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Understanding
Acne
What
You
Thought
You Knew
Gary I. Weinberger, MD, FACS
Intentionally Left Blank
Understanding Acne - A Whitepaper
Understanding Acne
What You
Thought You Knew
The Definitive Answer
for Lasting Skin Health
Gary I. Weinberger, MD, FACS
Langohr Publishing, LLC
Ft Lauderdale, FL: 33308
Understanding Acne
All Rights Reserved
Copyright ©2015
Gary I Weinberger, MD, FACS
http://LycopeneSkinCare.com
This White Paper may not be transmitted,
reproduced, or stored in part or whole without
written consent of the publisher except for
brief quotations in articles or reviews.
Langohr Publishing Group
Ft Lauderdale, Fl 33308
http://LangohrFoundation.com
ISBN-13: 978-0-9894390-0-8
Composed in the U.S.A.
All beauty comes from beautiful blood
and a beautiful brain
Walt Whitman
Understanding Acne - A Whitepaper
Intentionally Left Blank
Understanding Acne - A Whitepaper
P
reface
With all the products, home remedies, and potions
populating the internet these days it is amazing
anyone is able to become a specialist in the study of
acne, its causes, remedies, and what the clinical trials
have resolved to be most important - your skin’s
health in the long term.
Many products being sold will stop your acne - this is a
proven fact; but once the acne is gone, the important
fight is to accomplish concurrently the addition of the
required natural nutrients the skin needs to remain
healthy and acne free in the long-term.
This is the area where Dr Gary Weinberger excels.
While working with many of the most innovative skin
care companies in the world, he has helped to develop
many products that are on the cutting edge of skin
care technology. Whether he is travelling to Italy to
discover a better Lycopene for a hydrating skin cream,
or jetting to Holland to secure the purest micro-milled
Azelaic acid, Dr. Gary Weinberger knows no bounds
when it comes to securing the best ingredients for the
products he develops.
This whitepaper has tapped into Dr Weinberger’s
accumulated knowledge and thus becomes the
defininitive source of methods to fight acne, while
improving the overall health of your skin.
The Publishers
Understanding Acne - A Whitepaper
Gary Weinberger, M.D., F.A.C.S.
Understanding Acne - A Whitepaper
Gary Weinberger, M.D., F.A.C.S.
Gary did his undergraduate training at the University
of Cincinnati where he earned a Bachelor of Science
Degree in Zoology. He then graduated Summa Cum
Laude from the University of Bologna School of
Medicine.
After his graduation, Dr. Weinberger did a residency in
General Surgery and Urology at Millard Fillmore
Hospital, Buffalo Children's Hospital, and The Roswell
Park Memorial Cancer Institute in Buffalo, New York.
While in private practice in Manhattan, Dr. Weinberger
served as an Assistant Clinical Professor at New York
University School of Medicine as well as the Associate
Director of the Cabrini Center for Male Sexual
Dysfunction. Dr. Weinberger returned to Buffalo and
served as an Assistant Clinical Professor at the
University of Buffalo School of Medicine and Health
Sciences.
After leaving active medical practice, Dr. Weinberger
became interested in skin health and skincare and is
currently engaged in product research and
development for a variety of skincare companies.
Through his many publications he has become a
recognized authority on biologically active natural
skincare ingredients often lecturing throughout the
country. He is the Managing Director of Lycopene Skin
Care and is responsible for all formulation of the
products.
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
I
ntroduction
Understanding Acne
Its Cause and Treatment
In this paper I will attempt to discuss the current
state of knowledge regarding acne. Unfortunately, in
trying to discuss a complex topic like acne many of the
terms and concepts I refer to will be extremely
scientific and unfamiliar to the average reader.
I kindly ask you to be patient and not be scared off by
those intimidating scientific terms but hang in there
and continue reading. I have tried my best, in those
cases, to simplify the terminology into wording that
most of you can understand and by doing so give
you a clear and concise picture of acne, its causes
and treatment.
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
B
rief Review
The Anatomy of The Skin
Before we can begin to understand acne it is
important that we know a little about the anatomy of
the skin.
To begin with, contrary to what you may think, the
skin is an organ and in fact, the largest organ of the
human body covering an area of about 20 square feet.
The skin has many functions some of the most
important are to protect us from bacteria and environmental pollutants, help to regulate our body
temperature and permits us to detect changes in our
environment through the sensations of, touch, cold,
and heat.
The skin is composed of three layers. The outermost
layer, the epidermis, is a waterproof barrier that
comes in constant contact with our environment. It is
continuously exposed to and protects us from
bacteria, viruses, dirt, and a myriad of contaminants
that pollute the air around us. The epidermis also
contains Melanocytes which are the pigment
producing cells responsible for giving the skin its
various colors.
Understanding Acne - A Whitepaper
The next layer beneath the epidermis is called the
dermis and is composed of connective tissue, hair
follicles and sweat glands. This combination of a hair
follicle and a sweat gland is commonly referred to as
the pilo-sebaceous unit and a disease of this unit is
what we commonly refer to as acne. The many
causes of the disease of this unit will be discussed
later on under the section of the Causes of Acne.
The third layer of the skin is referred to as the
hypodermis and
composed largely
of connective
tissue and fat.
Understanding Acne - A Whitepaper
W
hat is Acne
Acne is a condition characterized by inflammation of
the pilo-sebaceous unit consisting of the hair follicles
and their associated sweat glands that produce an oily
substance called sebum. As a result acne can appear
anywhere on the body that has a high concentration
of these structures like the face, chest, and back.
