There are currently several factors to consider when it comes to acne:
- Hormonally mediated sebum overproduction (skin overproduces oil and makes the oil more sticky than normal)
- follicular hyperkeratinization (dead skin cells stick together and clog the pores)
- chronic inflammation of the pilosebaceous unit (the skin releases more inflammatory chemicals in people with acne)
- different types of p.acnes bacteria (which is why some skins do not react to antibacterial agents)
- Lipid peroxidation by free radicals (when sebum is oxidized, it becomes highly comedogenic)
Recent research shows that this last current factor – lipid peroxidation – actually drives the acne process and may even be the genesis of the entire chain of acne-causing events. Research has also shown that people with acne in both their skin and body simply experience more oxidative stress than people without acne. It is still unclear whether higher oxidative stress is the result or the precursor to an acne-prone illness. It can be a little of both, but regardless of that, oxidative stress is a factor that is paramount in curing acne.
We used to think that clogging of the follicles (comedones) caused the settlement and growth of p.acnes bacteria, which then led to inflammation (pimples).
In recent years, it has been found that there are several things going on in the skin long before the microcomedon is created that help create the perfect storm for the appearance of a pimple.
We don't know exactly why it happens, but for some reason, people who are prone to acne have an increased amount of pro-inflammatory factors around the pores and sebaceous glands. This means that before sticky sebum and skin cells cause grafting, large amounts of flammable chemicals oxidize the sebum in the pore. Lipid peroxidation of the sebum means that the sebum is no longer an inhospitable environment for p.acnes, but one in which anaerobic bacteria such as p. Acne can survive and thrive. It also greatly increases the comedogenicity of the sebum.
It is believed that inflammation and oxidative stress in the skin (pilosebaceous follicles) could create the conditions for all of the following factors that lead to acne.
Did you know that when antibiotics were heavily prescribed for acne sufferers, the theory was presented that antibiotics actually work against acne because they act as antioxidants in the body? In fact, a recent study found that doxycycline, a common antibiotic for oral acne treatment, reduced acne in subjects with moderate facial acne by over 80% after 3 months of subantimicrobial use.
How it works: Inflammation mediators cause sebum to oxidize. Oxidized sebum then becomes hospitable to p.acnes; p.acnes begins to multiply. The p.acnes bacteria then form free radicals, which further intensify both the existing oxidation and the inflammation, and a pimple develops.
This gives us some clues as to why zinc works so often (both internally and topically) as an acne remedy – it is an important antioxidant co-factoring mineral.
In later blog posts I will hopefully go into what we can do holistically / internally to compensate for these above-average levels of inflammation and oxidation in the body. However, with topical skin, research has shown that certain key antioxidants are used.
The antioxidant sodium ascorbyl phosphate (the stable form of vitamin C that we use in Illumina) was superior to benzoyl peroxide in curing acne.
DMMC (Dimethylmethoxy Chromanol), a synthetic, extremely stable, powerful and expensive antioxidant contained in Potentci and also in AMBAR's Daily Antioxidant Primer, has an excellent ability to prevent lipid peroxidation, the specific type of oxidation that related to acne.
Other antioxidants that, according to current research, are effective against this specific acne trigger are vitamin E, green tea and zinc.
Snack: Ensuring that your skin care product contains antioxidants suitable for acne can help to control the lipid peroxidation of the sebum, which is thought to be the cause of acne.