THE HOLISTIC APPROACH TO ACNE VULGARIS: HERBAL AND NUTRITIONAL INTERVENTIONS


INTRODUCTION

Acne vulgaris, or simply acne, is a condition that most of us are familiar with. During our puberty years, the chances that we experienced it or knew someone who did are exceptionally high. In fact, 85 percent of people between the ages of 12 and 24 show at least some minor symptoms of acne (1)

Acne occurs when the hair follicles become clogged with excessive sebum, causing abnormal keratinisation (skin hardening) and the proliferation of the bacterium Propionibacterium acnes within the follicle resulting in whiteheads, blackheads or pimples (11); It is most common among teenagers, although it can affect people of all ages (20). Acne affects mostly the face, back and chest and in some severe cases can cause scarring, depigmentation or hyperpigmentation of the skin potentially leading to negative psychological consequences such as anxiety, depression and low self esteem (24).

Conventional treatments for acne include topical application of antimicrobial and retinol creams and oral antibiotics and hormonal therapy for severe cases (11). Although these options have shown a various degree of efficacy to reduce the symptoms of acne, they might provide limited results if the root cause and the aggravating factors are not addressed. The goal of this article is therefore to discuss acne vulgaris in a broader, holistic context considering herbal and dietary strategies to ameliorate and resolve its symptoms.


ALL ABOUT HORMONAL AND IMMUNE REGULATION

Acne vulgaris is primarily a hormonal and immune condition (36) : skin cells respond in a noticeable fashion to androgens (37) and the correlation between hyperandrogenemia (excessive male sex hormones in the blood) and severe acne vulgaris is now well established (13). Acne in fact can be observed in certain conditions that cause high levels of free androgens to circulate in the bloodstream such as polycystic ovary syndrome (PCOS) and severe premenstrual syndrome (PMS) (27,10). The disruption of hormonal and immune balance leading to acne can have either external or internal causes; The most common external causes are:

  • Cosmetic products ingredients: Well-known hormone disruptors contained in make-ups, deodorants, body creams, toothpastes etc. include Parabens, Triclosan, PFAS, fragrances (Phthalates) , nanoparticles (zinc and titanium dioxide) and petroleum distillates (23)

  • Pesticides, herbicides and other chemicals: A fairly long list of pesticides and herbicides have direct action on the human endocrine and immune system (22). Other disruptive chemical compounds that are unfortunately found often in our environment include PCBs (4) and BPA (16)

  • Diet: There is no wonder in stating that processed foods are at the root of a plethora of immune and endocrine conditions. Refined sugars can severely damage insulin and immune system regulation (3, 7) ; Trans-fats and vegetable oils and trans fats are highly inflammatory (14, 25) and dairy products may contain remarkable concentration of sex hormones (19) In addition, abnormal gut permeability can abnormally activate immunity and lead to inflammatory conditions and autoimmunity (5).

  • Drugs and medications: Corticosteroids, lithium, DHEA, barbiturates, anticonvulsants, androgenic steroids, drugs containing bromides and iodides, interferon-beta some antibiotics and antimycotics have shown eruptions of acne vulgaris as an adverse side effect (26)

In addition, there have been identified internal factors which might contribute to the development of acne vulgaris including:

  • Psycho-emotional stress (35)

  • Gut dysbiosis (imbalanced gut flora). (17)

  • Metabolic conditions (diabetes, obesity, insulin resistance) (21)


A TRADITIONAL CHINESE MEDICINE PROSPECTIVE

The point of view on acne of Traditional Chinese Medicine (TCM) can provide further useful insights on the aetiology and treatment of this condition. TCM considers acne the result of damp heat accumulating in the organ systems of the Lung, Stomach, Spleen and Intestines and erupting through the skin (8). According to TCM expert Giovanni Maciocia, damp heat can be the result of the over-consumption of sweet and greasy foods, exposure to damp weather conditions, inability of the Spleen and Stomach to digest foods appropriately and excessive physical exercise; damp heat is a slow-resolving syndrome and tends to slow down the whole physiological processes (18)