Acne can be grouped into two categories, adolescent
acne and adult acne. Acne is most prevalent among
adolescents representing approximately 90% of the
cases and is seen in both males and females. The
remaining 10% of acne cases are seen in adults and
is predominant in females between the ages of
40 and 50.
It is generally understood that acne is caused by a
multiplicity of factors. One of the most important
factors is that individuals who suffer from acne
demonstrate an increase in sebum production.
Inflammation of the follicle secondary to proliferation
of the bacteria Proprionbacterium acneis which
becomes trapped within the follicle due to overproduction of sebum combining with sloughed dead
skin cells forming a plug that traps the bacteria. It is
now believed that P acneis is not directly responsible
for the infection but rather sets up an inflammatory
response within the follicle.
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
Propionibacterium acneis, by acting on TLR-2 (toll-like
receptor protein 2), stimulates the secretion of
cytokines (proteins responsible for the inflammatory
response), such as interleukin (IL)-6 and IL-8 by the
cells that line the hair follicles (keratinocytes) and
IL-8 and -12 in macrophages (cells that fight
infection), giving rise to inflammation. Certain P acneis
species may induce an immunological reaction by
stimulating the production of sebocyte and
keratinocyte antimicrobial peptides, which play an
important role in the innate immunity of the follicle.
Qualitative changes of sebum lipids induce alteration
of keratinocyte differentiation and induce IL-1
secretion, contributing to the development of follicular
hyperkeratosis (over production of keratin).
Sebum for its part is composed of lipids composed of
neutral and polar fatty acids. Polar fatty acids are
those fatty acids whose molecules have a charge and
act as ligands. A ligand is molecule that binds itself to
another usually larger molecule that once combined
act in a variety of roles involved in normal biologic
pathways. These charged fatty acids combine with
specific receptors on the nucleus of the cells called
PPARs or peroxisome proliferator-activated receptors.
PPAR’s are molecules that control many cellular
metabolic processes and upon activation by these
Understanding Acne - A Whitepaper
charged fatty acid molecules, PPARs
regulate the expression of such
metabolic processes as lipid
metabolism, insulin sensitivity, cell
differentiation, inflammation, proliferation and death. In short, PPARs are
the “DOORS” that once opened allow
the body to produce the essential
enzymes and proteins needed to
regain a normal steady state of health.
Another factor that plays a key role in acne is an
increase in androgens (male hormones) which control
both sebaceous gland size as well as sebum
production. It is now recognized that diet plays an
important role in acne. Recent studies show foods
with a high glycemic load foods like simple
carbohydrates and dairy products may induce
increased tissue levels of 5alpha-dihydrotestosterone
the active form of male hormones. As previously
stated male hormones are an important factor in
regulating sebaceous gland size and sebum
secretions. As the pilo-sebaceous unit “overproduces” sebum it combines with dead skin cells
forming a “plug” trapping bacteria which then
initiates the cascade of events causing inflammation
resulting in pimples and blemishes.
Understanding Acne - A Whitepaper
Sebum Fatty Acid
These new insights into the pathogenesis (cause) of
acne may lead to the considerations of possible
customized therapeutic regimens expected to lead to
innovative treatments in the near future.
All of these events that result in the inflammation of
the pilo-sebaceous unit, its rupture, and resulting
inflammation of the soft tissue surrounding the follicle
stimulate the wound healing process. Wound healing
is process that can be broken down into three stages:
inflammation, granulation tissue formation and repair
of the injured tissue.
Inflammation is the body’s response to foreign
substances such as bacteria. The body’s defense
mechanism is regulated by the immune system and is
triggered when chemicals are released by the white
blood cells into the affected tissue in attempt to
destroy the offending agent. The initial inflammatory
response to these chemicals is spasm of the blood
vessels within the tissue called “vasoconstriction”.
This happens in order to control blood loss that may
have been caused by the offending agent and the
resulting tissue damage and is characterized by
whitening or “blanching” of the skin. Once this
potential blood loss has been controlled the blood
vessels then open up again (vasodilate) and this
Understanding Acne - A Whitepaper
blanching of the skin is
now replaced by a
reddening of the skin
which may then feel
warm to the touch. A
variety of white blood
cells like granulocytes,
macrophages,
lymphocytes, fibroblasts,
and platelets then
release inflammatory
mediators like cytokines/chemokines IL-8 and IL-12
(interleukin 8 and 12) which then stimulate the
cascade of reactions that result in granulation tissue
formation.
It should be noted in addition to the white blood cell
response to inflammation, over-production of skin pigment
also occurs and plays an important role in the development
of post-acne “red” and “dark” spots frequently seen in
individuals who suffer from acne especially those with
darker skin types. Holland et al found that the inflammatory reaction around the pilo-sebaceous unit was
stronger and had a longer duration in patients with scars
than those without scars suggesting that treating early
inflammation effectively and rapidly may be the best
approach in reducing this devasting complication of acne.
Understanding Acne - A Whitepaper
A pimple on human skin
Granulation Tissue Formation: Granulation tissue
is new connective tissue and blood vessels that form
during the wound healing process. This new
connective tissue composed of collagen and elastin
begins approximately 3-5 days after the wound is
created. There are three types of collagen involved in
the wound healing process; collagen Type 1, Type 2
and Type 3. Early on in the wound healing process it
is Type 3 collagen that predominates with a small
amount (about 20%) collagen Type1. As the scar
starts to mature it is replaced with collagen Type1
(approximately 80%) more similar to that of
unwounded skin.
