cne is an inflammatory condition of the skin. It induces pimples and spots primarily on shoulders, neck, face, back, upper arms and chest. It may manifest as blackheads, pimples, whiteheads, nodules or cysts. Though it might occur at any age, puberty is the time when it primarily occurs because of the activation of sebaceous glands. Though it is not harmful it may leave behind epidermal scars. [1]

Types of Acne

  • Inflammatory acne occurs as a result of bacterial infection caused by P. Acnes bacteria.
  • Non-inflammatory acne leads to blackheads or whiteheads, but no nodules or cysts are seen.
  • Acne fulminans primarily affects male adolescents. This is an acute form of inflammatory acne appearing on back, chest and jaws.
  • Nodulocystic or Cystic acne is a severe type of acne characterized by big, swollen epidermal nodules and cysts.
  • Acne mechanica commonly affects athletes. This type of acne occurs as a result of excessive friction, heat and pressure. [2]

Depending on the Type of Symptoms Acne Is Graded the Following Ways

Grade I: Characterized by mild blackheads, whiteheads and small uninflamed pimples
Grade II: This is a moderate type of acne characterized by a recurrent outbreak of papules and pustules.
Grade III: You will see many pustules and papules, lot of swelling and few nodules.
Grade IV: This is the severe most form of acne which is characterized by lots of cysts, papules, nodules, and pustules. It is commonly seen in buttocks, face, chest, back, and neck. [3]

Common Symptoms of Acne Include

  • Dark spots appear on the epidermis
  • Whiteheads: This happens due to build up of pus under the epidermis resulting in the formation of a white colored head. As sebum and dead cells get deposited in the follicles whiteheads appear.
  • Blackheads: Seen primarily on the chin, around the nose or forehead, blackheads or comedones appear because of depositions inside follicles.
  • Cysts or nodules: These are painful, infected, inflamed acne and appear in the deeper layers of our skin.
  • Pustules and papules: Also, called pimples, these are small or medium-sized protrusions, red in color, round
  • and may not have a head.
  • Enhanced reactivity toward heat, sunlight, different products and sweat.
  • Scars left behind by acne.
  • Lowered self-esteem, depression and anxiety [4]

Causes of Acne

The main causes are the following:

  • Clogging of hair follicles by dead skin cells and sebum
  • Excessive production of oil
  • Overactivity of androgens, a type of hormone
  • Bacterial infection

Factors That Can Aggravate Acne

  • Diet: Studies have linked carbohydrate-rich foods like chips, bagels, and breads as well as skimmed milk and chocolate with worsening of acne.
  • Hormonal changes: During puberty in girls and boys level of androgen hormones increases and as a result there is enlargement of the sebaceous glands and resultant extra production of sebum. Pregnancy and consumption of oral contraceptive pills also bring about hormonal changes affecting the sebum levels.
  • Stress: It also can aggravate your acne
  • Medications: Medications containing testosterone, corticosteroids, and lithium can worsen acne.

Treatment Options of Acne

1. Nonprescription Treatment

  • Water and soap: Gently cleaning your face with soap and water twice a day may help you. However, it may not be of use if you already have acne.
  • Salicylic acid: Present in many lotions, cleansing pads, creams etc., salicylic acid can work on mild acne. It can clear up your pore and keep scarring at bay.
  • Benzoyl peroxide: It works on mild acne by imparting a bactericidal effect. Available as lotions, creams, cleansing pads etc., it needs to be applied continuously to keep acne at bay.
  • Topical retinol gel: It unblocks pores by increasing cellular turnover. Eight to twelve weeks of application is required for it to work.
  • Sulfur: It is a constituent of many anti-acne over the counter drugs.
  • Alcohol and acetone: Acetone works by removing oil from the epidermis whereas alcohol has bactericidal effects. Some over the counter medications have these as components.

