Prescription-Strength Natural Acne Treatments

Prescription-Strength Natural Acne Treatments
S
ometimes in life you are faced with decisions with no good options to choose from. Like the other day
we were watching TV with my wife. I wanted to watch Mythbusters, but she informed me in no uncertain terms that the options are a soap opera or a romantic comedy. As I said, no good options. You can
probably guess what happened. My wife got to watch her soap opera and I was exiled into the bedroom
with a book.
Jokes aside, acne has probably put you into a situation with no good options. For many the choices come
down to prescription drugs, natural treatments, or doing nothing.
Prescription drugs usually work. I can’t say about you, but taking antibiotics gets rid of acne for most
people. Similarly, using prescription topical solutions usually improves acne. But prescription drugs are not
without problems. You probably don’t want to keep taking antibiotics for the rest of your life, for one, the
long-term effects of antibiotic treatments remain largely unknown. And many prescription topical treatments cause dryness and skin irritation.
Another option is to try your luck by venturing into the world of alternative and natural treatments; maybe
try things like lemon juice, honey or other home-remedies. The internet and popular magazines are brimming with ‘tips and home remedies for getting rid of acne’. These natural alternatives are often cheaper and
certainly cause fewer side-effects than prescription solutions. The problem is that most of these alternatives
don’t work. Or if they do work, they are very inconsistent at best. And the 1% that does work is lost in the
noise, which makes finding them the proverbial task involving needles and haystacks.
The final option is doing nothing and hoping someday you grow out of acne. Yeah, I didn’t think so.
Not exactly the lineup dreams are made of.
Had I been writing this 5 to 10 years ago, I would said ‘Sometimes life sucks, hope you find something that
works for you’. Luckily for both of us science has progressed a lot during those 5 to 10 years, and scientists
now understand acne far better than mere 5 years ago.
Not only do they understand acne better, but scientists have also used that understanding to create new
therapies that are both safe and effective. These therapies have been studied head to head with current gold
standard acne treatments, such as oral antibiotics and retinoid creams. In many cases these new, natural
treatments come out ahead. In this report I’m going to share with you a few of those new treatments.
The goal of this short and sweet report is to show that natural doesn’t have to mean ineffective and inconsistent. In fact, I believe (based on scientific studies I’ve seen) that natural treatments are both more effective and safer than prescription treatments. With them you can make long-term changes in your skin
that aren’t possible with drugs.
Without further ado, let’s dive into the meat of the report.
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Sodium ascorbyl phosphate (SAP)
Vitamin C is a well-known antioxidant with well-established benefits for the skin. But vitamin C as ascorbic acid is very unstable and oxidizes easily (that’s why it’s an antioxidant). Because it’s unstable, it can cause
irritation in people with sensitive skin.
Sodium ascorbyl phosphate is a stable vitamin C derivate. It’s far more stable than vitamin C, and once on
the skin it’s converted into vitamin C. So it provides the benefits of vitamin C without the potential drawbacks.
Since 2005 SAP has been tested a handful of times, with each study showing very promising results.
A 2005 study published in the International Journal of Cosmetic Science showed that 5% SAP lotion was
more effective than benzoyl peroxide. After 12 weeks 76.9% of the group using SAP showed good/excellent
efficacy vs. 60.9% in the benzoyl peroxide group.
In another study 5% SAP lotion was compared to 1% clindamycin gel (a commonly used topical antibiotic). 78.9% of the people treated with the SAP lotion showed good/excellent efficacy vs. 38.9% in the
antibiotic gel group.
Finally, a 2009 study in the International Journal of Cosmetics Science pitted 5% SAP against topical retinoids. The SAP lotion reduced inflammatory lesions by 20.1% and 48.8% within 4 and 8 weeks respectively.
The corresponding results for retinoids were 21.8% and 49.5%.
Based on these studies, we can say that topical sodium ascorbyl phosphate is more effective than benzoyl
peroxide or topical clindamycin and as effective as topical retinoids. Not bad for what’s essential an everyday vitamin.
While you may not find SAP lotions in your average supermarket many SAP creams are available from
Amazon, iHerb.com and other online retailers.
References:
• J. Klock, et al. Sodium ascorbyl phosphate shows in vitro and in vivo efficacy in the prevention and
treatment of acne vulgaris. International Journal of Cosmetic Science. Volume 27, Issue 3, pages 171–
176, June 2005. http://onlinelibrary.wiley.com/doi/10.1111/j.1467-2494.2005.00263.x/abstract
• Ikeno H, Nishikawa T. An open study comparing efficacy of 5% sodium L- ascorbyl-2-phosphate lotion
with 1% clindamycin gel in the treatment of facial acne vulgaris. J Am Acad Dermatol. 2008;58 (Suppl
2):AB2.