Re-Modeling of Wounded Tissue: As the scar
matures, specialized skin cells called fibroblasts and
keratinocytes produce chemical substances called
metalloproteinases (MMP’s) and tissue inhibitors of
MMP’s that interact to remodel the wounded skin
back to its original form. It is the delicate balance of
the interaction of these enzymes that dictate whether
the resulting scar will be minimal (atrophic) or nodular
and raised (a keloid).
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
C
omplications of Acne
As has been previously discussed the complications
associated with acne can be devastating. The most
significant complications of acne are scarring and
hyperpigmentation (permanent dark spots) which are
not only responsible for its cosmetic repercussions but
also for its negative self-image psycho-social
implications. The interaction of acne and psychosocial
issues is complex and, in adolescence, can be associated
with developmental issues of body image, socialization
and sexuality. Previous studies on the psychosocial
impact of acne have documented dissatisfaction with
appearance, embarrassment, self-consciousness, and
lack of self-confidence in acne patients. Social dysfunction
has also been observed, including concerns about social
interactions with the opposite gender, appearances in
public, interaction with strangers, and reduced
employment opportunities.
At this point a more detailed look into this often
neglected aspect of acne is in order. The majority of
our understanding of the psycho-social impact of acne
in the adolescent population has been through case
reports and case-controlled studies. In an excellent
paper by J.K.L. Tan, MD from the Department of
Medicine, University of Western Ontario, he found
these types of studies although relatively inexpensive
and rapid to perform; are often fraught with certain
Understanding Acne - A Whitepaper
disadvantages including potential bias, inability to
predict events of precedence, and to provide
estimates on prevalence, incidence, or relative risk.
The development of psychological metrics to measure
the impact of acne on abstract concepts like quality of
life has helped to understand the relationship of acne
to these concepts.
The results of this psychometric analysis reveals that
patients who suffer with acne had greater impairment
in mental health scores compared to sufferers of
diseases like asthma, epilepsy, and diabetes. In
addition, acne sufferers reported higher degrees of
depression and anxiety when compared to patients
with these diseases.
Psychometric outcomes revealed that the effective
treatment of acne correlated in a positive way with
improvement in self-esteem, affect, shame,
embarrassment, body image and self-confidence.
A study out in Leeds, England based on review of
medical records of primary care practitioners showed
unemployment was significantly higher among acne
patients of both genders when compared to those
who did not suffer from acne.
Understanding Acne - A Whitepaper
Figure 1 - Case-control surveys: psychosocial effects of acne vulgaris
Study/Year
Participants
Instruments
Controls
Van der
Meeren/1985
40
Amsterdam questionnaire,
social anxiety scale
Normal Adult.
Students
Lasek/1988
6-
Skindex
Patients with psoriasis,
benign skin lesions, health
volunteers
Gupta/1998
72
Control Rating Scale for
Depression
Inpatients and outpatients
with alopecia areata, atopic
dermatitis, psoriasis
Myhill/1988
94
Self-Questionnaires
Adult normal controls,
adolescent high school
students
PreͲTreatment
Neuraticism,
psychomaticism,
anxiety
Most bothersome feature of
acne, appearance
functioning, emotions &
symptoms
Depression scores higher
than alopecia areata, atopic
dermatitis, psoriasis
outpatients. 6% expressed
active suicidal ideation
compared to none in
alopecia areata and 2% each
in atopic dermatitis and
psoriasis outpatients
No difference compared
to controls
- Depression and anxiety
scores greater than for
general dermatology patients,
psoriasis, and oncology
patients
- Females had more
emotional distress
- 18% clinically significant
depression
- 44% clinically significant
anxiety
- 41% possible cases of nonpsychotic psychiatric
disorder
- impairment in mental
health, social functioning,
energy, role limitations
- mental health scores worse
than for asthma, epilepsy,
diabetes, back pain, arthritis,
coronary artery disease
- No correlation with acne
grade
Pain/discomfort,
anxiety/depression, lower
perceived health status
PostTreatment
—
Improvement in all
parameters/ older patients
more likely to report on
improvement
—
Improved social
assertiveness, social
appraisal, confidence
Improvement in obsessivecompulsiveness, shame,
embarrassment
perfectionism, selfconsciousness, locus of
control, body image
34
Hospital Anxiety Depression
Scale
Normal population, general
dermatology outpatients,
psoriasis, oncology, and
psychiatric patients
Mallon/1993
111
Dermatology Life Quality
Index, Rosenberg measure of
self-esteem, General Health
Questionnaire 28, Short-Form
36
Population sample 18-64 yrs.
Klassen/2000
130
Dermatology Life Quality
Index, EuroQoL,
Short-Form 36
Population Sample
20-39 years
Krowchuk/1991
39
Piers-Harris self-concept
scale
Normative
Embarrassment and social
inhibition
embarrassment, social
inhibition, greater
acceptability of facial
appearance to peers
Grahame/22002
34
Hospital Anxiety Depression
Scale, Rosenberg selfesteem, Positive/ negative
affectivity
Self-control
—
self-esteem, positive affect
anxiety, depression, negative
affect
Kellet/1999
—
Improvement in all
parameters
Understanding Acne - A Whitepaper
These types of studies have been
carried out in many other countries
and the results seem to match when
compared to the general population of
those countries.
