't touch your face excessively--it may promote the spread of bacteria. Minimize sun exposure. A tan won't clear up acne, and may increase sebum production. Wash away perspiration after exercising.

When it comes to cosmetics, choose oil-free "noncomedogenic" moisturizers and makeup that won't block pores. Remove all makeup at day's end. And discard old makeup and moisturizers that may harbor bacteria; after a year, toss them.

HERBS FOR HEALTHY SKIN

Herbal treatments can detoxify the liver, stimulate bile flow, and regulate androgen hormones to help control acne. In Traditional Chinese Medicine, certain herbs are prescribed to "clear heat" from the blood, which may aid your complexion. Dosages will vary for individual patients. Like acne medications, some herbal options should not be used by pregnant women; consult your doctor before beginning an herbal regimen.

The herbs below are available in tablets, tinctures, teas, and/or decoctions. To make a decoction, cover 20 grams of the chopped dried herb in 3 cups of cold water, bring to a boil, simmer for 20 to 30 minutes until the liquid is reduced by a third, strain, and store it a cool place; consume this hot or cold.

A SYSTEMATIC APPROACH

Nearly all health philosophies have treatments for acne. Here are three to consider.

Ayurveda links ache to two of three doshas (constitutions): pittas (quick, passionate, high achievers) with sensitive skin, and kaphas (deliberate, compassionate, grounded) with oily skin. Cool, creative vatas tend toward drier skin, though some people are tridosha, and deal with combination skin. Practitioners advise careful blending of foods, spices, and oils for proper digestion, along with breathing, massage, and yoga.

Try this preparation for pitta and kapha skin: Mix 5 powdered grams each of neem, turmeric, amla, sandalwood, and multani mitti with 5 to 10 milliliters of water to create a paste. Apply in the morning and evening, let dry, then wash.

In homeopathy, most acne treatments contain microdose dilutions of calendula, echinacea, berberis, arnica, belladonna, and/or sulfur. Products like Nelsons Acne Gel or Hyland's ClearAc are available, or a homeopath may suggest a remedy for a person's overall constitution that addresses numerous issues. Acne associated with hormonal imbalance is often treated with pulsatilla or kali brom.

Traditional Chinese Medicine links the skin to the lungs, as they help spread fluid through the body. A practitioner seeks to harmonize the lung meridian, and to draw heat away from energy channels that lead to the face. Acupuncture points include areas on the elbow, between the thumb and forefinger, and above the inner kneecap.

Illustration by MONICA HELLSTROM

COPYRIGHT 2005 Weider Publications
COPYRIGHT 2005 Gale Group