A common inflammatory pilosebaceous disease characterized by comedones, papules, pustules, inflamed nodules, superficial pus-filled cysts, and, in extreme cases, canalizing and deep, inflamed, sometimes purulent, sacs. (The Merck Manual)

Acne is a common, potentially disfiguring skin disease. Unfortunately, it often affects those in an emotionally vulnerable stage of life — adolescents. Acne involves the sebaceous glands in the skin, which secrete lubrication (sebum) for the hair follicles (pilosebaceous follicles) and surrounding skin. These are located in greatest concentrations on the face, back, shoulders, and chest. Acne is most common in adolescents, with a peak in the late teens. Acne may, however, appear for the first time in the mid-20s or later and can persist into the 40s or 50s. Acne lesions are commonly of three types:

  • Blackheads are glands plugged with excessive material that discolors on exposure to air.
  • Whiteheads are small collections of pus within glands.
  • Nodules or, papules are the red and inflamed areas of more extensive infection.

A complex of causes underlies acne. Unfortunately, determining underlying causes is rarely as simple as blaming fats, chocolate, and sugar. Important predisposing factors include:

Genetic predisposition. Statistics suggest that the strongest single factor in the development of acne is family history. While the common conclusion is that the disorder has a genetic basis, it might be argued that it is related to generations of inappropriate nutrition.
Hormonal changes in adolescence. Stimulation of the sebaceous glands seems to occur with the production of androgens (the masculinizing hormone found in both sexes) at puberty. People with acne seem to produce normal amounts of androgens, but their skin may simply be unusually sensitive to its effects.
Skin flora. The bacteria normally present on the skin, or the skin flora, do not cause acne. However, blackheads and whiteheads are filled with trapped sebum and bacteria.
Nutrition. Although it is popularly thought that diet is a major factor in acne, there is no clear scientific evidence to support this. However, the quality of nutritional intake is fundamental to quality of life, so it makes sense to limit the intake of saturated fats and sugar, even if they do not cause acne.

One explanation for the physiological processes behind the characteristic skin eruptions of acne suggests this sequence of events:

Stimulation by androgens (male sex hormones) causes an increase in the amount and thickness of oil secretion, so more lipid is present in the follicles.
Changes in skin ecology promote bacterial growth, especially Propionibacterium acnes.
Sebaceous glands become obstructed by comedones (blackheads and whiteheads).
Any consequent disruption offollicular epithelium allows discharge of pus into the dermis.
Inflammatory reaction develops.

Pathological changes ensue in the following sequence: papules  → pustules  → nodules → cysts

Treatment of Acne

The endocrine system must be given tonic support. This is ideal, but general endocrine toning is not a simple thing. Toning work can be focused through the use of hepatic alteratives. If there has been long-term antibiotic use, the immune system must be strengthened. See chapter 21 for more information.

Actions Indicated

Alteratives are the core of any treatment. Hepatic alteratives are especially helpful.

Hormonal normalizers are indicated because of the androgen involvement. However, impacting these hormones in an appropriate way is not always a straightforward matter.

Antimicrobials help the body deal with secondary infection. They may be used both internally and topically.

Lymphatic tonics support lymphatic drainage from the skin and underlying tissues.

Hepatics are vital, partly for the generalized benefit imparted by their liver-toning effects, but also because they have a specific role in detoxification.

Diuretics are important in ensuring adequate elimination through the kidneys.

Anti-inflammatories can be helpful when used topically within the context of daily hygiene.

Astringents, used topically, help in cleansing and avoiding secondary infection.

Specific Remedies

Traditionally, there are no definite specifics here, other than hepatic alteratives. However, tea tree oil (Melaleuca alternifolid) has specifically relevant properties. The primary constituent of the oil is terpinene-4-ol, which constitutes up to 60% of the oil. Australian standards set a minimum content of 30% terpinene-4-ol. Tea tree oil and terpinene-4-ol in particular have been shown to possess significant antimicrobial properties. Organisms inhibited include Candida albicans, Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Propionibacterium acnes. For acne, tea tree oil applied topically in a 5% to 15% dilution three or four times daily is recommended.

Keep in mind that there is no specific herb that normalizes levels of androgens. Occasionally, however, Vitex can have a beneficial effect in adolescent girls.

A Prescription for Acne

  • Iris versicolor 1 part
  • Arctium lappa 1 part
  • Echinacea spp. 1 part
  • Galium aparine 1 part

Dosage: up to 5 ml of tincture three times a day. The patient should also drink an infusion of Urtica dioica two or three times a day. In addition, apply Calendula officinalis topically as a wash, in the form of an infusion mixed with distilled Hamamelis virginiana (witch hazel).

Broader Context of Treatment

There are a number of non-herbal issues to address, ranging from diet and hygiene to coping with a whole complex of emotions. It is often important to explain the nature of the problem to the patient, as well as the treatment you propose. Especially for adolescents, there may be a need to address unspoken feelings, such as fear and guilt. Be sure the patient understands the following issues:

Acne is not related to sexual activity. Masturbation and sex are not causes of acne. This antiquated notion harks back to the 16th century, when excess semen secretion was believed to aggravate acne. Marriage was purported to be the cure. It has no scientific validity.

Acne is not caused by dirt and cannot be washed away. It is related to an imbalance (hormonal or chemical) that causes the oil in the skin to form blackheads.

Personal hygiene is important, but an obsession with washing can aggravate the problem. It may be helpful to review some specifics with the patient:

Keep the hands away from the face, avoiding friction of the skin.

Do not squeeze pimples or blackheads, as squeezing the skin makes the acne worse. The blackhead may be pushed deeper into the skin, possibly causing the follicle to rupture.

Keep the hair off the face, and wash the hair daily, if needed.

Avoid cosmetics that contain synthetic chemicals.

Ideas about nutrition “dos and don’ts” for acne abound. Some generalizations are clear, including avoiding refined foods, red meat, and high-fat or carbohydrate-rich foods. A diet rich in green leafy vegetables and fruit is indicated.

Textbook of Natural Medicine recommends the following supplements:

  • Vitamin A: 100,00 IU/day for three months
  • Vitamin E: 400 IU/day
  • Vitamin C: 1,000 mg/day
  • Zinc: 50 mg/day (as picolinate)
  • Selenium: 200 meg/day
  • Brewer’s yeast: 1 tablespoon twice a day