Acne treatments are available in Gauteng at the Morningside, Parkhurst, Bedfordview, Fourways, West Rand, Irene, and Brooklyn clinics, as well as in the Western Cape at Cape Quarter, Claremont, Constantia, Century City, Stellenbosch, Paarl and Willowbridge clinics, and Kwa-Zulu Natal at the Ballito, Durban and Umhlanga clinics.
Acne (acne vulgaris) is a dermatologic condition that affects approximately 80-95% of adolescents as their bodies go through puberty, but luckily its occurrence declines over the following years until middle age. This condition is characterized by lesions that most often appear on the face and neck, but it is not uncommon to develop these lesions on the chest, back, shoulders, and upper arms too. Acne vulgaris, the most common skin disorder, affects virtually all individuals at least once. Incidence peaks in 18-year-olds, but substantial numbers of the 20- to 40-year age group also develop the disease.
Adolescent boys and young men are more likely to have acne than their female counterparts and make up the majority of severe scarring cases, due to the fact that acne is triggered by androgens (male hormone) fluctuations.
Women are more likely to suffer from ongoing acne that commences or reappears during their early adult years. Around 8% of women have acne persisting into their 30’s and in some, it continues into their 40's and occasionally 50's. Why this occurs is poorly understood but may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle.
There is also a subset of women with “true” hormonal acne who have abnormal levels of androgenic (male-type) hormones. These women often have accompanying excess facial hair (also hormonally regulated) and irregular menstrual cycles, although women who have normal hormone levels may also have excess hair. The sebaceous glands of patients with acne are likely to be hypersensitive to androgens (male-type) hormones.
Acne is characterized by the formation of comedones (blackheads), pimples, cysts and abscesses (in worst cases). These lesions are formed on the skin when the pores in the skin are blocked. This blockage causes oil to be trapped, together with dead skin and bacteria within the hair follicles. In normal circumstances, the sebaceous glands (which have the function of secreting an oily substance called sebum) are attached to the hair follicles and allows the sebum to travel up the hair follicle and onto the skin. However, if there is a blockage in the hair follicle, the sebum can't get out, and this can sometimes cause the formation of a blackhead (comedones).
Blackheads are the result of the blocked oil that oxidizes, causing further inflammation and an influx of white blood cells. Meanwhile, normally present bacteria (Propionibacterium acnes) begin to break down the trapped sebum within the hair follicle. The subsequent result is further aggravated inflammation, as white blood cells attack the bacteria. Pus forms within the lesion causing the lesion to enter the whitehead stage. In more severe stages with severe inflammation and infection, an abscess - a painful pus-filled pocket within the skin - may form.
Acne arises from the interaction of 4 factors:
- Dead skin cells blocking the oil duct results in Comedogenesis. The first sign of altered keratinization is a blackhead which consists of keratinized material and lipid material. This Abnormal Keratinization results in the formation of keratin plugs which blocks off the drainage of the sebaceous follicles, leading to the accumulation of inflammatory debris and increased bacterial numbers of P acnes.
- Too much oil production caused by androgenic hormonal stimulation of sebaceous glands at puberty or later (hormonal triggers).
- Too many bacteria: Proliferation of P acnes in this blocked follicle.
- Too much Inflammation: is a direct or indirect result of P acnes proliferation. Rupture of the inflammatory follicle onto the skin results in the redness around the acne lesion. Extension of inflammation into the skin results in the formation of inflammatory lesions of acne, which include papules, pustules, and nodules. The result is redness and pus.
There are numerous significant medical conditions that are associated with acne that need to be identified and addressed. Conditions such as low stomach acid, dysbiosis, and leaky gut all compromise skin but more importantly which have future health ramifications such as autoimmune disease, food sensitivities, allergies, asthma, depression, and even cancer if they are not adequately addressed. During your initial consultation with one of our qualified doctors, it may be advised that you are checked for low stomach acid, thereafter a complimentary Betaine HCl acid test is explained and done. Because;
- Adequate stomach acid is essential for the absorption of the minerals zinc, magnesium, calcium, iron, and folate which are essential for healthy skin.
- Adequate Stomach acid prevents dysbiosis.
- Adequate stomach acid will help prevent a "leaky gut "with all its health ramifications from developing.
In addition, low stomach acid will eventually lead to low levels of Zinc and other important minerals and vitamins which are essential for good healthy skin.
- Adequate stomach acid is essential for the absorption of the minerals zinc, magnesium, calcium, iron, and folate which are essential for healthy skin.
- Adequate stomach acid is necessary for the absorption of the B vitamins.