2. Prescription Treatment

  • Retinoids or vitamin A derivatives: Available as oral or topical medication, these work on moderate and severe acne. Isotretinoin works the best on cystic acne that is severe.
  • Antibiotics: These can be taken orally or applied topically. These act by lowering inflammation and removing the bacteria that cause acne. Topical erythromycin and clindamycin can be applied in combination with topical retinoid or benzoyl peroxide. Tetracycline, doxycycline, minocycline are some of the oral antibiotics.
  • Azelaic acid and dapsone: These topical medications have anti-inflammatory and antibacterial properties.
  • Spironolactone: It is a drug for oral consumption that works by inhibiting the effect of our hormones on our sebaceous glands.
  • Oral contraceptives: These work for females only as these can counteract the impact of testosterone, a male hormone, on acne.

Diet and Acne

Some food items that can cause or worsen acne include:

1. Dairy Products

Studies have linked worsening of acne with consumption of milk products in teenagers. Milk is said to enhance levels of insulin and that can further worsen your acne. Few studies have linked consumption of milk and ice-cream with four times increase in the likelihood of acne in young adults. Amino acids present in cow’s milk is said to activate production of IGF 1 by the liver. This is further linked to acne growth.

2. Omega 6 Fatty Acid Rich Foods

A diet rich in omega 6 fatty acids and low in omega 3 fats causes an imbalance that may give rise to inflammation and worsen your acne.

3. Refined Carbohydrates and Sugars

These include crackers, breads, white flour pasta, white flour cereal, white rice, sweetened beverages, honey, cane sugar etc. Frequent consumption of refined flour and added sugar increases your risk of acne. These spike our insulin levels which further worsen acne. Insulin also activates androgen hormones and IGF-1 and these contribute to the development of acne.

4. Fast Food

Regular consumption of fast food has been linked to enhanced acne risks. These include burgers, hot dogs, nuggets, sodas, milkshakes etc. Some studies have proposed that these may alter the expression of genes and hormone levels and therefore result in acne growth. [7]

5. Whey Protein Powder

The amino acids leucine and glutamine present in whey protein may contribute toward rapid cellular growth and division which may result in acne development. These may also boost insulin levels. Many studies have found a link between acne and consumption of whey proteins by male athletes.

6. Chocolate

Studies have linked consumption of chocolate with acne development. In a study, it was seen that when a male who was prone to acne ate 25 gm of 99% dark chocolate every day, their acne lesions increased in two weeks. In another study consumption of 100%, cocoa powder capsules for a week daily increased acne lesions. [5]

How to Eat Your Way to Acne Free Clear Skin

The following foods can help you give a naturally clear acne free skin:

1. Vitamin A and Beta Carotene

Beta carotene supports our immune system and is known to lower cellular and tissue damage induced by free radical oxidation, and thereby slows down the aging process. Foods rich in beta-carotene are sweet potato, broccoli, carrots, kale, collard greens, squash, spinach, mango, papaya, peaches etc. Beta carotene gets converted to vitamin A in our body. Vitamin A works against acne by reducing production of sebum by the sebaceous glands. A study revealed low levels of serum retinol or Vitamin A in people with severe acne. Food sources of vitamin A include oily fish, milk, liver, whole eggs, cheese, broccoli, spinach etc.

2. Vitamin B3 and B6

These can manage acne by enhancing blood flow to the epidermis. Vitamin B3 can be found in food items like rice and wheat bran, toasted wheat germ, baked potatoes, mushrooms, tuna, sesame seeds, halibuts, peanuts, almonds etc. Vitamin B6 can inhibit acne associated with the menstrual period. It also promotes the synthesis of lymphocytes needed for the healthy functioning of our immune system. Wheat flakes, avocado, bananas, dried figs, fresh chestnuts, beef livers, carrot juice, brewer’s yeast, watermelon, spinach etc. are good sources of vitamin B6.

3. Vitamin E

By virtue of its antioxidant properties, vitamin E boosts the immune system and offers anti acne benefits. Sources include green leafy vegetables, wheat germ, soybeans, avocado, peanuts, vegetable oil and almonds.

4. Vitamin C

Its antioxidant properties work against acne. You can get it from citrus fruits like lemons, oranges, kiwis; bell pepper; tomatoes; potatoes; strawberries; Brussel sprout; cabbage; papaya etc.