HERBAL, NUTRITIONAL AND LIFESTYLE INTERVENTIONS

  • Simple and organic skincare: In the initial paragraph there has been mentioned a long list of disruptive chemical agents that can commonly be found in cosmetic and skincare products. The first step towards the resolution of acne vulgaris is to become familiar with the list of endocrine and immune disruptive chemicals and to start carefully check their presence in the ingredient list of make ups, deodorants, perfumes and other topical applications; secondly, select products that have a simple composition preferably of natural and organic origin. Thirdly, topical application of lotions containing antibacterial and anti-inflammatory herbs such as thyme, tea tree and lavender can support the clearance of the infected follicles (32)

  • Anti-inflammatory diet: An anti-inflammatory diet characterized by the elimination of pro-inflammatory foods in favor of ones that fight inflammation off. Foods to be avoided include simple sugars, processed foods, hot-pressed vegetable oils, fried foods, trans fats and cow’s dairy products (3,7,14,15,25,19). Foods and spices that have remarkable anti-inflammatory properties include wild caught oily fish (rich in omega-3) (31), turmeric (12) and fermented plant foods (Sauerkraut, kimchi, tempeh etc.) (28). It is also important to choose organic where possible to prevent the intake of endocrine-disrupting pesticides. In addition, nutritional supplements that can accompany well an anti-inflammatory dietary regimen include high strength fish oil (31) probiotics (6), Vitamin D (34) and Vitamin C (9)

  • Clear damp/heat: Following an anti-inflammatory diet will largely support the clearance of the damp heat syndrome from the body (18). Herbal medicine can be extremely useful to clear excessive dampness and heat from the Lung and Intestines. The first herb to cool and dry the whole body is Burdock (Arctium lappa), which has an affinity for the blood and the liver and exerts diuretic, cleansing and tonifying properties (29). Another extremely useful herb is red clover (Trifolium pratense), which is not only a blood cleanser but it is used to balance female hormones (29). Other useful herbs with drying and cooling properties that act as lymphatic and blood cleanser include Nettle leaf (Urtica dioica) and Cleavers (Galium aparine) (29). In addition, supporting the body’s own detoxifying mechanisms can also become handy when trying to dispel dampness and removing excessive hormones. Using liver cleansing herbs such as dandelion root (Taraxacum officinale) (29) and Chai Hu (Bupleurum falcatum) will support the hepatic function and the cooling of the blood (2)

  • Stress management: Finally, supporting the individual in becoming more resilient to stressors can have a positive effect on the psycho-neuro-endocrine system. Adaptogenic herbs that can support the individual’s ability to better endure stress and calm the nervous system include Korean ginseng (Panax ginseng), Siberian ginseng (Eleuterococcus senticosus) (30), ashwagandha (Withania somnifera), Gotu Kola (Centella asiatica) and Licorice root (Glycyrrhiza glabra) (33)


CONCLUSION

Acne vulgaris is a remarkably common skin condition affecting a large portion of the teenage and young adult population in most Western countries. Conventional treatment, although effective at relieving symptoms, unfortunately often fails to address the underlying causes leading to the eruption of acne. The holistic approach to acne takes on the other hand in consideration various aspects of the person’s life and aims at restoring balance within the whole organism; there is evidence in fact that excellent results can be achieved by eliminating endocrine disruptors, regulating inflammation, clearing excessive damp heat and supporting stress management.



REFERENCES

  1. AAD (2022). Skin conditions by the numbers. [online] www.aad.org. Available at: https://www.aad.org/media/stats-numbers#:~:text=Sunscreen%20Vitamin%20D-.

  2. Acupuncture Today (2019). Bupleurum (chai hu). [online] www.acupuncturetoday.com. Available at: https://www.acupuncturetoday.com/herbcentral/bupleurum.php [Accessed 14 Oct. 2022].

  3. Barnard, R.J., Roberts, C.K., Varon, S.M. and Berger, J.J. (1998). Diet-induced insulin resistance precedes other aspects of the metabolic syndrome. Journal of Applied Physiology, 84(4), pp.1311–1315. doi:10.1152/jappl.1998.84.4.1311.

  4. Bretveld, R.W., Thomas, C.M., Scheepers, P.T., Zielhuis, G.A. and Roeleveld, N. (2006). Pesticide exposure: the hormonal function of the female reproductive system disrupted? Reproductive Biology and Endocrinology, [online] 4, p.30. doi:10.1186/1477-7827-4-30.