- Stomach acid activates protein-digesting enzymes and is necessary for proper digestion of protein.
- Adequate stomach acid is necessary for the pancreas to release its cascade of digestive enzymes for the absorption of carbohydrates and fat.
- Sub-optimal fat digestion means we won't benefit from the anti-inflammatory properties of omega-3 fats, nor the wide array of beneficial effects of fats for fertility, skin health, immunity, etc.
- Adequate stomach acid destroys pathogens (bacteria, fungi, parasites, etc) and a lack of stomach acid can lead to bad bacteria proliferating in the small intestine dysbiosis (bad bacteria) and unwanted parasites which have health ramifications down the line.
Having normal levels of stomach function the first important domino in a row of dominos: If stomach acid is adequate, the rest of one's digestion and absorption won't be compromised and the first domino won't fall and immune dysfunction is less likely down the line.
If digestion in the stomach is compromised due to low stomach acid, then the fall of the first domino will occur and the breakdown and absorption of nutrients in the stomach and beyond won't be optimal. In fact, digestion and absorption can be reduced to the point where even if someone is consuming a nutrient-dense diet, they can suffer both sub-clinical and overt deficiencies because they're not assimilating those nutrients because they have low stomach acid. Get your stomach acid checked by our Renewal Institute Doctors.
Acne can be classified as mild, moderate, or severe inflammatory acne and is based on lesion count and whether nodules are present, or not.
- Mild to moderate acne: papules, pustules, and comedones, without any nodules present in the skin.
- Severe acne has many papules, pustules, comedones, and/or more than 5 nodules present in the skin. Cysts may also be present in these severe cases.
Severe acne may be more common in males and this kind of acne should be referred to a Renewal Institute doctor as scarring is inevitable.
It is the choice of the individual to use natural and alternative therapies in the treatment of acne, either by itself, or to compliment conventional medications. These natural remedies can help to reduce inflammation, and infection, and in severe cases a combination of treatment might get the best results.
Vitamins A and E. The benefits of vitamins A and E in acne treatment was highlighted in a study in which investigators compared the plasma vitamin A and E concentrations in 100 untreated patients with acne, compared with 100 healthy controls. In the patients that suffered from acne the plasma concentrations of both vitamins were significantly lower than those of the healthy individuals. This showed a strong relationship between a decline in vitamin A and E levels and an increase in the severity of acne.
These findings supports previous research which found that supplementation with vitamin A is beneficial in inflammatory conditions, including acne. Equally, vitamin A deficiency induces inflammation and aggravates existing inflammatory conditions. In fact, vitamin A in its retinoid form has long been an important treatment for acne.
Lipoic acid. It has been tested for several decades how effective lipoic acid is in the treatment of acne. Reportedly, lipoic acid activates a factor in the body known as AP-1, which produces enzymes that digest damaged collagen and helps erase scars, including acne scars. Topical ointments that contain lipoic acid as an ingredient can assist in improving scarring, and this can be taken in oral supplements as well.
Zinc. This mineral is very potent in the treatment of acne as it appears to perform a threefold role. Firstly Zinc can help to reduce inflammation, secondly it kills Propionibacterium acnes (the main bacteria associated with the condition), and lastly zinc produces changes in the skin environment that make it more hostile to this bacterium for a longer time. A two-month study of the efficacy of zinc gluconate (30 mg once daily) in 30 patients with inflammatory acne showed a reduction in the number of inflammatory lesions after the treatment period, and improved effectiveness of the antibiotic erythromycin among patients with antibiotic-resistant organisms. In a double-blind study, a combination of 1.2% zinc and 4% erythromycin in a topical lotion was used by 14 individuals with acne. It was founds that the combination of zinc and erythromycin significantly reduced secretion of sebum after six weeks of treatment. Further, a topical preparation of zinc acetate was found to prolong the duration of erythromycin on skin, potentially overcoming some mechanisms of erythromycin resistance.
It is very interesting to note that clinical trials of zinc preparations have demonstrated their equivalence to antibiotics, with the added benefit of having more convenient dosing schedules, and less harmful effects of antibiotic treatment. A study that compared a cream containing chloroxylenol and zinc oxide showed no difference in efficacy compared with 5% benzoyl peroxide, but it did find significantly less skin drying and irritation with the zinc-containing cream. Finally, a 2005 study demonstrated that a gel containing clindamycin plus zinc, applied once or twice daily, achieved the same benefit obtained by clindamycin lotion alone used twice daily.
