Acne

At Body Renewal every new patient is checked for low stomach acid. A complimentary Betaine HCl acid test is explained and done in every consultation because:

• Adequate stomach acid is essential for absorption of the minerals zinc, magnesium, calcium, iron and folate which are essential for healthy skin.
• Adequate Stomach acid prevents dysbiosis.
• Adequate stomach acid will help prevent a "leaky gut "with all its health ramifications from developing.

• Adequate stomach acid is essential for absorption of the minerals zinc, magnesium, calcium, iron and folate which are essential for healthy skin.
• Adequate stomach acid is necessary for the absorption of the B vitamins.
• Stomach acid activates protein-digesting enzymes and is necessary for proper digestion of protein.
• Adequate stomach acid is necessary for the pancreas to release its cascade of digestive enzymes for absorption of carbohydrate and fat.
• Sub-optimal fat digestion means we won't benefit from the anti-inflammatory properties of omega-3 fats,nor the wide array of beneficial effects of fats for fertility, skin health, immunity, etc.
• Adequate stomach acid destroys pathogens (bacteria, fungi, parasites etc) and a lack of stomach acid can lead to bad bacteria proliferating in the small intestine dysbiosis (bad bacteria) and unwanted parasites which have Health Renewal ramifications down the line.

How can we expect to stay healthy and have healthy skin without constant breakouts and other Skin, Body or Health Renewal conditions if we have chronically poor nutrient and mineral absorption due to incomplete digestion?

Having normal levels of stomach function the first important domino in a row of dominos: If stomach acid is adequate, the rest of one's digestion and absorption won't be compromised and the first domino won't fall and immune dysfunction is less likely down the line.

If digestion in the stomach is compromised due to low stomach acid, then the fall of the first domino will occur and the breakdown and absorption of nutrients in the stomach and beyond won't be optimal. In fact, digestion and absorption can be reduced to the point where even if someone is consuming a nutrient-dense diet, they can suffer both sub-clinical and overt deficiencies because they're not assimilating those nutrients because they have low stomach acid. Get your stomach acid checked by our Body Renewal Doctors.

Acne (acne vulgaris) is a dermatologic condition which affects approximately 80-95% of adolescents as their bodies go through puberty, but luckily its occurrence declines over the following years until middle age. This condition is characterized by lesions that most often appear on the face and neck, but it is not uncommon to develop these lesions on the chest, back, shoulders and upper arms too. Acne vulgaris, the most common skin disorder, affects virtually all individuals at least once. Incidence peaks in 18-year-olds, but substantial numbers of 20- to 40-year age group also develop the disease.

Adolescent boys and young men are more likely to have acne than their female counterparts and make up the majority of severe scarring cases, due to the fact that acne is triggered by androgens (male hormone) fluctuations.

Women are more likely to suffer from ongoing acne that commences or reappears during their early adult years. Around 8% of women have acne persisting into their 30’s and in some it continues into their 40's and occasionally 50's. Why this occurs is poorly understood but may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle.

There is also a subset of women with “true” hormonal acne who have abnormal levels of androgenic (male-type) hormones. These women often have accompanying excess facial hair (also hormonally regulated) and irregular menstrual cycles, although women who have normal hormone levels may also have excess hair. The sebaceous glands of patients with acne are likely to be hypersensitive to androgens (male-type) hormones.

The effects of acne should not be underestimated. It can persist for years; produce disfigurement and permanent scarring; and have significant psycho-social consequences, including diminished self-esteem, embarrassment, social withdrawal, depression, anxiety and unemployment. The extent and severity of these effects underline the importance of providing adequate therapy, such as the Lamelle Clarity range which produces more than 80% improvement in 8 weeks in mild to moderate cases.

