The Causes of and Possible Solutions to Acne Vulgaris

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne. While not a life threatening condition, acne can be upsetting and disfiguring. When severe, acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring. Why does acne happen?

- An inflamed spot occurs due to the release of inflammatory fatty acids by a particular bacterium known as p.acnes, which causes the body’s defence systems to respond.
- You would however not get p.acnes colonisation of the hair follicle duct without a plug forming.
- The plug forms due to an increase in skin cell turnover, increased keratin deposition narrowing the opening of the hair follicle duct, combined with increased sebum production, which mixes with the debris to cause a blockage and a plug to form.
- The increased sebum, keratin and cell turnover would not happen if linoleic acid levels in the skin had reduced dramatically.
- Linoleic acid levels reduced due to the development of sensitivity to the hormone DHT.
- DHT is formed from testosterone. The chemical reaction naturally happens throughout the body and the conversion of testosterone to DHT is assisted and promoted by the enzyme called 5-alpha reductase. (All chemical reactions in the body are controlled and accelerated by enzymes).

Possible solutions to the underlying causes of acne:

1) Stop hormonal fluctuations. This is impossible although people do try by taking plant hormones, HRT and royal jelly. But basically it is best not to mess with our natural hormonal balance.

2) Use Roaccutane. This will affect the conversion of testosterone to DHT, but this will occur all over the body and DHT plays a role in a number of body functions and suppressing it leads to a number of possible side effects.

3) Reduce DHT levels in the hair follicle and in sebaceous gland area only, known as the pilo-sebaceous unit. If it were possible to prevent testosterone from converting to DHT in the acne area of the skin but not stopping this conversion elsewhere in the body could reduce skin sensitisation and the resulting linoleic acid loss, but without affecting the conversion of testosterone to DHT in other parts of the body. This would be great in principle if one can alter the conditions in the pilosebaceous unit for an extended period of time so that DHT levels were reduced locally during the times in our lives when normal hormone levels were ‘out of sync’ with a topical preparation could lead to a reduction in the triggering of the acne process. Two products called tri-ethyl citrate and ethyl linoleate which are safe and release citric acid and linoleic acid can change conditions in the skin which slows down the enzyme 5-alpha reductase and hence testosterone conversion to DHT is slowed down locally. The testosterone conversion to DHT will still occur but just somewhere else in the body, meaning other bodily processes are not affected.

4) If one could also replenish linoleic acid levels in the skin then this would lead to a slow down in oil production and skin cell turnover rates and keratin deposition, preventing the plug forming and the colonisation by p.acnes.

5) One could take linoleic acid supplements and foods high in linoleic acid. However linoleic acid is used by many parts of the body and one would have to take possibly toxic levels to affect skin levels significantly enough through oral supplementation alone. Doing this without going to excess is probably however a good thing and it has been noticed that the Eskimos (the Inuit) did not suffer from acne until they were introduced to western diets. However if one can find a way to supplement skin linoleic acid levels using a topical preparation then this would also have an impact on the acne process.

6) Getting linoleic acid into the skin is not easy but you can use special delivery technology using special molecular structures in creams such as Oleosomes and involving techniques with fancy names such as Drysyst technology to help this process. Also if one uses ethyl linoleate, then skin bacteria will help break this down and release linoleic acid into the skin (look for products containing ethyl linoleate.)

7) One could normalise cell turnover to reduce skin thickening and also reduce keratin increases in skin cells. This would help to prevent blocking of the pilo-sebaceous duct. Retinol A based creams have been shown to normalise skin cell turnover rates. However a potential side effect of retinol products is increased sensitivity to UV and maybe increased skin cancer risk. So users of retinol based products are advised strongly to use a high SPF sunscreen while using retinol based products. There is a chemical called triethyl citrate which also normalises keratin deposition and skin cell turnover rates and without causing photo-sensitivity (please search for products containing triethyl citrate).

8) Reduce oil levels on the skin. This is normally done by using detergents to keep surface oil levels down. Doing this on its own just leads to more oil production and one gets into a downward spiral with a ‘negative feedback loop’ leading to further increase (up regulation) of sebum (oil) production. However oil control is important and using mild detergents can help in controlling the acne process. Using a combination of triethyl citrate and ethyl linoleate has been shown in a clinical trial published in the British Journal of Dermatology at the end of 2007 which showed sebum production rates reduced by up to 68% with an average of 55%.

9) Use exfoliants and detergents to help unblock ducts by dissolving and removing plugs and keeping skin debris levels down and also reducing skin thickening. This is effective and can help but if the skin is inflamed and sore then exfoliants can, make the skin more sensitive and sore. It maybe better to use chemical exfoliants rather than irritating physical skin exfoliants. Better still use those which have shown to affect sebum production rates such as Salicylic acid and Pyruvic acid which are both hydroxy acids (also known as fruit acids). These are the only two who have shown a sebo-static effect which means temporarily slowing oil production. Another common chemical exfoliant used is glycolic acid but this has not shown to have a sebo-static effect. Also salicylic acid has shown to help with skin thickening by loosening skin cells. See products containing Salicylic acid and Pyruvic acid).

10) Even products with fruit acids may irritate some skins, and some acne sufferers such as younger skins can be very sensitive and actually don’t have excessive skin thickening. One could use a gentle non irritating cleansing agent containing products such as silicone and glucose based cleansers which are very skin friendly, and also contain triethyl citrate which will normalise skin thickening by addressing over active skin cell turnover, thereby addressing skin thickening from within the skin.

11) Control p.acnes levels. Keeping hair follicle ducts open and oxygen rich is one way but blockages can still happen. So if you are going to control p.acnes than ideally do this without attacking skin staphylococci as discussed earlier due to MRSA development risks. One can use antibiotics to do this and they may be indicated in pustular scarring acne but for most we know that p.acnes releases enzymes to break down the plug to release nutritious fatty acids which also can cause an inflammatory response from the body. If you change conditions in the pilosebaceous unit so these enzymes don’t work as well you can slow down this process and reduce the amount of food and consequently reduce the growth of p.acnes without attacking good skin bacteria (staphs) (see an example of how this ca be achieved)

12) Reduce inflammation. Using products to control bacteria will reduce inflammation but also anti-inflammatory’s used to reduce inflammation. Stopping the release of the inflammatory fatty acids is another way, but also mopping up the inflammatory free radicals produced is an additional way of controlling inflammation. Antioxidants are useful in this regard and the best antioxidants are probably skin soluble version of vitamin C such as ascorbic acid and others such as Ascorbyl Palmitate and especially Ascorbyl tetra-isopalmitate (see an example of a product containing these).

In Summary

If you have a product range which alters conditions to slow DHT production locally, increase linoleic acid levels in the skin, that normalise skin cell turnover, keratin deposits and sebum production while also having mild sebo static chemical exfoliants or silicone and glucose based cleansers. If this product also had, staph friendly antibacterials to control p.acnes, feeding and development combined with antioxidants to help control the inflammatory process, then you would have a highly effective product range which could be obtained with or without prescription and is supported by eminent dermatologists across the world, including the top dermatologist on acne in the UK who has had his independent trail published din the most respected dermatology journal in the world, then you would be onto a winner. If this product was incredibly reasonably priced you would think it would dominate the treatment options of acne.