Acne Vulgaris Naturopathic Protocol
Acne Vulgaris Naturopathic Protocol
This Acne Vulgaris Naturopathic Protocol is provided as information for patients of HealthMasters Naturopath Kevin Tresize ND as part of a treatment plan to assist patients with understanding of their treatment plan and should not be substituted for medical advice, diagnosis or treatment. It is important to note that this is a summary only and is intended to assist discussion between practitioner and patient as part of consultations. This Acne Vulgaris Naturopathic Protocol may be changed to suit the individual requirements of the patient and should not be substituted for medical advice, diagnosis or treatment.
HealthMasters Naturopath Kevin Tresize ND
Acne vulgaris is an inflammatory disease of the skin that affects those areas which contain the largest sebaceous glands, including the nose, central forehead, medial cheeks, medial chin, back, and trunk. Generally self-limiting, acne is characterised by comedones (black heads) and inflammatory lesions such as papules, pustules and in more severe cases, cysts and nodules. Lesions are generally more severe and prevalent in males, but more persistent in females. Acne may appear in neonates and infants, but mostly occurs during adolescence (an estimated 85% of those between 15-24 years of age are affected to some degree), and typically resolves by age 30.
Rising androgen levels are characteristic of adolescence which induces insulin resistance and alters cellular signalling, influencing the turnover of skin cells at hair follicles and sebum production. In turn, this causes blockage of hair follicles, leading to the formation of small cysts called comedones as well as proliferation of Propionibacterium acnes, an anaerobic gram positive diptheroid. Chemo-attractants produced by this anaerobic organism promote the entrance of immune cells into the affected area resulting in inflammation. P. acnes also hydrolyse triglycerides into free fatty acids which contribute to inflammation and follicular obstruction.
2. Aetiology and Risk Factors
Major causative factors and risk factors that can contribute to the incidence of acne include
- High insulin levels, associated with insulin resistance, are implicated in the development of acne, through the dual stimulation of epithelial cell proliferation and increased androgens, leading to an increase in sebum production. A high Glycaemic Load diet is therefore a risk factor.
- Fluctuating hormones associated with adolescence, menstruation (acne tends to flare 2 to 7 days pre-menstruation), or pregnancy.
- Acne patients of both genders have been found to have serum zinc levels on average 28.3% lower than control subjects. Hair levels were 24.3% lower and nail levels were 26.7% lower than controls. (Pohit J, et al. Zinc status of acne vulgaris patients. J App Nutr 1985; 37(1):18-25).
- Genetic predisposition - particularly affects the severity of presentation
- Certain medications - corticosteroids used topically or in high oral doses; anabolic (androgenic) steroids; oral contraceptives; lithium, isoniazid, phenytoin and phenobarbitone may also cause eruptions. High levels of halogens such as iodine (from kelp, for example) may also lead to or exacerbate acne.
- Topical cosmetic or hair products containing vegetable or animal fats may further block skin.
- Environmental irritants such as industrial cutting oils, tar, wood preservatives, sealing compounds, and other pollutants
- Friction and sweating - for example, from headbands, back packs, bicycle helmets, or tight collars, can initiate or aggravate inflammatory acne lesions.
- Squeezing and picking comedones can worsen acne.
3. Signs and Symptoms
- Open comedones ("blackheads") that contain easily expressed material. Blackheads are dark in appearance and resemble (but do not represent) dirt, and do not generally cause localised inflammation.
- Closed comedones ("whiteheads") that appear as 1 to 2 mm white papules and contain material that is not easily expressed
- Inflamed papules, pustules, or nodules
- Large cysts and nodules, which form in a small number of acne sufferers and may drain and leave scars
- Scarring which may have several manifestations depending on both the skin type and the type and extent of acne. Scarring may manifest as small pits or "ice-pick" scars on the face and/or trunk; small or large atrophic and/or depressed scars; or hypertrophic scars (most often seen in those with darker skin colour).