• C. Ruamrak, et al. Comparison of clinical efficacies of sodium ascorbyl phosphate, retinol and their
combination in acne treatment. International Journal of Cosmetic Science. Volume 31, Issue 1, pages
41–46, February 2009. http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2494.2008.00479.x/abstract
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Zinc
Zinc?? Ho hum.. could this get any older? Granted, zinc is not exactly a new treatment for acne. It’s been
used for several decades and most acne patients have probably heard of it. But did you know that zinc supplements can be nearly as effective as oral antibiotics in treating acne – and with much fewer side-effects?
This is exactly what a study published in the prestigious journal Dermatology found.
In the study 332 patients were randomized to receive either 30mg of zinc or 100 mg of minocycline for 3
months. Both the participants and the doctors evaluating them were blinded, so neither the patients nor
the evaluators knew which treatment each participant got. Blinding eliminates bias and possible placebo
effects from muddying the results.
This study found that minocycline more effective than zinc, but not by that much. After 1 month the average reduction in pimple count was 9% higher in the antibiotic group and 17% higher after 3 months.
So, while antibiotics were more effective, the real story is that a low-cost zinc supplement can produce
results comparable to oral antibiotics. It’s not like the zinc group only saw a minor effect, both treatments
effectively reduced inflammatory acne. As the study concludes:
Conclusion: Minocycline and zinc gluconate are both effective in the treatment of inflammatory acne, but
minocycline has a superior effect evaluated to be 17% in our study.
If you had to take zinc or antibiotics for the rest of your life, which one would you choose? I can’t say about
you, but most people would go with zinc.
There’s no question that antibiotics can kill the beneficial bacteria in the gut. The effects of long-term antibiotic use are not well-known. There’s emerging evidence that gut problems are linked to skin problems.
It’s been shown that disturbances in the bacterial balance in the gut are far more common among people
with acne and other skin problems. From my own experience I can confidently say that my acne is linked
to gut health. For example, after eating onions I feel bloated and constipated. A day or two later my scalp
breaks out in painful pimples.
Given the connection between gut and the skin, I would be wary of disturbing the bacterial balance in the
gut with antibiotics.
For much more on the gut-acne connection please see this:
http://www.acneeinstein.com/gut-skin-connection/
References
• Dreno B, et al. Multicenter Randomized Comparative Double-Blind Controlled Clinical Trial of the
Safety and Efficacy of Zinc Gluconate versus Minocycline Hydrochloride in the Treatment of Inflammatory Acne vulgaris. Dermatology 2001;203:135–140 http://www.karger.com/Article/FullText/51728
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Vitamin B3 (nicotinamide/niacin)
Vitamin B3 is one of the unsung heroes of acne treatment. It’s been shown to suppress bacteria on the skin,
repair the skin barrier function, and protect the skin against inflammatory damage.
It’s been compared to topical antibiotics in two separate studies. In 1995 The International Journal of Dermatology published the first one. In that study 4% nicotinamide gel was found more effective than 1%
clindamycin gel. Inflammatory lesions were reduced by 60% in the nicotinamide group and 43% in the
clindamycin group.
In 2011 International Journal of Cosmetic Science published a similar study, again comparing 1% clindamycin to 4% nicotinamide. This time the nicotinamide lotion also contained linoleic acid, an essential fatty
acid that shows potential in eczema. The results in both groups were similar, though the nicotinamide/
linoleic acid lotion showed slightly better efficacy.
Nicotinamide supplementation may also help. Unfortunately there is very little research on this. In one
study the participants received an antioxidant supplement containing 750mg of nicotinamide, 25mg of
zinc, 1.5mg of copper and 500 mcg of folic acid. 79% of the participants reported their acne got either moderately or much better during the 8-week study. Though there are some problems with the way this study
was done, so the results may not be that reliable. Unfortunately, the combination of nicotinamide and zinc
has never been compared to oral antibiotics.
References:
• Morganti P, et al. Topical clindamycin 1% vs. linoleic acid-rich phosphatidylcholine and nicotinamide
4% in the treatment of acne: a multicentre-randomized trial. Int J Cosmet Sci. 2011 Oct;33(5):467-76.
http://www.ncbi.nlm.nih.gov/pubmed/21668835
• Shalita AR, et al. Topical nicotinamide compared with clindamycin gel in the treatment of inflammatory acne vulgaris. Int J Dermatol. 1995 Jun;34(6):434-7. http://www.ncbi.nlm.nih.gov/pubmed/7657446
• Niren NM, Torok HM. The Nicomide Improvement in Clinical Outcomes Study (NICOS): results of
an 8-week trial. Cutis. 2006 Jan;77(1 Suppl):17-28. http://www.ncbi.nlm.nih.gov/pubmed/16871775
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Why these treatments work… and how to take this further?