Niacinamide (nicotinamide). Niacinamide is one of the two principle forms of niacin, and proves to be very effective in acne treatment when applied topically to the skin. In a State University of New York study, a 4% nicotinamide gel was compared to a 1%clindamycin gel for the treatment of moderate inflammatory acne in 76 patients. Treatment was applied twice daily for eight weeks. At the end of treatment, 82% of the nicotinamide patients and 68% of the clindamycin patients were improved. An additional fact to keep in mind with the use of topical clindamycin is that it is also associated with the development of resistant microorganisms, which makes the use of niacinamide even more preferred. Nicotinamide cream has also been shown to reduce the amount of sebum present on the skin, thus assisting in acne treatment.
Essential Fatty Acids (EPA /DHA). The two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well-known tried & tested anti-inflammatories that have been shown in dozens of studies to reduce general inflammation. Although their effect on acne and skin inflammation has not yet been extensively studied, their ability to reduce inflammation in general suggests they might be beneficial with a role in the treatment of acne. Several studies have found that omega-3 fatty acids are absorbed through the skin and can reduce inflammation in a particular area.
Herbal Therapy. Even though herbal therapy is often suggested for acne, there are few controlled scientific studies that have been conducted to confirm any claims. In a double-blind, placebo-controlled clinical trial of Ayurvedic (ancient Hindu) herbal preparations, researchers randomly assigned either placebo or one of four Ayurvedic formulas to 82 people with moderate cases of acne. One formulation, Sunder Vati, significantly reduced the number of inflammatory and non-inflammatory acne lesions. Sunder Vati consists of a combination of ginger (Zingiber officinale), Holarrhena antidysenterica, and Embelia ribes.
Several other herbs have anti-inflammatory properties that may be helpful in the treatment of skin conditions, although there are no scientific studies that have been performed with acne. The herbs include calendula (Calendula officinalis), German chamomile (Matricaria recutita), witch hazel (Hamamelis virginiana), and licorice root (Glycyrrhiza glabra). These herbs are found in some natural skin-care products, and may be effective on an individual basis.
There are various product houses that offer topical treatment specifically for acne. Topical therapies include:
Treatments available at Renewal Institute to treat acne and improve results:
- Microdermabrasion gently polishes the skin. Can be used for mild acne, where the lesions are not currently active.
- Deep Cleanse Facials are cleansing facials which are prescribed once a month to remove pustules and comedones so as to facilitate the healing of the acne condition with as little damage to the skin as possible.
- At Renewal Institute we offer the following peels for our acne patients: Beta Salicylic acid peel and Azelaic Peel for our acne patients depending on your skin type, severity and budget.
- The Laser Genesis procedure, a 5-in-one treatment, reduces the size of the sebaceous gland, reduces inflammation in the papule and nodule, reduces pore size, and improves acne scarring and pigmentation. For deep nodules, the Titan is a deep infra-red laser/Light procedure that reduces inflammation and kills the bacteria in the deep painful nodule(s) and helps prevent scarring.
- PDT/LED photodynamic therapy uses red and blue light therapy, plus a salicylic acid silk peel to improve acne by destroying bacteria and reducing inflammation in the acne lesion.
- Standalone PDT/ LED treatment alternating with the red and the blue light every 48 hours. 8 treatments would be needed to improve acne.
- The blue light kills the acne bacteria.
- The red light is anti-inflammatory.
- Carboxytherapy around acne lesions, or into acne scars, reduces the acne lesion and improves the acne scarring.
- Intralesional steroids into acne nodules reduce the acne lesion by decreasing inflammation.
As each patient's case is different we will tailor a treatment program specifically for your circumstances and budget. A highly professional team led by a Medical Doctor assesses every patient and an appropriate combination of treatment together with a long-term maintenance program is recommended.
If you have Minimal acne (see definition above), you can come into one of our branches and our qualified and knowledgeable staff/ therapists will advise you on topical home therapies. If you want to have in office treatments such as a peel or Microdermabrasion, then please make an appointment with one of our Renewal Institute Doctors.
HOWEVER if you have MILD to MODERATE acne, then you will need to make an appointment with one of the Renewal Institute doctors for a full evaluation.
The challenge with your case is that it is fairly complex in that you are dealing with a number of concerns all of which affect one another at once. So in a case like yours it is terribly difficult to help you in this type of forum. Truth be told there are quite a few things that can affect the various issues you have mentioned and some of these overlap, so treating a few core issues, may very well give you improvement on a number of the issues you are struggling with. The best advice that I can give you is to come and see me or one of our Dr’s who can take a proper medical history and establish a time line and run the necessary tests to give you the best, comprehensive treatment plan to help you.