4. Core Treatment
4.1 Skin specific nutrition for healing and repair
2 capsules twice daily
4.2 If with digestive dysbiosis, poor liver function, or environmental toxin exposure
4.3 Manage blood sugar levels and insulin sensitivity through diet and exercise
Wellness and Healthy Ageing Program
If overweight or obese:
4.4 If premenstrual acne
Vitex, Ginger and Withania to Increase Progesterone - 1 tablet daily with food
4.5 If insulin resistance
Cocoa, Cinnamon and Chromium for Metabolic Syndrome - 1 tablet twice daily with food
4.6 Ongoing maintenance of detoxification clearing tissue wastes
Blood and Lymphatic Detoxification - 1 tablet twice daily
|Formula Catch Phrase||Key Benefits|
|Blood and Lymphatic Detoxification||Cleavers, burdock, nettle, blue flag and danshen are blended with essential oils and selenium, to stimulate circulation, reduce inflammation and address dysbiosis to correct imbalances commonly associated with acne.|
|Cocoa, Cinnamon and Chromium for Metabolic Syndrome||Cocoa, cinnamon and gymnema blend with nutrients for early or advanced stages of insulin resistance to support cardio-metabolic health. Cocoa (45% polyphenols) enhances glucose uptake, insulin responses and mood balance, whilst antioxidant cinnamon reduces post-prandial blood sugar levels. B vitamins, zinc and chromium support glucose transport and overall energy metabolism. Gymnema is included to manage sweet cravings and taste.|
|High Bioavailability Zinc with Vitamin C||Zinc and vitamin C are amongst the most critical nutrients in healthy immunity and skin function, involved in wound healing, immune balance and resistance to infection.|
|High Purity, Low Reflux, Concentrated Fish Oil||Fish oils modulate the production of inflammatory prostaglandins, eicosanoids, leukotrienes and thromboxane. Omega 3 essential fatty acids also support healthy immune signalling and support skin health.|
|Vitex, Ginger and Withania to Increase Progesterone||An herbal and nutritional blend designed to manage the symptoms and causes of progesterone deficiency, working in both the brain and the body to provide effective relief for irregular cycles and infertility.|
5. Supportive Lifestyle Programs
|Metagenics Clinical Detoxification Program||
Detoxification may be indicated in the treatment of Acne Vulargis. The Metagenics Clinical Detoxification Programs are designed to address the primary source of toxicity in patients, and encourage elimination of and protection against these toxins. A questionnaire is available for patients to complete which assist the Practitioner in determining the most appropriate program. There are three programs available:
|Shake It Professional Weight Management Program||There is growing evidence that obesity is a disorder of energy homeostasis, and that the set-point for obese individuals is set to a higher level. The Shake It Practitioner Weight Management Program is a novel 3 phase program structure to prevent metabolic adaptation, reset the patient’s metabolic set point, and provide regular psychological breaks from active dieting in order to achieve sustained weight loss. The program as collection of supportive materials in order to implement behaviour change techniques and two diet options: Ketogenic (low carbohydrate, higher fat), or Low fat (lower fat, liberal carbohydrate).|
|Wellness and Healthy Ageing Program||This program recommends a low glycaemic load diet with lifestyle recommendations for exercise, relaxation, intellectual stimulation and effective stress management – all factors associated with healthy ageing and chronic disease prevention.|
6. Diet and Lifestyle
- The relationship between diet and acne, for many, remains controversial. However, recent published findings support a link between diet and acne (Cordain). It proposes that a high Glycaemic Load diet (a typical western diet) leads to a persistent elevation of serum insulin. Elevated insulin is known to lead to epithelial cell proliferation and increased sebum production, both risk factors for acne.
- Intervention trials using a low GL diet have shown significant improvements in adolescent acne incidence and severity.
- A diet high in soluble fibre, antioxidants, phytonutrients, essential fatty acids from nuts and fish, plus copious fluid is generally recommended, along with reductions in sugar, white flour, refined and processed oils, sources of trans fatty acids and dairy products.
These findings explain the modern phenomenon of the high prevalence of adolescent ,and hormonally stimulated, acne, due to the interaction of insulin with sex hormones
7. Point-of-care and Pathology Tests
|TEST / SCREEN||INTERPRETATION GUIDELINES|
|Omega-3 Index Test||A validated test that measures red-blood cell (RBC) EPA and DHA status to personalise supplemental and diet prescriptions, as well as identifying those at risk of health conditions associated with omega-3 deficiency. An Omega-3 Index in the desirable range of 8%-12% is an indicator of better overall health.|
8. Pharmaceutical Treatments
- Topical Antimicrobials and Keratolytics: Benzoyl peroxide may be effective for inflammatory acne, although its use may be limited by side effects such as redness and scaling. Salicylic acid and alpha hydroxy acids may also be useful in some circumstances.
- Antibiotics: treatment with oral antibiotics should be continued for several months and may be tapered if clinical improvement is evident. Although the mechanism of action of antibiotics is via anti-inflammatory as well as antibacterial effects, the development of resistance has led to the restriction of systemic antibiotics to more severe acne, in combination with topical agents. Topical antibiotics (e.g., clindamycin or erythromycin) are used for mild to moderate acne; and are more likely to be used for short periods only, and in combination with other agents.
- Retinoids: Isotretinoin is an analogue of vitamin A and is intended for highly refractory, inflammatory acne; prescribed orally to reduce both sebaceous gland size and sebum production. Given the high degree of teratogenicity, the prescribing of this agent is thought best reserved for dermatology specialists. Topical retinoids, such as tretinoin, are widely used as first line treatments for mild to moderate acne, although similarly are not for use during pregnancy.
- Combined Oral Contraceptives: not considered primary treatment for acne, these may be a useful adjunct, particularly in women with signs of hyperandrogenism. Oestrogen reduces free testosterone levels through inhibition of ovarian androgen production and enhancement of testosterone-binding globulin: the progestin component of oral contraceptives, however, may aggravate acne. Therefore, oral contraceptives with low androgenic potential, such as those including gestodene, desogestrel or cyproterone, should be selected.