Another significant complication of
acne is a condition referred to as PostInflammatory Hyperpigmentation or
PIH. These are extremely difficult to
treat dark spots that result from overproduction of the pigment melanin
produced by the specific cell in the skin
called melanocytes in response to
inflammation. Although this condition
can be seen in all sufferers of acne it is
more prevalent in darker skinned and
ethnic individuals with a frequency as
high as 50 percent. As has been
previously commented on the ability to
reduce the incidence of these side
effects is directly proportional to the
speed and effectiveness with which the
inflammatory lesions are treated.
Understanding Acne - A Whitepaper
H
istory of Acne
Acne certainly cannot be considered a serious disease
when compared to diseases like cancer and heart
disease. However, its economic and soci-psychological
impact is enormous for those who suffer from acne.
Acne is not a “new” disease and appears to be first
talked about in Ancient Egypt.
Early hieroglyphs identified a word “aku-t”, meaning
boils, blains, sores, pustules, or any inflamed swelling.
The early Greek and Roman writers may have referred
to a condition that more resembles rosacea rather
than acne however, they did seem to coin two terms
“ionthoi” and “vari” which spoke of a condition
occurring at puberty and most likely more similar to
what we would call “acne vulgaris” a condition
separate and distinct from rosacea. So far as we can
tell the origin of the word “acne” is a misrepresentation of the Greek word “acme” or “anything that
comes from the surface” although no real historical
support exists for this idea.
In the sixteenth century several observations were
written in English describing a condition characterized
by an abundance of melancholy blood in which there is
adiposity of the upper part of the body with boils,
much urine, and “black poushes”. It should be noted
that Shakespeare in his play describes the face of King
Understanding Acne - A Whitepaper
Henry V as being full of bubukles, and whelks, and
knobs, and flames o’ fire. A literary reference either to
acne or rosacea.
The seventeenth century writer Sennert frequently
expressed ideas similar to the writings of Theocritus
and Rhodiginus dealing with rosacea and acne under
the same heading. In the eighteenth
century most physicians felt that
treating such minor conditions like
acne and rosacea was beneath their
dignity, however, later in that century
those prejudices began to change.
During the next few centuries the
medical literature began to swell with
information on acne firmly
establishing acne as a disease of the
sebaceous gland. Recently, the
pathogenesis or the “how” this
inflammation occurs as well as
contributing factors like diet which
has been shown to worsen this
condition have been further clarified.
Understanding Acne - A Whitepaper
T
reatment of Acne
Many acne treatments have been available throughout
the ages and most of these treatments in one form or
the other are still in use today. In Ancient Egypt
topically applied honey was used and most likely had
some beneficial antibacterial effect while the Romans
unclogged pores and cleansed the skin using a
mixture of sulfur and bath salts
In 1873 cell salt therapy become the benchmark
treatment for acne and was thought to be effective in
replacing deficiencies in the body’s cell salts that were
responsible for causing acne. This treatment, in fact,
is still used by homeopathic physicians to this day.
In the 1920’s benzoyl peroxide was found to kill the
bacteria responsible for acne and is still the basis for
many of the most popular anti-acne treatments today.
In the latter half of the twentieth century antibiotics
proved to be effective.
More elaborate treatment modalities like Retin A,
Accutane, and blue light therapy have all been tried,
some with success and some not so much due to the
severe side effects.
Understanding Acne - A Whitepaper
We all wish we could just “peel” our acne away
Some other more elaborate acne
treatments using Retin A (the
molecule above) and blue light
therapy (right).
Understanding Acne - A Whitepaper
Many times the psychological effects of
acne are as important and the physical
manifestations. (Above and Left)
Understanding Acne - A Whitepaper
Unfortunately, some of the
ingredients used for acne products
will fight your acne; but then are
drying to the skin, thus causing an
unhealthy cycle where the skin
cracking allows additional new
bacteria to get under the skin layers
and start the acne cycle all over again.
(Above and right)
Understanding Acne - A Whitepaper
A
cne Fighting Treatments
So what can you use to fight your acne? Most acne is
fought with topical products. There are a rash of such
products and all advocate their mix of ingredients.
There are also some more creative therapies such as
hormones and light treatments. Of course if your acne
is severe you should visit a dermatologist for advice on
its treatment.
Most acne can be treated at home with conventional
acne products. My experience has been to pay as
much attention to your overall skin health as you do
to the fight against the acne. Finding a product that
will accomplish both these tasks is the true quest.
Check the products ingredients and study what each
is designed to accomplish on your skin. Only then can
you be comfortable using the particular product.
On the following pages are some of the widely used
ingredients to combat acne breakouts, and some of
the extra ingredients used to help with your total skin
health. Realize that many of the ingredients in acne
products are there as a vehicle for skin absorption, or
preservatives to increase shelf life. Be aware of which
ingredients are natural, or derived from natural
sources, and which are purely chemical and
superfluous to what you are trying to accomplish.
Whenever possible I prefer the natural approach.
Understanding Acne - A Whitepaper
Three successful battles against acne won; and the before
(left) and after (right) photos.
Understanding Acne - A Whitepaper
I
ngredients that Fight Acne
Antibiotics:
Antibiotics, especially the tetracyclines have been used
to kill the bacteria that are responsible for establishing
the inflammatory conditions that can cause acne. The
big problem with using antibiotics is that over time
the bacteria become resistant and the antibiotic loses
its effectiveness.