Acne is characterized by the formation of comedones (blackheads), pimples, cysts and abscesses (in worst cases). These lesions are formed on the skin when the pores in the skin are blocked. This blockage causes oil to be trapped, together with dead skin and bacteria within the hair follicles. In normal circumstances, the sebaceous glands (which have the function of secreting an oily substance called sebum) are attached to the hair follicles and allows the sebum to travel up the hair follicle and onto the skin. However, if there is a blockage in the hair follicle, the sebum can't get out, and this can sometimes cause the formation of a blackhead (comedones). Blackheads are the result of the blocked oil that oxidizes, causing further inflammation and an influx of white blood cells. Meanwhile, normally present bacteria (Propionibacterium acnes) begin to break down the trapped sebum within the hair follicle. The subsequent result is further and aggravated inflammation, as white blood cells attack the bacteria. Pus forms within the lesion causing the lesion to enter the whitehead stage. In more severe stages with severe inflammation and infection, an abscess - a painful pus-filled pocket within the skin - may form.

Acne arises from the interaction of 4 factors:

1. Dead skin cells blocking the oil duct results in Comedogenesis. The first sign of altered keratinization is a blackhead which consists of keratinized material and lipid material. This Abnormal Keratinization results in formation of keratin plugs which blocks off the drainage of the sebaceous follicles, leading to accumulation of inflammatory debris and increased bacterial numbers of P acnes.

2. Too much oil production caused by androgenic hormonal stimulation of sebaceous glands at puberty or later (hormonal triggers).

3. Too many bacteria: Proliferation of P acnes in this blocked follicle.

4. Too much Inflammation: is a direct or indirect result of P acnes proliferation. Rupture of the inflammatory follicle onto the skin results in the redness around the acne lesion. Extension of inflammation into the skin results in formation of the inflammatory lesions of acne, which include papules, pustules, and nodules. The result is redness and pus.

• Hormones; In both men and women, the androgen hormones are present in much higher concentrations at puberty and acne results. Polycystic Ovarian Syndrome (PCOS) leads to higher levels of male hormones which can cause acne in female patients.
• Genetic factors (family members have bad acne)
• Flare Factors for acne are: stress and depression, menses and puberty (new onset hormones).
• Environmental factors such as high humidity causing swelling of the skin.
• Diet: a poor, unhealthy diet high in saturated fats, MSG's and preservatives can aggravate acne in someone who is allready prone to this condition.
• Cosmetics especially certain moisturizers and foundations.

• Cinnamon oil,
• Cocoa butter,
• Cocus nucifera,
• Isoprpopyl isostearate,
• Isopropyl myristate,
• Isopropyl myristate,
• Butyl stearate,
• Isostearyl neopentanoate,
• Myristyl myristate,
• Octyl palmitate,
• Isocetyl srearate,
• Propylene glycol 2,
• Myristyl propionate,
• Lanolin,
• Peppermint oil,
• Decyl oleate, and
• Octyl stearate.

Acne can be classified as mild, moderate or severe inflammatory acne and is based on lesion count and whether nodules are present, or not.

• Mild to moderate acne has papules, pustules and comedones, without any nodules present in the skin.
• Severe acne has many papules, pustules, comedones and/or more than 5 nodules present in the skin. Cysts may also be present in these severe cases.

Severe acne may be more common in males and this kind of acne should be referred to a Skin Renewal doctor as scarring is inevitable.

• Open comedones (blackheads): These lesions are very common and consist of dilated pores and/or hair folicles , that are filled with a combination of sebum, dead skin cells and bacteria. This mixture gets trapped within the follicle creating a central, dark and solid plug. The follicles are not completely blocked, and it appears black because of oxidation of the trapped mixture, not dirt.
• Closed comedones (whiteheads): These form when the dead skin cells and sebum completely block the opening of a hair follicle, usually following after a blackhead has formed.
• Pustules: This whitehead type of lesions is pus-filled and inflamed. Once these lesions rupture into the skin, they form pustular heads.
• Papules: This type of whitehead (5 mm or less) is a type of lesions that has become swollen, red and inflamed.
• Nodules: This type of lesions is a solid, dome- or irregularly shaped, inflamed lesions that extend deep into the skin. If left untreated these lesions can cause tissue damage and scarring because it affects deeper skin layers too. This type of nodular acne is the most severe form of the condition and can be very painful, even without touch.
• Cysts: These sac-like lesions contain a liquid, or semi-liquid, substance that is made up of white blood cells, bacteria and dead skin cells. Left untreated they can result in scarring, and may be very painful and severely inflamed. When an individual has the formation of cysts and nodules together it is called nodulocystic acne, which is also very severe and requires medical treatment.