  5. Camilleri, M. (2019). Leaky gut: mechanisms, measurement and clinical implications in humans. Gut, [online] 68(8), pp.1516–1526. doi:10.1136/gutjnl-2019-318427.

  6. Cristofori, F., Dargenio, V.N., Dargenio, C., Miniello, V.L., Barone, M. and Francavilla, R. (2021). Anti-Inflammatory and Immunomodulatory Effects of Probiotics in Gut Inflammation: A Door to the Body. Frontiers in Immunology, [online] 12. doi:10.3389/fimmu.2021.578386.

  7. Della Corte, K., Perrar, I., Penczynski, K., Schwingshackl, L., Herder, C. and Buyken, A. (2018). Effect of Dietary Sugar Intake on Biomarkers of Subclinical Inflammation: A Systematic Review and Meta-Analysis of Intervention Studies. Nutrients, [online] 10(5), p.606. doi:10.3390/nu10050606.

  8. Duan, P.-P., Yan, C.-Q., Feng, H.-S., Chen, Y., Sun, N., Yao, Y.-Q., Tian, K.-B. and Wang, G.-A. (2021). Clinical study on acupuncture treatment of gastrointestinal damp-heat acne. Medicine, 100(44), p.e27503. doi:10.1097/md.0000000000027503.

  9. Ellulu, M.S., Rahmat, A., Ismail, P., Khaza’ai, H. and Abed, Y. (2015). Effect of vitamin C on inflammation and metabolic markers in hypertensive and/or diabetic obese adults: a randomized controlled trial. Drug Design, Development and Therapy, 9, p.3405. doi:10.2147/dddt.s83144.

  10. ERIKSSON, E., SUNDBLAD, C., LISJO, P., MODIGH, K. and ANDERSCH, B. (1992). Serum levels of androgens are higher in women with premenstrual irritability and dysphoria than in controls. Psychoneuroendocrinology, 17(2-3), pp.195–204. doi:10.1016/0306-4530(92)90058-f.

  11. Haider, A. (2004). Treatment of Acne Vulgaris. JAMA, 292(6), p.726. doi:10.1001/jama.292.6.726.

  12. Hewlings, S. and Kalman, D. (2017). Curcumin: A Review of Its’ Effects on Human Health. Foods, [online] 6(10), p.92. doi:10.3390/foods6100092.

  13. Iftikhar, U. and Choudhry, N. (2019). Serum levels of androgens in acne & their role in acne severity. Pakistan Journal of Medical Sciences, [online] 35(1), pp.146–150. doi:10.12669/pjms.35.1.131.

  14. Iwata, N.G., Pham, M., Rizzo, N.O., Cheng, A.M., Maloney, E. and Kim, F. (2011). Trans Fatty Acids Induce Vascular Inflammation and Reduce Vascular Nitric Oxide Production in Endothelial Cells. PLoS ONE, 6(12), p.e29600. doi:10.1371/journal.pone.0029600.

  15. Juhl, C., Bergholdt, H., Miller, I., Jemec, G., Kanters, J. and Ellervik, C. (2018). Dairy Intake and Acne Vulgaris: A Systematic Review and Meta-Analysis of 78,529 Children, Adolescents, and Young Adults. Nutrients, [online] 10(8), p.1049. doi:10.3390/nu10081049.

  16. Kaya Ozden, H. and Karadag, A.S. (2021). Could endocrine disruptors be a new player for acne pathogenesis? The effect of bisphenol A on the formation and severity of acne vulgaris: A prospective, case‐controlled study. Journal of Cosmetic Dermatology, 20(11), pp.3573–3579. doi:10.1111/jocd.14364.

  17. Lee, Y.B., Byun, E.J. and Kim, H.S. (2019). Potential Role of the Microbiome in Acne: A Comprehensive Review. Journal of Clinical Medicine, [online] 8(7), p.987. doi:10.3390/jcm8070987.

  18. Maciocia, G. (2012). Damp-Heat. [online] Giovanni-Maciocia. Available at: https://giovanni-maciocia.com/damp-heat/.

  19. Malekinejad, H. and Rezabakhsh, A. (2015). Hormones in Dairy Foods and Their Impact on Public Health - A Narrative Review Article. Iranian journal of public health, [online] 44(6), pp.742–58. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524299/.