Azelaic Acid:
A relatively new treatment for acne azelaic acid is a
nonodecanoic acid derived from grains and other
plants like coconuts. It is effective against both acne
vulgaris as well as rosacea. Unlike other acne
treatments azelaic acid is not only active against the
active inflammatory phase of acne but is also effective
in reducing the appearance of the side effects of acne
like hyperpigmentation and scarring.
Azelaic acid has a triple action in combating acne.
Firstly, it is bacteriacidal against the bacteria
responsible for acne Proprionbacillus acneis, but it has
anti-tyrosinase activity. Tyrosinsase is the enzyme
necessary to convert tyrosine into the skin pigment
melanin. By blocking this enzyme abnormal amounts
of melanin produced by chronic inflammation are
prevented from forming the dark spots frequently
seen following repeated acne eruptions.
Understanding Acne - A Whitepaper
Azelaic acid also has some anti-DNA activity that may
impart an ability to block the formation of scar tissue.
It should be mentioned that azelaic acid has been
reported in clinical trials to be effective in treating
certain pre-malignant skin lesions like lentigo-maligno.
Of all the acne treatments available my personal
favorite is the azelaic acid because it is natural and not
only effectively deals with pimples but also addresses
the complications frequently associated with acne
without excessive drying of the skin.
Benzoyl Peroxide:
Benzoyl peroxide has been around since
the 1920’s and was the first organic
peroxide intentionally synthesized. It is
the main component in many of today’s
acne product like ProActiv.
Benzoyl peroxide breaks down when it
comes in contact with skin into benzoic
acid and oxygen. Although neither is particularly toxic
it does not necessarily mean that BP is safe. Benzoyl
peroxide’s action as an oxidizing agent can be
corrosive to the skin as well as having bleaching
properties.
Understanding Acne - A Whitepaper
BP commonly causes dryness and irritation. Although
most people develop a tolerance after a week or so a
small percentage of people are more sensitive and
complain of burning, redness, itching, peeling and
swelling. In 1977 a study using a human
maximization test, 76% of subjects acquired a contact
sensitization to BP. Studies have highlighted the
cancer causing potential of BP. A 1981 study from the
journal Science concluded “caution should be
recommended in the use of this and other free radical
generating compounds”.
With so many other options available and safer I am
not a real fan of BP. My experience has led me to draw
the conclusion that a significant number of patients do
not tolerate BP well with compliance then becoming a
real issue. Natural botanicals, like azelaic acid, are not
only as effective as BP but have been shown to be
effective in preventing the appearance of the
complications often associated with acne like
permanent dark spots and scarring especially in
darker skinned and ethnic individuals.
Understanding Acne - A Whitepaper
Isotretinoin and tretinoin:
Tretinoin is the acid form of Vitamin A. It is available
as Retin-A, Atralin, Renova, Airol, Avita, and Retacnyl
to name just a few.
Tretinoin may act by modifying gene expression
altering protein synthesis and epithelial cell growth
and differention.
Among the side effects of tretinoin are drynesss,
increased sensitivity to sunlight, redness, itching,
scaling, and burning. Because tretinoin may cause
thinning of the skin, it is strongly recommended to
avoid hair waxing as the top layer of the epithelium
may be removed leaving the skin red,
inflamed, and sore for several days.
Isotretinoin (Accutane)
Isotretinoin’s most dangerous side
effect is birth defects due to in-utero
exposure. In 2009, the manufacturers
of Accutane decided to pull it off of the
United States market after having lost
millions of dollars in lawsuits to
Accutane users who developed inflammatory bowel disease that resulted in some cases of
users having their colons removed.
Understanding Acne - A Whitepaper
Salicylic Acid:
Salicylic Acid from the latin “salix”, willow tree, from
whose bark the substance was originally obtained is a
type of phenolic acid and a beta hydroxy acid. SA is a
keratolytic agent that works by exfoliating the skin to
unplug clogged pores where trapped dirt, skin oils,
and bacteria reside. By allowing the pores to drain and
eliminating the source of the inflammation pimples
and blemishes can begin to heal.
The disadvantage to SA is that it is effective as a spot
treatment and not well suited for use over wide areas
of the face. It is also not effective in addressing the
complications often associated with acne like scarring
and post-inflammatory hyperpigmentation.
Sulfur:
Sulfur is a mineral with the distinctive odor of rotten
eggs. It has been used as an acne treatment since the
times of Ancient Rome when it was mixed with other
mineral salts. Today it is applied topically as a soap,
lotion, cream or gel to treat acne. Sulfur acne remedies
are sold under several brand names in the U.S.,
including Sul-Ray, Murad, Thylox Acne Treatment,
Sulmasque. Its exact mode of action is not clear and it
is less commonly used than BP or salicylic acid.
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
O
ther Ideas
Light Therapy:
As we have previously discussed the inflammation
seen in the acute phase of acne is caused by a type of
bacteria called Proprionbacillus acneis.This bacteria
can be killed by exposing the skin to a beam of light of
a certain wavelength which is blue in color, although it
appears that a combination of blue light and red light
also seems to be effective. Multiple treatments are
necessary when using this type of treatment.
Hormonal Therapy:
In women, acne can be improved with hormonal
therapy. The combination of cyproterone (a hormone
that de-activates male hormones) with an estrogen
(female hormone) is effective in reducing male
hormone levels which we have previously discussed is
one of the causes of acne.