Acne can be caused by both environmental and genetic factors, but genetics seems to the predominate cause of the condition in most individuals. It was found in one large twin study that 81% of disease variance (that is, the difference from what would normally be expected) was attributed to genetic effects, and the remaining 19% to environmental factors. Furthermore the study also showed that if an individual has a family history of acne it significantly increased personal risk of developing the condition.

Puberty is the stage in a person’s life when there is an increase in the production of the male hormone testosterone (in both men & woman) which leads to the enlargement of the sebaceous glands in the skin and creates a contributing factor to acne formation. If the sebaceous glands are enlarged they produce more sebum, which leads to the aforementioned plug formation, and this then creates a fertile environment in which bacteria can grow and multiply.

Unlike male-hormones (androgens), female-hormones (estrogens) have a beneficial effect on acne, this is then why some doctors recommend the use of birth control pills for women who have acne. However, when a woman's estrogen levels decline acne may worsen (this drop in the hormone levels happen each month just before the menstrual cycle begins).

Acne or acne-like lesions can also develop in response to various substances, including corticosteroids, lithium, and some psychotropic drugs. There are also other environmental causes such as exposure to tobacco smoke, coal tar derivatives and industrial oils which need to be steered clear of. Substances to also avoid include oils in aerosol sprays, as well as excessive washing or scrubbing of the skin. Over washing can aggravate acne because it causes increased skin-oil production leading to more acne formation. There are types of cosmetics, oil-based hair products, and suntan lotions which can block oil glands and worsen acne so they are best avoided. It is better to use hypoallergenic, oil-free and water-based products that do not clog pores. It is interesting to note that, despite popular opinion, the conventional medical view is that acne is not caused by poor hygiene or by eating specific foods, such as chocolate, pizza, and soda although the evidence is mixed.

An individual’s diet has long been suspected as a contributor to acne. It is believed by many people that foods such as greasy pizza, chocolate and refined sugars cause acne and worsen the condition. Meanwhile, the conventional dermatological community is adamant that diet does not contribute to acne,dismissing most dietary concerns as myths.

There are however a few well-designed scientific studies which found that the truth is probably somewhere between these two extremes relating to diet. There is some very initial evidence that a diet with a high glycemic index (which simply means it contributes to high levels of glucose in the blood) may contribute to acne. In one small study it was found that by avoiding glycemia-inducing foods, "some results appeared promising," but that the small sample size (consisting of only 11 young men aged 15 to 20) was not enough to draw significant conclusions. Another study examined the role of dairy consumption in acne cases. This was a very large study that included questionnaires submitted by more than 47,000 high-school-age women (14-18years old), and found a positive correlation between acne and total milk and skim milk consumption. It was speculated that the association may be due to hormones and bioactive molecules found in dairy milk. Other studies have confirmed that the Western diet in general, which is high in fats, refined carbohydrates, and sugar, is conducive to acne.

It is clear that there are multiple causes and contributing factors that cause the onset and progression of acne. Conventional medicine has many powerful drugs that could be used and helpful in treating acne, but they only address one of those factors. It is also possible that these can cause various side effects which could be harmful and create further complications.

It is the choice of the individual to use natural and alternative therapies in the treatment of acne, either by itself, or to compliment conventional medications. These natural remedies can help to reduce inflammation, and infection, and in severe cases a combination of treatment might get the best results.

Vitamins A and E. The benefits of vitamins A and E in acne treatment was highlighted in a study in which investigators compared the plasma vitamin A and E concentrations in 100 untreated patients with acne, compared with 100 healthy controls. In the patients that suffered from acne the plasma concentrations of both vitamins were significantly lower than those of the healthy individuals. This showed a strong relationship between a decline in vitamin A and E levels and an increase in the severity of acne.

