Scott Rollins, M.D.

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October 4, 2012
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ROLLINS: Treating acne from the inside and out

Most people have experienced acne. For some it is merely an occasional nuisance while others find it to be a seriously embarrassing and frustrating issue that seems to defy all logical treatment. And for a few it can leave emotional scars that are more than just skin deep.Successful acne treatment requires getting to the root cause of the acne and fixing it at the source. We need to address issues with skin turnover, bacteria and fungal infections, inflammation in the body and hormone imbalances. And yes... diet, stress, and sleep also play a role.Acne is the result of clogging of the skin's oil glands, with or without inflammation and infection. We know that acne is caused by hormones and bacteria. The oil glands secrete a waxy oil called sebum, and become whiteheads (closed and plugged oil glands), blackheads (open and plugged oil glands), and pustules (red and inflamed, often infected). At a basic level the simplest form of acne is when the oil glands are plugged by the normal outer layer of dead skin, called keratin.Good skin care involves twice daily washing, moisturizing, and sun protection. We recommend cleansers that gently and effectively rejuvenate the skin by dissolving surface oil, bacteria and impurities without harmful over drying, leaving your skin feeling fresh and clean. A good moisturizer should be oil-free and provide nutrients that encourage healthy skin. By combining a sunscreen with moisturizer it makes for a very simple step in your daily regimen. We recommend the ABI product line for basic skin care with outstanding results.When it comes to make-up, avoid heavy pore-clogging, high-fragrance foundations such as Revlon, Loreal, Maybelline, Mary Kay, Lancome, Elizabeth Arden, etc. We suggest mineral make-up which does not clog pores. Our favorite brand is YoungBlood, which is full of nutrients and antioxidants, even including sunscreen.Control of acne requires an effective and convenient way to control sebum production and gently exfoliate dead skin cells. This can be done with daily topical treatments, such as glycolic and salicylic acid topicals, retinoids, and fruit peels. Microdermabrasion can be very helpful in preventing keratin build up but can worsen acne during a flare up.

A crucial part of successful acne treatment is to understand the role of infection. P. Acnes is a common bacteria that inhabits oil glands, causing a worsening of the size and inflammation of plugged glands. Once acne moves beyond whiteheads or blackheads into pustules or boils, then additional treatment is indicated. For milder cases, prescription topical antibiotics often work well. For more intensive infections, systemic antibiotics are helpful. The Blu-U light therapy effectively kills the P. Acnes bacteria. Adding the photosensitizing agent Levulan to the Blu-U is great for the most resistant cases.For many people acne is a sign of underlying inflammation or problems with the immune system as a whole. Everything from diet, stress, poor sleep, infections and allergies might be playing a role in acne due to inflammation.Certain foods cause acne due to the effects on various hormones in the body that deal with inflammation. High sugar and high glycemic diets will cause spikes in insulin and with it our stress hormone cortisol will rise. Cortisol will directly stimulate the sebum glands and cause acne. Too much saturated fat in the diet will cause inflammation and high cortisol. Stress and lack of sleep will both cause high cortisol, and again, this can lead to more acne.Sneaky underlying infections in the gut or bloodstream, such as the yeast Candida, can cause inflammation and acne. Interestingly, the "good" bacteria in the body, especially in the gut, play a big role in keeping the immune system strong and helping to keep "bad" microbes and inflammation under control. When the immune system is weakened it allows the otherwise harmless microbes to take over - and this can happen in the skin. The beneficial bacteria in the gut also play a role in removing toxins and excess hormones from the body, both of which may help acne. We often treat for infections such as Candida and include a probiotic (our body's beneficial bacteria) supplement as part of our acne treatment plan.Believe or not, delayed food allergies can cause acne due to the resulting inflammation and increased cortisol hormone production. We see numerous cases where acne just disappears as patients eliminate certain foods they are allergic to such as gluten or dairy products.The skin is often a tell-tale sign of an underlying hormone imbalance. Similar to cortisol, the androgens or "male hormones" such as DHEA, testosterone, and its byproduct DHT, all increase oil production in the skin and stimulate hair growth. When the androgens are in excess relative to the "female hormones" such as estrogen and progesterone then the skin can become oily, hairy, or both.Pre-menopausal women commonly have estrogen-dominant cycles due to a lack of sufficient progesterone, causing pre-menstrual breakouts. During and after menopause many women experience a flare up of acne not seen since their teens or at all due to the falling levels of estrogen and progesterone. Other hormone conditions such as low thyroid and polycystic ovarian syndrome can affect the skin. A hormone analysis is a very important step in acne treatment and correction of hormone imbalances will improve skin and overall health. In some cases we prescribe medications that block hormone receptors in the skin.

Our acne treatment protocol typically involves treating the skin directly while evaluating the whole person beneath. Certainly proper skin care and aesthetic procedures will do wonders for reducing acne and improving skin health but we also help with lifestyle issues such as dietary changes, stress management, and improving sleep - all of which can build the immune system and reduce acne-promoting inflammation. An integrated medical-aesthetic approach looking for underlying causes is often the "cure" for difficult to treat acne. We've seen many cases where years of acne frustration ended simply and quickly with proper treatment of immune system or hormone imbalances. For better acne treatment, consider an approach that works inside and out!Scott Rollins, M.D., is board certified with the American Board of Family Practice and the American Board of Anti-Aging and Regenerative Medicine. He specializes in bioidentical hormone replacement, thyroid and adrenal disorders, fibromyalgia and other complex medical conditions. He is founder and medical director of the Integrative Medicine Center of Western Colorado ( Call 970-245-6911 for appointments or more information.

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The Post Independent Updated Oct 4, 2012 04:10PM Published Oct 4, 2012 04:08PM Copyright 2012 The Post Independent. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.