Understanding Acne - A Whitepaper
Understanding Acne - A Whitepaper
C
onclusions
I have tried to simplify the current thinking on the
causes and treatments of acne in terms,I hope, the
reader can understand. The current state of the art
has defined acne as a disease of the pilo-sebaceous
unit whose causes are multifactorial including diet
driven hormonal variations that result in over-active
sebaceous glands. Scientific research is making great
strides in eradicating this disease with research
moving towards a vaccine against inflammatory acne.
It should be noted that all acne preparations can cause
some mild irritation and sun sensitivity so it is
recommended to use a sunscreen on your face with an
SPF rating of at least 30 if you are going to be
exposed to the sun for any prolonged period of time.
Your comments are always welcome.
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B
ibliography
1. a b Adityan B, Kumari R, Thappa DM (2009). "Scoring systems in acne vulgaris". Indian J Dermatol Venereol Leprol 75 (3): 323–6. doi:10.4103/0378-6323.51258. PMID
19439902.
2. "Acne Vulgaris: Article by Julie C Harper". eMedicine. 2009-08-06. Retrieved 2009-12-21.
3. James WD (April 2005). "Clinical practice. Acne". N Engl J Med 352 (14): 1463–72. doi:10.1056/NEJMcp033487. ISSN 0028-4793. PMID 15814882.
4. Arndt, Hsu, Kenneth, Jeffrey (2007). Manual of dermatologic therapeutics. Lippincott Williams & Wilkins. ISBN 0-7817-6058-5.
5. a b Anderson, Laurence. 2006. Looking Good, the Australian guide to skin care, cosmetic medicine and cosmetic surgery. AMPCo. Sydney. ISBN 0-85557-044-X.
6. Thiboutot, Diane M.; Strauss, John S. (2003). "Diseases of the sebaceous glands". In Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Fitzpatrick's
dermatology in general medicine (6th ed.). New York: McGraw-Hill. pp. 672–87. ISBN 0-07-138076-0.
7. Boil Drawing Salve, lovetoknow.com
8. a b Boils (Skin Abscesses), medicinenet.com
9. a b Goodman G (July 2006). "Acne and acne scarring - the case for active and early intervention" (PDF). Aust Fam Physician 35 (7): 503–4. ISSN 0300-8495. PMID 16820822.
10. Purvis D, Robinson E, Merry S, Watson P (December 2006). "Acne, anxiety, depression and suicide in teenagers: a cross-sectional survey of New Zealand secondary school
students". J Paediatr Child Health 42 (12): 793–6. doi:10.1111/j.1440-1754.2006.00979.x. ISSN 1034-4810. PMID 17096715. One study has estimated the incidence of
suicidal ideation in patients with acne as 7.1%: * Picardi A, Mazzotti E, Pasquini P (March 2006). "Prevalence and correlates of suicidal ideation among patients with skin disease".
J Am Acad Dermatol 54 (3): 420–6. doi:10.1016/j.jaad.2005.11.1103. ISSN 0190-9622. PMID 16488292.
11. Henry George Liddell, Robert Scott, A Greek-English Lexicon, on Perseus
12. "acne" at Dorland's Medical Dictionary
13. "acne vulgaris" at Dorland's Medical Dictionary
14. "acne rosacea" at Dorland's Medical Dictionary
15. "Acne Scars". www.acne-lasertreatment.net. Retrieved 2010-09-09.
16. Simpson, Nicholas B.; Cunliffe, William J. (2004). "Disorders of the sebaceous glands". In Burns, Tony; Breathnach, Stephen; Cox, Neil; Griffiths, Christopher. Rook's textbook
of dermatology (7th ed.). Malden, Mass.: Blackwell Science. pp. 43.1–75. ISBN 0-632-06429-3.
17. "Frequently Asked Questions: Acne". U.S. Department of Health and Human Services, Office of Public Health and Science, Office on Women's Health. 2009-07-16. Retrieved 2009-07-30.
18. Melnik B, Jansen T, Grabbe S (February 2007). "Abuse of anabolic-androgenic steroids and bodybuilding acne: an underestimated health problem". J Dtsch Dermatol Ges 5
(2): 110–7. doi:10.1111/j.1610-0387.2007.06176.x. ISSN 1610-0379. PMID 17274777.
19. Taylor, M.; Gonzalez, M.; Porter, R. (2011). "Pathways to inflammation: Acne pathophysiology". European journal of dermatology : EJD 21 (3): 323–333.
doi:10.1684/ejd.2011.1357. PMID 21609898.edit
20. Chiu Annie, Chon Susan Y., Kimball Alexa B. (2003). "The Response of Skin Disease to Stress: Changes in the Severity of Acne Vulgaris as Affected by Examination Stress".
Archives of Dermatology 139 (7): 897–900. doi:10.1001/archderm.139.7.897. PMID 12873885.
21. National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (January 2006). "Questions and Answers about Acne" [1], p. 5.
22. Yosipovitch G, Tang M, Dawn AG, et al. (2007). "Study of psychological stress, sebum production and acne vulgaris in adolescents". Acta Derm. Venereol. 87 (2): 135–9.
doi:10.2340/00015555-0231. PMID 17340019.
23. USA. "Acne is Not Associated with Yet-Uncultured Bacteria". Ncbi.nlm.nih.gov. Retrieved 2012-08-26.
24. USA. "Population Genetic Analysis of Propionibacterium acnes Identifies a Subpopulation and Epidemic Clones Associated with Acne". Ncbi.nlm.nih.gov. Retrieved 2012-08-26.
25. "National Guideline Clearinghouse". Guideline.gov. 11/12/2007.