These findings supports previous research which found that supplementation with vitamin A is beneficial in inflammatory conditions, including acne. Equally, vitamin A deficiency induces inflammation and aggravates existing inflammatory conditions. In fact, vitamin A in its retinoid form has long been an important treatment for acne.

Lipoic acid. It has been tested for several decades how effective lipoic acid is in the treatment of acne. Reportedly, lipoic acid activates a factor in the body known as AP-1, which produces enzymes that digest damaged collagen and helps erase scars, including acne scars. Topical ointments that contain lipoic acid as an ingredient can assist in improving scarring, and this can be taken in oral supplements as well.

Zinc. This mineral is very potent in the treatment of acne as it appears to perform a threefold role. Firstly Zinc can help to reduce inflammation, secondly it kills Propionibacterium acnes (the main bacteria associated with the condition), and lastly zinc produces changes in the skin environment that make it more hostile to this bacterium for a longer time. A two-month study of the efficacy of zinc gluconate (30 mg once daily) in 30 patients with inflammatory acne showed a reduction in the number of inflammatory lesions after the treatment period, and improved effectiveness of the antibiotic erythromycin among patients with antibiotic-resistant organisms. In a double-blind study, a combination of 1.2% zinc and 4% erythromycin in a topical lotion was used by 14 individuals with acne. It was founds that the combination of zinc and erythromycin significantly reduced secretion of sebum after six weeks of treatment. Further, a topical preparation of zinc acetate was found to prolong the duration of erythromycin on skin, potentially overcoming some mechanisms of erythromycin resistance.

It is very interesting to note that clinical trials of zinc preparations have demonstrated their equivalence to antibiotics, with the added benefit of having more convenient dosing schedules, and less harmful effects of antibiotic treatment. A study that compared a cream containing chloroxylenol and zinc oxide showed no difference in efficacy compared with 5% benzoyl peroxide, but it did find significantly less skin drying and irritation with the zinc-containing cream. Finally, a 2005 study demonstrated that a gel containing clindamycin plus zinc, applied once or twice daily, achieved the same benefit obtained by clindamycin lotion alone used twice daily.

Niacinamide (nicotinamide). Niacinamide is one of the two principle forms of niacin, and proves to be very effective in acne treatment when applied topically to the skin. In a State University of New York study, a 4% nicotinamide gel was compared to a 1%clindamycin gel for the treatment of moderate inflammatory acne in 76 patients. Treatment was applied twice daily for eight weeks. At the end of treatment, 82% of the nicotinamide patients and 68% of the clindamycin patients were improved. An additional fact to keep in mind with the use of topical clindamycin is that it is also associated with the development of resistant microorganisms, which makes the use of niacinamide even more preferred. Nicotinamide cream has also been shown to reduce the amount of sebum present on the skin, thus assisting in acne treatment.

Essential Fatty Acids (EPA /DHA). The two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well-known tried & tested anti-inflammatories that have been shown in dozens of studies to reduce general inflammation. Although their effect on acne and skin inflammation has not yet been extensively studied, their ability to reduce inflammation in general suggests they might be beneficial with a role in the treatment of acne. Several studies have found that omega-3 fatty acids are absorbed through the skin and can reduce inflammation in a particular area.

Herbal Therapy. Even though herbal therapy is often suggested for acne, there are few controlled scientific studies that have been conducted to confirm any claims. In a double-blind, placebo-controlled clinical trial of Ayurvedic (ancient Hindu) herbal preparations, researchers randomly assigned either placebo or one of four Ayurvedic formulas to 82 people with moderate cases of acne. One formulation, Sunder Vati, significantly reduced the number of inflammatory and non-inflammatory acne lesions. Sunder Vati consists of a combination of ginger (Zingiber officinale), Holarrhena antidysenterica, and Embelia ribes.

Several other herbs have anti-inflammatory properties that may be helpful in the treatment of skin conditions, although there are no scientific studies that have been performed with acne. The herbs include calendula (Calendula officinalis), German chamomile (Matricaria recutita), witch hazel (Hamamelis virginiana), and licorice root (Glycyrrhiza glabra). These herbs are found in some natural skin-care products, and may be effective on an individual basis.

