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Acne: spot the difference

Up to 50% of teenage girls and 75% of boys have acne, but if you are seeing clients who are suffering with acne into their twenties or older their hormones may well be the problem.

Acne can be an ongoing problem for people whose skin has become sensitive to a hormone imbalance with excess androgens (male hormones) such as DHEAS (dehydroepiandrosterone) and testosterone. (Women should naturally have about 10% of the male level of testosterone.)

Why does acne happen? 
Excess testosterone will stimulate the sebaceous, or oil-making, glands in the skin and this will cause pores to block. This generates an ideal environment for bacteria to thrive and when that happens it will stimulate an immune response. It is the immune response that causes the inflammation, redness, pus and any possible scarring. Consideration of the impact of constant stimulation to the immune system like this should be taken into account with acne sufferers but often is not. The immune response is modulated by the stress hormone, cortisol, which means that stress can also play a role in the problems of acne by way of creating vicious circle. The acne constantly stimulates the immune system, which requires a response from the adrenals to modulate it, and then the adrenals become tired and eventually depleted so that the person’s immune system no longer functions at its optimal level and leaves them susceptible to colds, viruses and whatever else may be going around at the time.

Treating the symptom of the skin outbreak in these cases is not addressing a possible cause! Nonetheless, there are some medical treatments on offer, such as topicals containing Retin-A, the use of antibiotics such as tetraclycline and erythromycin and even the use of the Pill (especially those brands containing cyproterone acetate such as Dianette, which is approved for women with severe acne). However, Dianette should only be prescribed for a few menstrual cycles because there are serious health concerns. For example, a UK study, involving nearly 100,000 women showed that women taking this type of Pill (containing cyproterone) had four times the risk of blood clots than a Pill containing another type of synthetic progestin (levonorgestrel) (Lancet, 2001). Unfortunately we regularly hear of women who have been on Dianette for quite some time. Another familiar prescription on the acne circuit is Roaccutane or Accutane, which works by reducing sebaceous gland activity. However, it has been found to be a major factor in birth defects, an increase in depression with suicidal thoughts as well as decreased night vision to mention just a few of its side effects. Other research has found that it may also increase the level of blood fats which can affect the liver and/or increase the risk of colon cancer. It has been linked with at least 15 suicides in the UK and around 200 in the US.

So, what may be the underlying cause?
Female acne can be a sign of PCOS (Polycystic Ovarian Syndrome), the most common hormone disorder in women of reproductive age.
An explanation of cystic ovaries …
A high testosterone level may be indicative of cystic ovaries (only about 25 – 50% of women with cystic ovaries also have elevated levels of DHEAS) and this condition presents a baffling array of symptoms:

  • Ovarian cysts with ovaries up to 2.5 times larger than normal;
  • Irregular or absent periods;
  • Acne;
  • Inability to lose weight;
  • Excessive body or facial hair and thinning of scalp hair;
  • High blood pressure; and,
  • Hormonal imbalance symptoms that include depression and irritability.

Ovarian cysts ae products of failed or disordered ovulation. Part of the cystic ovary question is whether it is full-blow syndrome or not and to determine whether it is, it could be a good idea to test for insulin resistance as this can add to the acne problem through poor blood sugar control and its dietary consequences. Dietary consequences can mean reaching for a high sugar or high carbohydrate snack to address a real energy deficit, but the resultant rapid rise in blood sugar will cause an insulin response, which will cause an inflammatory response which will perpetuate an acne problem.

There is no medical treatment for PCOS until, perhaps, a woman wants to become pregnant and finds a level of infertility that seems to need medical assistance. However, this is not a condition that requires medication or intervention if a hormone balancing approach is adopted.

What can be done about acne?
It is likely that it is because of a hormonal imbalance, and with testing the bio-available levels of hormones it is much easier to establish what the imbalances are and how to address them in the most effective and targeted way. However, if it is shown that testosterone and/or DHEAS levels are elevated this is what can be done …

If PCOS is likely, an approach can be put forward using natural progesterone cream in a specific way that will help to suppress ovulation attempts and allow the ovaries to heal. This will also help to balance out oestrogen and testosterone levels and the impacts of these hormones as well as support the adrenals, from where the DHEAS comes.

Anti-androgen botanicals can also be helpful when they are complemented by a good general nutritional support supplement as well as botanicals and vitamins for support of the adrenal glands.

If the insulin question is also addressed through changing the diet and extra help with insulin sensitisation from nutritional support formulas this can prevent further problems that can evolve into the serious health condition of diabetes.

Combine this approach with a good and natural skin cleansing programme that will allow your skin to find its natural balance again and you should start to see sustainable results that nurture the body and the skin.

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