ACNE

Multiple factors contribute to acne. One is a change in keratin, a protein produced by skin cells. Excess keratin can clump together to block the oil ducts within hair follicles, producing those spots or pimples. The bacteria that inhabit these tiny hair follicles can also play a role, especially in teen acne.

While teen acne affects boys and girls in equal numbers, adult acne seems more common in women than in men. Some experts attribute this to hormonal changes that occur during the menstrual cycle.

When used regularly, certain drug treatments can control acne. They take several weeks to work, however, and some treatments cause an initial worsening in acne before the skin begins to clear.

DRUG TREATMENT

Topical Retinoids
Tretinoin (Retin-A), adapalene (Differin), tazarotene (Zorac).

Function: increase generation of new cells and sloughing of old cells to decrease pore blockage.

Side effects: mild dryness, itching, chapping and peeling, particularly during the first few weeks; may cause acne to worsen initially; may increase skin reactions to sunlight.
Caution: do not use if you are pregnant or while attempting to become pregnant.

Keratolytics
Salicylic acid (Acnisal); salicylic acid and sulphur; resorcinol and sulphur (Eskamel).

Function: soften and loosen keratin, aiding its removal from the skin.

Side effects: warmth, tingling, peeling, sensitivity to wind or cold, pigment change in treated area.

Antibiotics
Topical types: erythromycin, erythromycin plus benzoyl peroxide, clindamycin (many trade names).

Function: kill bacteria on the skin.

Side effects: initial burning or stinging on contact.

Oral types: tetracyclines (many products).

Function: kill bacteria in all body systems.

Side effects: stomach upset, nausea, vomiting, diarrhoea, dizziness,. lightheadedness; doxycycline can increase photosensitivity.

Oral Contraceptives
Many trade and brand names.

Function: counteract the effects of male hormones called androgens on the oil glands.

Side effects: fluid retention, breast tenderness, break-through bleeding, nausea, vaginal discharge, brown skin blotches, headaches.

Other Drugs

Benzoyl peroxide (Acnecide, Nericur, PanOxyl).

Function: act as an antibacterial agent.

Side effects: skin dryness and mild irritation with redness and chapping, especially in first weeks of use; do not use with tretinoin or similar products.

Isotretinoin (Roaccutane).

Function: reduce oil gland size and activity (usually reserved for stubborn acne.)

Side effects: lip scaling, dry, itchy and peeling skin, dry mouth, eye inflammation, skin reactions to sun exposure; less commonly bone and joint pain, tendonitis, elevated blood triglycerides and liver enzymes; can cause serious birth defects.

WASH LESS, SMILE MORE

Many people have the mistaken impression that the cause is dirty skin. Not so. Aggressive and frequent washing actually aggravates the condition. Besides, washing the skin's surface doesn't rid the follicles of bacteria and excess oils. It's better to wash gently with a mild cleanser. Morning and evening is probably often enough.

HERBAL REMEDIES

Tea Tree (Melaleuca alternifolia)
The pungent oil from this Australian tree, used externally, acts against the bacteria associated with acne. One study found that a 5 per cent tea tree oil preparation worked as well as 5 per cent benzoyl peroxide in treating acne, but with fewer side effects.

To use tea tree oil for acne, gently cleanse skin and pat dry. Then apply a 5 to 15 per cent dilution of the oil to problem areas (purchase a diluted product or dilute your own in jojoba oil). Repeat twice daily, morning and evening.

Caution: may cause a rash, so try a test spot and wait 24 to 48 hours. Do not take internally.

Lavender (Lavandula angustifolia)
The essential oil of lavender is antibacterial, anti-inflammatory and somewhat astringent; it's good to have around the house for general skin irritations and minor burns. To use lavender essential oil, dot it on individual blemishes with a cotton bud as needed.

Burdock (Arctium lappa)
Taken internally, this root promotes sweating and urination. The roots, leaves and seeds of burdock all can be used, but, in commercial preparations, you'll most commonly find the root. Rich in minerals, this plant is used as a food by many cultures.

Typical dosage: up to 4 cups of tea per day (simmer 1 tablespoon of dried root in 450 millitres of water for 15 minutes); or two 400- to 500-milligram capsules three times per day; or 1 to 2 teaspoons of fluid extract three times per day. To use burdock tea as a face wash, make the tea, then cool it and use a clean cloth to apply it to the skin. Rinse with cool water.

