Staring Down Acne
At 29, she enrolled in a six-month plan of supplements and balanced meals devised by Georgianna Donadio, Ph.D., founder and program director of the National Institute of Whole Health. "After six months," Nancy says, "I was pulling the hair away from my face for the first time, and people were saying how much my complexion had improved."
the food factor
"A poor diet really affects the liver," says Donadio. "The liver dampens and tempers the intensity of androgen hormones, which trigger oil production in the sebaceous glands."
While a 1969 landmark study seemed to prove there is no causal link between diet and acne, a 2002 study at Colorado State University suggested that a diet high in refined carbohydrates boosts insulin, which elevates hormones and stimulates sebaceous glands. Investigators noted that islanders in Papua New Guinea and Paraguay, whose diets were similar only in that they were free of typical Western refined carbs, remained untroubled by acne.
The research isn't conclusive, yet many dermatologists won't argue with those who peg outbreaks to diet. "When a patient comes in and says, 'Every time I eat peanut M&Ms, I break out,' I tell them to stay away from that particular food," says Tina Alster, M.D., director of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C.
For a proactive approach, add flaxseeds to your diet. They contain lignans, phytoestrogens that are believed to stabilize a woman's ratio of estrogen and progesterone. Flaxseeds also contain essential fatty acids, which have anti-inflammatory actions, among other benefits.
The recommended daily dose of lignans varies per person, though a rounded tablespoon of ground flaxseeds is commonly prescribed. (Some flaxseed oils lack the lignans component, so check labels and look for certified flaxseed.) A standardized lignans extract now exists, and is used in products like Jarrow Formulas Flax Essence, Nature's Life Golden Flaxseed Lignans, Spectrum Organic Enriched Flax Oil, and Swanson Health Products LinumLife High Lignan Complex.
Other methods to attain hormonal harmony include increasing complex carbohydrates (whole grains, vegetables, legumes) to maintain blood sugar levels; getting enough sleep and exercise; controlling stress; taking calcium, magnesium, and vitamins C and B complex; and utilizing bio-identical hormone treatments.
pills and lotions
Medical strategies have come a long way since X-rays were used to shrink sebaceous glands. Today, dermatologists employ a variety of techniques to decrease sebum production, kill the bacteria that elicit inflammation, and help exfoliate skin around the pores.
Prescription retinoid lotions (Retin A, Differin, Tazorac) loosen plugs or prevent them from forming, and speed skin-cell turnover.
Benzoyl peroxide kills bacteria, and is often used in prescription lotions with or without an antibiotic (erythromycin, clindamycin). Milder acne may be controlled with nonprescription products like Proactiv that contain lower concentrations of benzoyl peroxide. Similar products use salicylic acid, lactic acid, or sulfur to help control bacteria; these acids are sometimes combined with sage, green tea, and aloe vera.
Glycolic- or salicylic-acid peels, performed by dermatologists, can facilitate the penetration of topical medicines and unclog pores.
A three-to-six-month course of oral antibiotics (tetracycline, doxy-cycline, minocycline) may be recommended for moderate to severe inflammatory acne. Many antibiotics cause photosensitivity, so avoid the sun, and take acidophilus to replace beneficial bacteria in the digestive tract eliminated by the drugs.
Isotretinoin (brand name Accutane) is a synthetic derivative of vitamin A used for severe nodular acne. While Accutane has a high success rate, its potential side effects include drying, nosebleeds, headaches, joint pain, severe depression, and possible liver damage and birth defects. The FDA has a centralized registry of isotretinoin patients, prescribers, and dispensers, which mandates two negative pregnancy tests and the use of two forms of contraception for patients on the drug. To mitigate some risks, doctors sometimes prescribe Accutane at less than the recommended dosage, drawing out the usual course of treatment from five months up to nine months. But even in low doses, the danger of birth defects is not reduced.