Treating Acne Part 1
Treatments of acne should be focused on the events that cause acne. So that’s pore obstruction (or plugging of the pilosebaceous unit), increased sebum production, ongoing inflammation, overgrowth of bacteria, particularly P. acnes and P. granulosum, and increased inflammation and infection.
Let’s start with talking about botanicals that have antibacterial activity. This would be activity that helps fight the P.acnes and P. granulosum bacteria. One of these botanicals is resveratrol. Resveratrol is a type of polyphenol—a natural substance packed with micronutrients that can be found in plants—that is naturally present in grapes, berries (such as cranberries, blueberries and mulberries.) A phytoalexin, resveratrol is produced by plants as a protective antibiotic to fight off fungal attacks, drought, UV radiation and inflammation. “Resveratrol has anti-inflammatory, antibacterial and antifungal properties, which calm down the skin, reduce skin-aging and may keep [the skin] free of infections,” explains Kansas City double board-certified dermatologist Viseslav Tonkovic-Capin, M.D. Due to its antimicrobial properties, resveratrol inhibits the growth of acne-causing bacteria.
Another botanical with antibacterial properties is the Magnolia Species, it’s in the class of phenolic compounds. It suppresses or kills bacteria. The phenolic compounds in the Magnolia Species that are particularly helpful in combatting acne are magnolol and honokiol. These two phenols have a very strong antibacterial effect, there’s no adverse topical effects like increased inflammation or sensitization. It’s also a strong antioxidant and anti-inflammatory.
Benzoyl Peroxide is a very common treatment of acne. Benzoyl Peroxide is an over the counter and industrial medication/chemical that is antibacterial but let’s talk about its mechanism. It’s present in varied topical concentrations from 1-10%. The way in which Benzoyl Peroxide exerts it’s antibacterial effects is that is has a cytotoxic or cell killing ability, that’s how it kills the bacteria. The cell killing goes up with the level of concentration, Benzoyl Peroxide works by a mechanism of inducing free radical damage. It also depletes antioxidants in the skin because its free radical generating. After only 7 days of using 10% Benzoyl Peroxide, 93.2% of all Vitamin E in the skin is gone. Used all the way up! That’s how much free radical damage is introduced with Benzoyl Peroxide use. Now, it should be as no surprise that using Benzoyl Peroxide causes a pro-inflammatory response in the skin. So, this mechanism is really working against itself—-it also induces water loss in the skin. Dry skin = more inflammation and more inflammation = more acne. I usually advise against the use of Benzoyl Peroxide as an acne treatment.
Another known treatment of acne is Azelaic Acid. Azelaic Acid is a naturally occurring acid found in grains such as barley, wheat, and rye but it’s the lab engineered form that is typically used in skincare products. It has antimicrobial and anti-inflammatory properties. It can be used to treat mild to moderate acne and both comedonal and inflammatory acne. A couple downsides of using Azelaic Acid is that it can cause skin irritation and isn’t the best option for people with more melanin in their skin as it can cause discoloration.
One of the best treatments for acne is to increase desquamation, also known as exfoliation. We can increase this process to help with acne. This is helpful because you’re moving cells of the epidermis up more quickly and you’re moving the sebum out of the pilosebcaeous unit more quickly. One of the ingredients that increases desquamation or exfoliation is Retinol. Vitamin A is retinol, it’s needed for skin and human body function and is required in the human diet. Our bodies cannot create Vitamin A on its own so we must create a diet that’s rich in Vitamin A foods. Vitamin A is needed for healthy epidermal turnover. Topical Vitamin A has shown to be helpful for acne and has minimal side effects. Vitamin A is also a a great antioxidant and anti-inflammatory, which are both functions needed in the healing of acne and the skin.
Alpha Hydroxy Acids (AHA) are another proven treatment of acne. AHA’s are water-soluble acids usually sourced from fruit that helps increase the exfoliation process in the skin. This group may be made in the lab or come from botanicals. Of all the AHA’s Glycolic Acid is most commonly used because its absorbed easily into the skin. Glycolic Acid is the smallest molecule of the group of AHA’s. Other AHA’s include Lactic Acid, Malic Acid, and Mandelic Acid.
Beta Hydroxy Acid (BHA) is the other group of chemicals that’s helpful with acne. BHA’s are also exfoliants but they act on the sebum on in the pilosebaceous unit. The BHA’s are lipid-soluble. Because sebum is a fat the BHA’s dissolve in the sebum, they clean out the accumulated debris that’s so problematic in acne. Salicylic Acid is the prototype of the BHA’s, the botanical source is made from White Willow Bark Extract. This extract contains a molecule called salicin. Salicin is an anti-inflammatory agent in the body and because it’s a botanical it has a tendency to be gentler on the skin and work as an antioxidant as well.
Enzymes are another effective treatment of acne. They encourage and increase exfoliation. Two very popular enzymes used for acne are bromelain and papain. Bromelain comes from pineapple and papain comes from papaya. This group works as resurfacers by breaking up the bridges that hold cells of the epidermis (stratum corneum) together. These are called desmosomes. Desmosomes are a structure by which two adjacent cells are attached, formed from protein plaques in the cell membranes linked by filaments Enzymes break this up and allow the outer surface of the epidermis to exfoliate more rapidly.
We touched base earlier on Vitamin A and the importance of its role in our bodies. The molecule of Vitamin A can be and is often chemically modified and these derivatives and pharmaceuticals are used in the treatment of acne. As the molecule is increasingly changed the likelihood of side effects increases. The stronger compounds increase the rapid exfoliation and can cause irritation, peeling, and flaking. A chemically engineered Vitamin A Derivative is Tretinoin aka Retin-A. This is the least modified molecule of the retinoid group. Retinoids are derivatives of Retinol and refers to the group of slightly modified Vitamin A molecules. It works by increasing cell turnover which reduces dead cells from clogging pores.
Acne lesions are cellular wounds, and if left untreated, the wound may become a breeding ground for bacteria and increase the risk of permanent scarring. To help effectively heal the skin and restore it to optimal health, we must treat acne with a combination of botanicals (known wound healers), professional treatments (like peels that have higher concentrations of AHA’s/BHA’s), using effective skincare at home (ie: controlled exfoliation with Retinol and anti-inflammatory products), and maintaining a healthy lifestyle (less stress, antioxidant rich diet, plenty of water + sleep.)