If an individual chooses to use aggressive dietary supplementation it should be discussed and supervised by a qualified physician. Several of the nutrients suggested in this protocol may have adverse effects.

These include:

EPA/DHA

Consult your doctor before taking EPA/DHA if you take warfarin (Coumadin). Taking EPA/DHA with warfarin may increase the risk of bleeding.

Discontinue using EPA/DHA a minimum of two weeks before any surgical procedure, to prevent excess bleeding.

Lipoic Acid

Consult your doctor before taking lipoic acid if you have diabetes and glucose intolerance. Monitor your blood glucose level frequently. Lipoic acid may lower blood glucose levels.

Tea Tree Oil

Tea Tree can cause contact dermatitis (skin irritation), so use in moderation and apply a test patch first.

Vitamin A

Do not take vitamin A if you are pregnant, or plan to fall pregnant in the next year, or breast feeding or have hypervitaminosis A.

Do not take vitamin A if you take retinoids or retinoid analogues (such as acitretin, all-trans-retinoic acid, bexarotene, etretinate, and isotretinoin). Vitamin A can add to the toxicity of these drugs, causing serious adverse reactions.

Do not take large amounts of vitamin A, dosage should be small and controlled. Taking large amounts of vitamin A such as Roaccutane may cause acute or chronic toxicity. Early signs and symptoms of chronic toxicity include dry, rough skin; cracked lips; sparse, coarse hair; and loss of hair from the eyebrows. Later signs and symptoms of toxicity include irritability, headache, pseudotumor cerebri (benign intracranial hypertension), elevated serum liver enzymes, reversible non-cirrhotic portal high blood pressure, fibrosis and cirrhosis of the liver, and death from liver failure.

Vitamin E

If you are taking anti-coagulant or anti-platelet medications, or have a bleeding disorder, consult your healthcare provider before taking this product, to ensure no adverse reactions will follow.

Zinc

High doses of zinc (above 30 milligrams daily) can cause adverse reactions.

Zinc can cause a metallic taste, headache, drowsiness, and gastrointestinal symptoms such as nausea and diarrhea when too much is consumed.

High doses of zinc can lead to copper deficiency and hypochromic microcytic anemia secondary to zinc-induced copper deficiency.

High doses of zinc may suppress the immune system.

Acne can damage the dermis (the layer of skin just underneath the epidermis) which could lead to permanent scarring.

There are various product houses that offer topical treatment specifically for acne. Topical therapies include:

• Lamelle Clarity,
• Neostrata,
• SkinCeuticals,
• as well as Antibiotics and prescription medicines if indicated.

Treatments available at Skin Renewal to treat acne and improve results:

Microdermabrasion gently polishes the skin. Can be used for mild acne, where the lesions are not currently active.

Deep Cleanse Facials are cleansing facials which are prescribed once a month to remove pustules and comedones so as to facilitate healing of the acne condition with as little damage to the skin as possible.

An Extraction Peel is a Beta Salicylic acid peel combined with a Deep Cleanse Facial and Laser Genesis.

At Skin Renewal Renewal we offer the following peels for our acne patients: Beta Salicylic acid peel, Azelan and TCA peels for our acne patients depending on Skin Type, severity and budget.

The Laser Genesis procedure, a 5 in one treatment, reduces the size of the sebaceous gland, reduces inflammation in the papule and nodule, reduces pore size, improves acne scarring and pigmentation. For deep nodules, the Titan is a deep infra red laser/Light procedure that reduces inflammation and kills the bacteria in the deep painful nodule(s) and helps prevent scarring.

10 or 15% TCA Peel overlays to the affected areas improves the active acne lesion as well as improving PIH and acne scarring.

PDT/LED photo dynamic therapy uses red and blue light therapy, plus a salicylic acid silk peel to improve acne by destroying bacteria and reducing inflammation in the acne lesion.

Standalone PDT/ LED treatment alternating with the red and the blue light every 48 hours. 8 treatments would be needed to improve acne.

The blue light kills the acne bacteria.

The red light is anti inflammatory.