26. a b c Ferdowsian HR, Levin S (March 2010). "Does diet really affect acne?". Skin Therapy Lett. 15 (3): 1–2, 5. PMID 20361171.
27. a b Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. (August 2007). "The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet
on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial.". Journal of the American Academy of Dermatology .
28. Melnik BC, Schmitz G (October 2009). "Role of insulin, insulin-like growth factor-1, hyperglycaemic food and milk consumption in the pathogenesis of acne vulgaris". Exp.
Dermatol. 18 (10): 833–41. doi:10.1111/j.1600-0625.2009.00924.x. PMID 19709092.
29. Davidovici, Batya B; Wolf, Ronni (Jan 2010). "The role of diet in acne: facts and controversies". Clin Dermatol 28 (1): 12–6. PMID 20082944.
30. Cordain, L. (2005). "Implications for the Role of Diet in Acne". Seminars in Cutaneous Medicine and Surgery 24 (2): 84–91. doi:10.1016/j.sder.2005.04.002. PMID 16092796.
31. Leeds, Cook's and Pillsbury scales obtained from here
32. a b Ramos-e-Silva M, Carneiro SC (2009). "Acne vulgaris: review and guidelines". Dermatol Nurs 21 (2): 63–8; quiz 69. PMID 19507372.
33. a b c d e Sagransky M, Yentzer BA, Feldman SR (October 2009). "Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris". Expert Opin Pharmacother
10 (15): 2555–62. doi:10.1517/14656560903277228. PMID 19761357.
34. Bernadine Healy (2005-05-09). "Pledging for Accutane". US News Best Health.
35. Shalita AR, Smith JG, Parish LC, Sofman MS, Chalker DK (June 1995). "Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris".
Int. J. Dermatol. 34 (6): 434–7. doi:10.1111/j.1365-4362.1995.tb04449.x. ISSN 0011-9059. PMID 7657446.
36. Procter & Gamble. "Niacinamide Research" (PDF).
37. Wong RC, Kang S, Heezen JL, Voorhees JJ, Ellis CN (December 1984). "Oral ibuprofen and tetracycline for the treatment of acne vulgaris". Journal of the American Academy of
Understanding Acne - A Whitepaper
Dermatology 11 (6): 1076–81. doi:10.1016/S0190-9622(84)80192-9. PMID 6239884.
38. Taylor, MB. (1999). "Summary of mandelic acid for the improvement of skin conditions". Cosmetic Dermatology 21: 26–28.
39. Kawada A, Aragane Y, Kameyama H, Sangen Y, Tezuka T (November 2002). "Acne phototherapy with a high-intensity, enhanced, narrow-band, blue light source: an open
study and in vitro investigation". J Dermatol Sci 30 (2): 129–35. doi:10.1016/S0923-1811(02)00068-3. ISSN 0923-1811. PMID 12413768.
40. Kjeldstad B (March 1984). "Photoinactivation of Propionibacterium acnes by near-ultraviolet light". Z Naturforsch [C] 39 (3–4): 300–2. ISSN 0341-0382. PMID 6730638.
41. Ashkenazi H, Malik Z, Harth Y, Nitzan Y (January 2003). "Eradication of Propionibacterium acnes by its endogenic porphyrins after illumination with high intensity blue light".
FEMS Immunol Med Microbiol 35 (1): 17–24. doi:10.1111/j.1574-695X.2003.tb00644.x. ISSN 0928-8244. PMID 12589953.
42. "New Light Therapy for Acne" (archive) U.S. Food and Drug Administration, FDA Consumer, November–December 2002, (Original URL)
43. "510(k) Summary: CureLight's ClearLight Phototherapy Device" (PDF). FDA, Office of Device Regulation, Center for Devices and Radiological Health. 2002-08-16. Retrieved 2009-07-30.
44. Papageorgiou P, Katsambas A, Chu A (May 2000). "Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris". Br J Dermatol 142 (5): 973–
8. doi:10.1046/j.1365-2133.2000.03481.x. ISSN 0007-0963. PMID 10809858.
45. "DUSA Pharmaceuticals (DUSA) to Stop Developing Phase 2 Acne Treatment". Biospace. 2008-10-23. Retrieved 2009-07-30.
46. Brightman L, Chapas A, Geronemus R. "Ablative Fractional Resurfacing of Acne Scars". Lasers Surg Med. 40:381-386. 2008 [2]
47. "Health | Doubts over acne laser treatment". BBC News. 2004-06-15. Retrieved 2009-12-21.
48. By: (2004-03-28). "Manage Account - Modern Medicine". Dermatologytimes.com. Retrieved 2009-12-21.
49. "Enforcement Report". Recalls, Market Withdrawals, & Safety Alerts. FDA. 2004-01-14. Retrieved 2009-07-30.
50. Kwon HH, Yoon JY, Hong JS, et al. (May 2012). "Clinical and histological effect of a low glycaemic load diet in treatment of acne vulgaris in Korean patients: a randomized,
controlled trial.". Acta Derm Venereol 92 (3): 241–246. doi:10.2340/00015555-1346.. PMID 22678562.
51. Yarnell E, Abascal K (Dec 2006). "Herbal medicine for acne vulgaris". Alternative and Complementary Therapies 12 (6): 303–309. doi:10.1089/act.2006.12.303.
52. Graupe K, Cunliffe WJ, Gollnick HP, Zaumseil RP. (Jan 1996). "Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials
and experimental reports". Cutis 57 (1 suppl): 20–35. PMID 8654128.