It sounds like you are dealing with a few issues on your skin and in a case like that it really is very difficult to give you the best advice over a forum like this. Diet is not always the problem when it comes to problematic skin. From the little bit of information you have given me it would seem like you’re struggling with pigmentation as well as Acne breakouts that seem to be a re-occurring issue. That being the case, the most important thing to do would be to find the triggers of your problem/s and focus the treatment on targeting those triggers, otherwise these problems are just going to keep on coming back. We would need to do a proper medical history and really investigate what is going on here. Are you close to any of our branches? I would really recommend that you come to see me or one of our Doctors so that we can get you the best help and advice.
Acne is an interesting beast. It can have any number of triggers including hormones, over-supplementation, under-supplementation, wearing fabrics that constantly cause blocking of the pores. So there are so many variables. Interestingly enough, the cause that rears its head 90% of the time, is in fact, believe it or not… GUT HEALTH! The imbalance of “good vs bad bacteria” in the gut. Most often this situation if left untreated, leads to leaky gut syndrome, which in turn leads to hormonal imbalances, vitamin and mineral deficiencies, weakening and sensitising of the skin, which in turn causes more Acne. So I would start by investigating what the trigger is in your case and then work accordingly.
You need to be aware of the fact that both eczema and Acne have internal triggers. They are not simply skin conditions. Rather they are a warning light that something inside your body is not happy. While treating these conditions topically gives some relief, topical creams and products are just helping treat the symptoms and not addressing the cause. My best recommendation to you is to come and have a consultation with one of our Skin Renewal Doctors. Rather let’s figure out the cause and the triggers and treat the cause of the problem.
This is not an uncommon occurrence, unfortunately. The problem is that the Tetracycline and Rosex gel, while brilliant tools to help with coping with the Rosacea is only a temporary solution as it is treating a SYMPTOM, and not the actual CAUSE of the problem. So unfortunately, it will keep the problem at bay for a short while, but recurrence will happen due to the underlying triggers not being treated. VERY often the problem is internal and normally gut-related. The aim to help you in the long term would be to sort out what is triggering your Rosacea and then focus the treatment on that trigger so that we address the cause. While that is happening, we can certainly also treat what we are seeing topically to help deal with the appearance of your skin, but the real issue needs to be to focus on managing the cause so that you don’t get this problem reoccurring all the time.
Generally acne from the ears, down towards the jawline, indicates a hormonal imbalance of sorts. It’s usually not just simply a skin issue. In your particular case, I would suggest that you first see a Skin Renewal Doctor to get a medical history and to investigate what has changed in your meds, lifestyle, stress, sleeping habits and gut health in the last 6 or so months, as these are all very important pieces of the puzzle. This will most likely help us to identify a trigger, and then the course of action would be to target that trigger, and deal with the skin. If you JUST deal with the skin you are going to have persistent relapses because you aren’t addressing the cause of the break outs. Acne, especially nodular acne as you are describing, is not simply a skin issue, so no matter how good you are with moisturising or cleansing or looking after the skin’s surface, you are not treating the cause. I would highly recommend a thorough consultation with one of our Doctors.
Unfortunately, toothpaste is not very good for the skin at all, as it can be mildly abrasive, given the fact that it is made to clean your hard teeth. So unfortunately, what has happened is that you have stripped the skin of its barrier where the toothpaste has been applied, and then you get an inflammatory response in that area and then you get post inflammatory hyperpigmentation as a result of this. If the skin is still peeling, I would suggest applying a VERY thin layer of Vaseline to create a “temporary barrier” in that area, followed by a good SPF. If you are wanting to prevent dark marks from forming on your skin then it is vital to at LEAST use a good SPF every single day. If you simply want a very cost effective moisturiser, then I would suggest using something like Epimax, which is available cheaply at most pharmacies and even some department stores, but using a good facial SPF over your moisturiser every morning is vital. Once your skin is healed, I would suggest you reassess what it looks like and then take it from there.
It’s definitely the best idea to first establish exactly WHAT changes you wish to see on your skin, and then choose your skin care products accordingly. There is a lot to be said for “cherry picking” the best combination of products to give you the changes in your skin that you want to see. I’m going to have to generalise in your case, because I have not seen your particular skin for myself. Generally I find that Indian patients struggle with pigmentation and uneven skin tone. Being younger, I would say in terms of that particular issue, you need to focus on prevention and maintenance. You might want to look into ingredients such as Vit C, anti-oxidants and Vit A (for night time use). A good SPF 50 should be applied daily in the mornings.