Let’s take a moment to understand why these treatments work. You know the whole give man a fish vs.
teach him to fish thing. There’s a reason and logic to why these treatments work. And once you understand
that logic, you understand acne, and can apply the lessons to other areas of your life for even better results.
All acne is a result of one thing: inflammation. Yes, yes, I haven’t forgotten about hormones or other factors
behind acne. But those things are not as important as inflammation, as you’ll soon learn.
At the beginning a pimple is nothing but a blocked pore. Dead skin cells have formed a plug that prevents
sebum from flowing out of the skin follicle. A protein called keratin forms the structure of the skin (and
nails and hairs). This though protein binds skin cells together. Dying cells receive a command to break
these bonds and separate. In healthy skin this happens smoothly. But acne-prone skin produces too much
keratin, and the dying skin cells have difficulties separating. So the skin follicle becomes filled with larger
clumps of dead cells – instead of individual dead cells. Much like logs damming a river, these clumps block
the skin follicle.
Without the outlet blocked, sebum cannot flow out of the follicle, yet the sebaceous glands keep pushing
more sebum into the skin follicle. Much like a water balloon, the walls of the skin follicle expand. For various reasons, oxygen content of the blocked pore plummets. Oxygen-poor environment is ideal for the P.
Acnes bacteria and encourages their growth. Contact to bacterial cell wall toxins irritates the skin cells and
invites immune response. This causes redness and pain associated with an inflammatory pimple. Sometimes the ballooned skin follicle bursts and spills out the inflammatory material. This causes inflammation
to spread even wider and creates a large red area on the skin.
This whole process starts with inflammation.
Studies have provided quite strong evidence that inflammation in the skin is the trigger that starts the
whole process. And without this initial inflammatory insult the pimple would have never gotten started. For example, studies have shown the following:
• Inflammation is present even at the earliest stages of a pimple, much before bacteria colonize the
blocked pore
• Severity of acne is linked to the amount of inflammation present in the blocked pore
• Test tube studies have shown that when the types of cells that produce keratin and sebum (keratinocytes and sebocytes, respectively) are exposed to inflammatory molecules they start producing more
keratin and sebum.
• Studies have shown reduction in acne with topical and oral antioxidants, such as the studies we talked
above
There are very good reasons to believe that if you can prevent inflammation in the skin you can prevent
acne altogether.
Sebum, hormones and other factors
What about hormones? Surely I’m not denying that acne is hormonal? Certainly not, so let’s see how sebum
and hormones affect acne.
This is stating the obvious, but the skin is your most exposed organ. 24/7 it’s exposed to the elements and
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potential sources of inflammation, such as UV rays, ozone in air pollution, etc. Because of constant exposure it needs constant antioxidant protection. Damage to the skin barrier would compromise survival over
long-term. Damaged skin barrier allows too much moisture to escape your body and would make you
more susceptible to infections as more pathogens can enter the body. That’s why the antioxidant reserves
in the skin are constantly replenished.
How sebum drives antioxidant demand
Most of these antioxidants are found in sebum. It seems that the fatty acids in sebum are more prone to
oxidation than proteins in skin cells. A fatty acid called squalene seems to be really important here. Studies
have shown a tight correlation between secretion of squalene and vitamin E. Perhaps because, while squalene is quite stable, it becomes highly destructive once it oxidizes. Upon inflammatory damage squalene
turns into squalene peroxide. Animal studies have shown that application of squalene peroxide on the skin
causes a pimple to form. Furthermore, the degree of damage to squalene determined the severity of the
pimple. Finally, skin biopsies have shown high levels of squalene peroxide in acne-afflicted areas.
You probably know that people with acne produce more sebum than people with healthy skin, anywhere
from 60% to 300% more. But did you also know that acne-prone skin produces proportionally more squalene than normal skin? One study showed 220% more squalene in acne-prone skin than in healthy skin. In
the same study overall sebum production was about 60% higher in people with acne, so the proportion of
squalene in total sebum was about 38% higher in acne patients.
This means that acne-prone skin needs far more antioxidant protection than normal skin. And there’s evidence to show that the antioxidant system just cannot keep up with this demand. Studies have consistently
shown lower levels of antioxidant enzymes and vitamins in acne-prone individuals as compared to people
with healthy skin. This has been shown to be the case both in blood and in sebum.