Dandelion (Taraxacum officinale)
Like burdock, dandelion root helps the body dispose of unwanted skin bacteria. It also stimulates digestion and supports the liver - the major organ that helps rid the body of toxins and excess hormones, including the androgens that trigger breakouts.

Dandelion leaves are also full of vitamins and minerals, many of which help maintain healthy skin. You can eat the young, fresh leaves raw in salads or steam them. The root, which is usually dried, chopped and roasted, is moderately anti-inflammatory.

Typical dosage: 3 to 4 cups of tea per day (simmer 2 teaspoons of dried chopped root in 4 litre of water for 20 minutes or steep 2 teaspoons of dried leaf in 1/4 litre of hot water for 15 minutes); or two 400- to 500-milligram capsules three times per day; or I to 2 teaspoons of fluid extract three times per day.

Calendula (Calendula officinalis)
This herb is a traditional remedy for many types of skin problems.

Its orange petals are antibacterial and anti-inflammatory, properties that can relieve acne symptoms. To use it, make a tea by steeping 1 teaspoon of dried flowers in 4 litre of hot water for 5-to 10 minutes. Strain, let cool and apply to the face with a cotton ball or clean cloth.

Agnus castus (Vitex agnus-castus)
If your acne seems hormone-related or is among your premenstrual symptoms, agnus castus can help.
Typical dosage: 40 drops liquid extract each morning; or 1 capsule dried extract each morning.
Caution: do not use if you are pregnant.

Oregon Graperoot (Berberis aquifolium) and Goldenseal (Hydrastis canadensis)
Each of these herbs may help acne in two ways. First, each promotes good digestion and liver function, which help the body get rid of toxins. Second, berberine, which both herbs contain, is a potent antibacterial herb. To use as a wash, see 'Antibacterial Wash or Paste'.
Typical dosage: up to six 500- to 600-milligram capsules per day in divided doses; or 10 to 20 drops of tincture three times per day.
Caution: do not use either herb internally if you are pregnant (external use is safe).

Camomile (Matricaria recutita)
Here's a cheery flowering herb containing the anti-inflammatory essential oil azulene, named for its blue colour. To use camomile, make a skin wash by steeping 1 tablespoon dried flowers in 1/4 litre of hot water for 10 minutes. Strain and apply with a cotton ball or clean cloth. You can also dab the essential oil on to blemishes, or look for skin-care products that contain camomile or azulene.

Rose (Rosa spp.)
Heavenly smell, soothing, antiseptic action - what's not to love about roses for natural skin care? Look for rosewater made with real rose essential oil. Put it into a spray bottle, close your eyes and spray on your face as often as you like.

Grapefruit Seed Extract
This potent antimicrobial agent is useful in any condition that involves fighting bacteria. To use, add 5 drops of grapefruit seed extract to 120 millilitres of water and use as a face wash; or add 5 drops to 60 millilitres of witch hazel mixed with 60 millilitres of cider vinegar and use as a toner when you wash your face.

Aloe (Aloe vera)
This soothing, anti-inflammatory, antibacterial gel helps heal wounds of all kinds. Buy only the pure gel and use topically as needed.

Recipies

FACE SMOOTHIES
Fruit acids help get rid of excess amounts of the protein keratin and those dead skin cells that may otherwise clog pores. They act like commercial salicylic acid formulas without the side effects. Put fruits, such as grapes and strawberries or pineapple husks into a blender and purge. Apply the mixture like a mask; leave on for 10 to 15 minutes, and wash off. Alternatively, look for natural face products that contain fruit acids.

ANTIBACTERIAL WASH OR PASTE

These two recipes use the antibacterial properties of two herbs containing berberine.

To make a wash:
2 teaspoons chopped dried Oregon graperoot or goldenseal root 450 millilitres water
Simmer all ingredients for 10 to 15 minutes. Strain and cool; use to wash face or soak a clean cloth and use as a compress.

To make a paste:
1 teaspoon powdered Oregon graperoot or goldenseal root
A few drops of water
5 drops lavender oil
Mix all ingredients. Apply to pimples; let dry. Rinse or gently wash off. NOTE: Oregon graperoot stains fabric.