Carboxytherapy around acne lesions, or into acne scars, reduces the acne lesion and improves the acne scarring.

Intralesional steroids into acne nodules reduces the acne lesion by decreasing inflammation.

For more severe nodular acne, PDT/ALA therapy may be recommended, and this would be an alternative to Roaccutane. 7 to 10 days of downtime can be expected with this procedure. A follow up treatment 6 weeks later would provide even better results. Skin rejuvenation can also be expected.

As each patient's case is different we will tailor a treatment program specifically for your circumstances and budget. A highly professional team led by a Medical Doctor assesses every patient and an appropriate combination treatment together with long term maintenance program is recommended.

Nodular/Severe acne must be seen by our integrative medical doctors at Health Renewal for further assessment and work up and laboratory tests. Often in these severe cases there are other contributing factors that also need to be treated along with the acne.

The goals of acne treatment are to:

• lessen physical discomfort from inflamed acne lesions
• improve appearance
• prevent or minimize potential adverse psychological effects
• minimize any scarring
• treating lesions and preventing new lesions from developing.

Topical treatment – Clarity is indicated for patients with non-inflammatory comedones or mild to moderate inflammatory acne. Medications used in topical treatment may act primarily against comedones (comedolytic agents) or inflammatory lesions (antibacterial agents and antibiotics). A principal goal of therapy should be reduction or elimination of the precursor of all acne lesions— microcomedones.

For all health conditions, the nutraceuticals are individually tailored by the Health Renewal Doctor. The doctor will decide- based on your history, physical examination and blood tests what would be the best for you and your specific needs and/or deficiencies. It cannot be overemphasized that one must not self-medicate. Self-Medicating is done when a person takes prescription medication or nutraceuticals on their own without a doctor's supervision and/or consent. By not having a physical examination and blood testing done by a qualified and practising integrative medical practitioner, you could be not treating vital deficiencies or conditions such as elevated testosterone levels, or polycystic ovaries. In addition, there is no single supplement or, topical product prescribed to clients as there is no magic bullet that can support all the essential nutrients that one's body needs. Today's food is not functional and we need to supplement in order to maintain optimal bodily functions and nutrition.

If you have Minimal acne (see definition above), you can come into one of our branches and our qualified and knowledgeable staff/ therapists will advise you on topical home therapies. If you want to have in office treatments such as a peel or Microdermabrasion, then please make an appointment with one of our Skin Renewal Doctors.

HOWEVER if you have MILD to MODERATE acne, then you will need to make an appointment with one of the Skin Renewal doctors for a full evaluation. If you do a treatment, the price of the consultation comes off the price of the first treatment.

NB: If you have SEVERE acne, you WILL have to see one of our Health Renewal doctors for a full evaluation which will include laboratory / blood testing.

1. Avoid the sun as overexposure to the sun can worsen acne, and cause post inflammatory hyperpigmentation (PIH) of inflamed lesions.
2. Use cosmetics sparingly. Use only hypoallergenic, breathable cosmetics such as Heliocare 360 Color Oil-Free Gel SPF 50.
3. Wash face gently in the mornings and at night with unscented, oil-free cleansers and keep the skin clean. It is important to remember: Acne is not caused by dirt. Avoid scrubbing inflamed skin as this will make acne worse and spread the infection to larger parts of the skin.
4. Resist the urge to squeeze, scratch or pick at acne lesions. Let them drain when they are ready. Causing trauma to the skin will result in potential scarring and worsening of the condition as infection spreads.
5. Young men who suffer from moderate to severe acne should use a new razor blade every time they shave to lessen risk of infection.
6. It is important that men avoid alcohol-based aftershaves. If possible, use herbal alternatives that include essential oils of lavender, chamomile, or tea tree oil to sooth the skin.
7. Eliminate foods which are high in fat, hormones, and iodine.
8. Ensure your diet consist of a wide range of whole, natural foods, especially raw foods. Avoid processed foods with additives and trans-fatty acids.
9. Drink adequate liquids, especially pure water and green tea, which helps to flush your system and keep the skin hydrated.