This is why antioxidant supplements and creams show such good results. They replenish depleted antioxidant storages and attack acne before it even gets started.
Are antioxidants the ultimate cure for acne?
Unfortunately not, and this is where we need a healthy dose of realism.
Antioxidants do show promise, and should be part of your acne treatment program, but please don’t jump
into the conclusion that you can eradicate acne with antioxidants alone. It’s possible this happens for some
people, but I don’t think it’s the case for the majority.
This is where reality departs from neat theories and gets messy. While inflammation causes acne the same
way for everybody, the source of that inflammation is probably different for each and every person. Some
common sources include:
• Diet – inflammatory fats, sugar, etc.
• Stress – a neurotransmitter called substance P can directly cause inflammation at the skin. Substance P
is released during stress and anxiety.
• Gut problems – A condition known as increased intestinal permeability, colloquially leaky gut syndrome, allows inflammatory substances to escape from the gut into the bloodstream. The gut and the
skin are also tightly connected with nerve fibers, and it’s been shown that bacterial balance in the gut
affects the bacteria in the skin. So disturbances in gut health can cause skin problems in ways scientists
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don’t yet understand. What is known is that people with skin problems have much higher rates of gut
problems.
• Exposure to irritating chemicals – like in personal care and acne treatment products.
Because there are so many potential sources of inflammation, there are also many potential causes, and
cures, for acne. This explains why some people get clear after cutting out wheat (allergic reaction to gluten),
some from meditation exercises (less stress), and some from eliminating particular personal care products
(exposure to irritating chemicals in those products).
Then there are less obvious cases. Take me as an example. I can go on a McDonald’s binge for a week and
never see a pimple on my face. But give me a raw onion and 30 minutes later my stomach starts feeling
bloated and a day or two later I get painful pimples on my scalp. Something in onions irritates my gut and
that shows up on my skin, I suspect fructose intolerance.
Unfortunately there is no simple way to know where the skin-damaging inflammation originates. For example, no studies have done to show that eating onions causes acne! I figured it out with detective work and
by understanding the logic and mechanism behind acne, i.e. I knew the right places to look at. But now that
I know it, controlling acne is simple. I just have to avoid the few trigger foods, eat a reasonably healthy diet
and take good care of my skin. Why I get acne and how to get rid of it is no longer a mystery.
I believe that anyone can have similar results. You just have to do the detective work and figure out the real
root causes behind your acne.
My book Clear for Life – Science-Based Natural Acne Treatment Program helps you to do just that. In
the book I go over several ‘acne hotspot’ areas. Together we’ll go over how these areas can affect your acne,
and, more importantly, what you can do to fix the problems.
Clear for Life is available from Amazon as both paperback and Kindle versions.
References:
• Ichiro Kurokawa, et al. New developments in our understanding of acne pathogenesis and treatment.
Experimental Dermatology. Volume 18, Issue 10, pages 821–832, October 2009. http://onlinelibrary.
wiley.com/doi/10.1111/j.1600-0625.2009.00890.x/full
• Harris HH, et al. Sustainable rates of sebum secretion in acne patients and matched normal control
subjects. J Am Acad Dermatol. 1983 Feb;8(2):200-3. http://www.ncbi.nlm.nih.gov/pubmed/6219137
• Apostolos Pappas, et al. Sebum analysis of individuals with and without acne. Dermatoendocrinol.
2009 May-Jun; 1(3): 157–161. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835908/
• Whitney P Bowe, Alan C Logan. Clinical implications of lipid peroxidation in acne vulgaris: old wine
in new bottles. Lipids in Health and Disease 2010, 9:141. http://www.lipidworld.com/content/9/1/141
• Anthony HT Jeremy, et al. Inflammatory Events Are Involved in Acne Lesion Initiation. Journal of Investigative Dermatology (2003) 121, 20–27; doi:10.1046/j.1523-1747.2003.12321.x. http://www.nature.
com/jid/journal/v121/n1/full/5601829a.html
• Monica Ottaviani, et al. Lipid Mediators in Acne. Mediators Inflamm. 2010; 2010: 858176. http://www.
ncbi.nlm.nih.gov/pmc/articles/PMC2943135/
• Mauro Picardo, et al. Sebaceous gland lipids. Dermatoendocrinol. 2009 Mar-Apr; 1(2): 68–71. http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC2835893/
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• Jens J. Thiele, Swarna Ekanayake-Mudiyanselage. Vitamin E in human skin: Organ-specific physiology and considerations for its use in dermatology. Molecular Aspects of Medicine. Volume 28, Issues 5–6, October–December 2007, Pages 646–667. http://www.sciencedirect.com/science/article/pii/
S009829970700057X
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