  20. Mayo Clinic (2020). Acne - Symptoms and causes. [online] Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/acne/symptoms-causes/syc-20368047.

  21. Melnik, B.C. (2018). Acne vulgaris: The metabolic syndrome of the pilosebaceous follicle. Clinics in Dermatology, [online] 36(1), pp.29–40. doi:10.1016/j.clindermatol.2017.09.006.

  22. Mnif, W., Hassine, A.I.H., Bouaziz, A., Bartegi, A., Thomas, O. and Roig, B. (2011). Effect of Endocrine Disruptor Pesticides: A Review. International Journal of Environmental Research and Public Health, [online] 8(6), pp.2265–2303. doi:10.3390/ijerph8062265.

  23. Naveed, N. (2014). The Perils of Cosmetics. Journal of Pharmacological Sciences and Research, [online] 6(10), pp.338–341. Available at: https://www.researchgate.net/profile/Niha-Naveed/publication/287325979_The_Perils_of_Cosmetics/links/618ea1273068c54fa5d93ea4/The-Perils-of-Cosmetics.pdf.

  24. NICE (2021). CKS is only available in the UK. [online] NICE. Available at: https://cks.nice.org.uk/topics/acne-vulgaris/background-information/complications/.

  25. PEI YEE, T. (2019). EFFECTS OF OXIDISED OILS ON INFLAMMATION-RELATED CANCER RISK. Journal of Oil Palm Research, 31(1). doi:10.21894/jopr.2019.0007.

  26. Pontello Junior, R. and Kondo, R.N. (2013). Drug-induced acne and rose pearl: similarities. Anais Brasileiros de Dermatologia, [online] 88(6), pp.1039–1040. doi:10.1590/abd1806-4841.20132586.

  27. Rodriguez Paris, V. and Bertoldo, M.J. (2019). The Mechanism of Androgen Actions in PCOS Etiology. Medical Sciences, [online] 7(9). doi:10.3390/medsci7090089.

  28. Shahbazi, R., Sharifzad, F., Bagheri, R., Alsadi, N., Yasavoli-Sharahi, H. and Matar, C. (2021). Anti-Inflammatory and Immunomodulatory Properties of Fermented Plant Foods. Nutrients, [online] 13(5), p.1516. doi:10.3390/nu13051516.

  29. Taylor, S. (2021). The humoral herbal : a practical guide to the Western energetic system of health, lifestyle and herbs. London: Aeon Books.

  30. Teeguarden, R. (2000). The ancient wisdom of the Chinese tonic herbs. New York: Warner Books.

  31. Wall, R., Ross, R.P., Fitzgerald, G.F. and Stanton, C. (2010). Fatty acids from fish: the anti-inflammatory potential of long-chain omega-3 fatty acids. Nutrition Reviews, [online] 68(5), pp.280–289. doi:10.1111/j.1753-4887.2010.00287.x.

  32. Wińska, K., Mączka, W., Łyczko, J., Grabarczyk, M., Czubaszek, A. and Szumny, A. (2019). Essential Oils as Antimicrobial Agents—Myth or Real Alternative? Molecules, [online] 24(11), p.2130. doi:10.3390/molecules24112130.

  33. Winston, D. and Maimes, S. (2019). Adaptogens : herbs for strength, stamina, and stress relief. Rochester, Vermont: Healing Arts Press.

  34. Yin, K. and Agrawal, D.K. (2014). Vitamin D and inflammatory diseases. Journal of Inflammation Research, [online] 7, pp.69–87. doi:10.2147/JIR.S63898.

  35. Zari, S. and Alrahmani, D. (2017). The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clinical, Cosmetic and Investigational Dermatology, Volume 10, pp.503–506. doi:10.2147/ccid.s148499.

  36. Zouboulis, C.C. (2020). Endocrinology and immunology of acne: Two sides of the same coin. Experimental Dermatology, 29(9), pp.840–859. doi:10.1111/exd.14172.

  37. Zouboulis, C.C. and Degitz, K. (2004). Androgen action on human skin -- from basic research to clinical significance. Experimental Dermatology, [online] 13 Suppl 4, pp.5–10. doi:10.1111/j.1600-0625.2004.00255.x.


47 views0 comments