53. Morelli V, Calmet E, Jhingade V. (Jun 2010). "Alternative therapies for common dermatologic disorders, part 2.". Prim Care 37 (2): 285–296. PMID 20493337.
54. Bassett IB, Pannowitz DL, Barnetson RS. (Oct 1990). "A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne.". Med J Aust. 153 (8): 455–458. PMID 2145499.
55. Enshaieh S, Jooya A, Siadat AH, Iraji F. (Jan-Feb 2007). "The efficacy of 5% topical tea tree oil gel in mild to moderate acne vulgaris: a randomized, double-blind placebocontrolled study.". Indian J Dermatol Venereol Leprol. 73 (1): 22–25. PMID 17314442.
56. Pazyar N, Yaghoobi R, Bagherani N, Kazerouni A. (Sept 2012). "A review of applications of tea tree oil in dermatology.". Int J Dermatol. doi:10.1111/j.13654632.2012.05654.x.. PMID 22998411.
57. a b Vos, T (2012 Dec 15). "Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of
Disease Study 2010.". Lancet 380 (9859): 2163–96. PMID 23245607.
58. White GM (August 1998). "Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris". J. Am. Acad. Dermatol. 39 (2 Pt 3): S34–7.
doi:10.1016/S0190-9622(98)70442-6. PMID 9703121.
59. Shah SK, Alexis AF (May 2010). "Acne in skin of color: practical approaches to treatment". J Dermatolog Treat 21 (3): 206–11. doi:10.3109/09546630903401496. PMID 20132053.
60. "Tretinoin (retinoic acid) in acne" (Free full text). The Medical letter on drugs and therapeutics 15 (1): 3. January 1973. ISSN 0025-732X. PMID 4265099.
61. Jones H, Blanc D, Cunliffe WJ (November 1980). "13-cis retinoic acid and acne". Lancet 2 (8203): 1048–9. doi:10.1016/S0140-6736(80)92273-4. ISSN 0140-6736. PMID 6107678.
62. Bérard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D (February 2007). "Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective". British
Journal of Clinical Pharmacology 63 (2): 196–205. doi:10.1111/j.1365-2125.2006.02837.x. PMC 1859978. PMID 17214828.
63. Holmes SC, Bankowska U, Mackie RM (March 1998). "The prescription of isotretinoin to women: is every precaution taken?". The British Journal of Dermatology 138 (3):
450–5. doi:10.1046/j.1365-2133.1998.02123.x. PMID 9580798.
64. Kim J (October 2008). "Acne vaccines: therapeutic option for the treatment of acne vulgaris?". The Journal of Investigative Dermatology 128 (10): 2353–4.
doi:10.1038/jid.2008.221. PMID 18787542.
65. Farrar MD, Howson KM, Bojar RA, et al. (June 2007). "Genome Sequence and Analysis of a Propionibacterium acnes Bacteriophage". Journal of Bacteriology 189 (11): 4161–
7. doi:10.1128/JB.00106-07. PMC 1913406. PMID 17400737.
66. Kellett SC, Gawkrodger DJ. The psychological and emotional impact of acne and the effect of treatment with isotretinoin. Br J Dermatol 140(2):273-82 (1999 Feb).
67. Gupta MA, Gupta AK. Depression and suicidal ideation in dermatology patients with acne, alopecia areata, atopic dermatitis and psoriasis. Br J Dermatol 139(5):846-50 (1998 Nov).
68. Mallon E, Newton JN, Klassen A, Stewart-Brown SL, Ryan TJ, Finlay AY. The quality of life in acne: a comparison with general medical conditions using generic questionnaires.
Br J Dermatol 140(4):672-6 (1999 Apr).
69. Klassen AF, Newton JN, Mallon E. Measuring quality of life in people referred for specialist care of acne: comparing generic and disease-specific measures. J Am Acad Dermatol
43(2 Pt 1):229-33 (2000 Aug).
70. Lasek RJ, Chren MM. Acne vulgaris and the quality of life of adult dermatology patients. Arch Dermatol 134(4):454-8 (1998 Apr).
71. Krowchuk DP, Stancin T, Keskinen R, Walker R, Bass J, Anglin TM. The psychosocial effects of acne on adolescents. Pediatr Dermatol 8(4):332-8 (1991 Dec).
72. Myhill JE, Leichtman SR, Burnett JW. Self-esteem and social assertiveness in patients receiving isotretinoin treatment for cystic acne. Cutis 41:171-3 (1988).
73. Grahame V, Dick DC, Morton CM, Watkins O, Power KG. The psychological correlates of treatment efficacy in acne. Dermatol Psychosom 3(3):119-25 (2002 Sep).
74. Van der Meeren HLM, van der Schaar WW, van den Hurk CMAM. The psychological impact of severe acne. Cutis 36(1):84-6 (1985 Jul).
75. Cunliffe WJ. Acne and unemployment. Br J Dermatol 115(3):386 (1986 Sep).
76. Aktan S, Ozmen E, Sanli B. Anxiety, depression, and nature of acne vulgaris in adolescents. Int J Dermatol 39(5):354-7 (2000 May).
77. Smithard A, Glazebrook C, Williams HC. Acne prevalence, knowledge about acne and psychological morbidity in mid-adolescence: a community-based study. Br J Dermatol
145(2):274-9 (2001 Aug).
Understanding Acne - A Whitepaper
Understanding Acne
What You Thought You Knew
Gary I Weinberger, MD, FACS
Lycopene Skin Care
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