5. Zinc

It works by promoting transportation of vitamin A which in turn takes care of the functioning of the sebaceous glands. Zinc in high amounts may help bring down secretions from sebaceous glands by inhibiting transformation of testosterone to its active form. Studies have linked zinc deficiency with increased risks of acne in adolescent males. Foods that are rich in zinc include red meat, oyster, poultry, milk, wheat germ and bran, whole grains and seafood.

6. Selenium

Selenium is a significant constituent of glutathione peroxidase, an antioxidant enzyme. Research has linked acne with lower levels of this enzyme in the body. In a study, significant improvement in pustular acne was seen post daily consumption of a supplement having selenium and vitamin E. Some of the selenium-rich foods that you can consume include whole grains, seafood, mushrooms, Swiss chard, garlic, onion, meat, wheat bran etc.

7. Chromium

As chromium, can help in the regulation of blood sugar levels it could be beneficial against acne. In a study, the condition of acne of the participants improved fast after consumption of 400 mcg of chromium daily. Some of the food sources include blackstrap molasses, liver of calf, brewer’s yeast, wheat bran and germ, prunes, oysters, chicken breast etc.

8. Omega 3 Fatty Acids

It works against acne by lowering certain biochemicals in the blood that cause inflammation. Some of these directly affect sebum production and inflammation of the pilosebaceous unit. Food sources include fatty fish like mackerel, tuna and lake trout as well as plant sources like soybean, walnuts, and avocados. [8]

9. Green Tea

It has the phytochemical epigallocatechin 3 gallate which is known for anti-inflammatory and antioxidant benefits. It not only helps reduce inflammation but also may indirectly affect dihydrotestosterone levels in the body. This hormone stimulates sebum and triggers acne.

Acne Fighting Food Supplements

1. Cinnamon

Cinnamon helps reduce insulin levels which is a trigger of acne. A study revealed that regular consumption of just half a teaspoon of cinnamon can bring about 20% reduction in blood sugar level in 14 days.

2. Alpha Lipoic Acid

A strong antioxidant and a coenzyme, ALA helps in blood sugar control. It also helps remove toxins from the body. You need 100 to 200 mg daily.

3. Apple Cider Vinegar

Consuming four tablespoons of apple cider vinegar before consumption of carbohydrates is believed to reduce acne breakout. Excessive carbohydrate consumption needs to be followed by 4 tablespoons more of apple cider vinegar. It should be unpasteurized, organic and unfiltered. Drink it cold and follow with water or tea.

4. Quercetin

Present in the skins of onions and red apple, quercetin works against acne by reducing the synthesis of insulin-like growth factor. You can take quercetin supplements in the dose of 500 mg a day. [8]

Low Glycemic Load Diet

A study suggests that a low glycemic diet could bring about significant improvement in the lesions of both non-inflammatory and inflammatory acne in 10 weeks. Subjects in the study were given low glycemic index (GI) foods like whole grains, beans, breads, vegetables, fish, barley, fruits etc. Protein sources provided 25% of energy, fats 30% and 45% of energy was attained from low GI foods. [9] Foods with low glycemic index include beans and legumes, nuts and seeds, whole grains, fruits like pear, peaches, apple, grapefruit etc. You can avoid those with high GI like white rice, instant oats, white bread, white potatoes, boxed cereals, candies, sweetened baked products, certain crackers etc. Fruits that are less ripe have a lower glycemic index than ripe fruits. It is better to combine carbohydrates with healthy protein and fats as this lowers the rate of conversion of carbohydrates to blood sugar. This is beneficial when you are handling acne. [10]

Herbs or Herbal Supplements

  • Milk thistle: Supplements of this herb can give a clearer skin by removing toxins from the liver.
  • Dandelion root: A cup of dandelion root tea taken daily may give you clearer complexion by purifying your blood and inhibiting acne breakouts.
  • Rosemary: Rosemary tea also works against acne.
  • Chlorella: It is also beneficial against acne and boosts our immunity.

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