Acne

If you think you're alone in your struggle against adult acne, you may be surprised to learn that some 10 percent of Americans between ages 25 and 44 have the same problem. Most are women, though some men get acne, too.

While acne can be embarrassing, it's seldom serious. The majority of cases respond well to self-care. Combining over-the­counter acne treatments with proven alternative remedies may be your ticket to clear, problem-free skin.

Acne begins in hair follicles that are connected to the sebaceous glands. These glands produce oil, or sebum, which helps keep the skin from drying out. Normally, the oil flows out of the hair follicles and travels through the pores to the surface of the skin. Along the way, it picks up dead skin cells that are constantly sloughing off inside the hair follicles.

This process is disrupted during puberty, when the body's level of male sex hormones called androgens surges higher. Androgens enlarge the sebaceous glands, boosts oil production, makes the walls of hair follicles less flexible, and causes shedding skin cells to clump together. Combine these changes with the bacteria that live inside hair follicles, and conditions are ripe for plugs to form. These plugs, called comedones, block pores and lead to acne.

Once a plug forms, it may get pushed to the surface of the skin, where it protrudes slightly. This is what's known as a black­head. The dark color of a blackhead comes not from dirt but rather from skin pigment that gets mixed into the plug as it travels to the surface. Usually, a blackhead does not become a full-fledged pimple.

If a plug doesn't move to the surface of the skin but instead continues to grow inside a hair follicle, it can rupture the follicle wall. Then the oil, dead skin cells, and bacteria that made up the plug spill into the tissue around the follicle, causing a minor infection. In response, infection-fighting white blood cells rush to the scene. Their battle against the invading bacteria produces a pimple.

Pimples take three basic forms: Pustules are the classic whiteheads. Papules are red bumps that remain bumps-they don't turn into whiteheads. Nodules are cysts that form on the surface of the skin. These can cause scarring.

Pimples and blackheads seem to prefer facial skin, which has the most sebaceous glands. But they can also appear on the chest and back, where the skin has quite a few of those oil-producing glands, says Nicholas J. Lowe, M.D., clinical professor of dermatology at the University of California, Los Angeles, School of Medicine.

Some 85 percent of young people between ages 12 and 25 experience acne. Most outgrow the condition over time, as their bodies adjust to the higher levels of androgens. But if your acne has lingered well into adulthood, it doesn't mean that you have even more androgens than everyone else. Rather, you may be extrasensitive to these hormones.

There's also the possibility that some other factor is putting you at risk. In women, the hormonal fluctuations that occur during the menstrual cycle and pregnancy can trigger breakouts. So can taking oral contraceptives or postmenopausal hormone-replacement therapy. Other contributing factors include stress, sunlight, cosmetics, and some medications. Facial irritation can also be a problem-for instance, from holding the phone next to your face all day.

No matter what the cause of acne, the treatment remains pretty much the same. Mainstream medicine offers an array of over­the-counter and prescription medicines that do a good job of clearing skin quickly. But if you want to enhance the effectiveness of whatever medication you're using, or if you've tried a number of medications without success, consider adding a blend of natural and alternative remedies to your skin-care regimen.

Best Choices

Nutrition

Partake of more fiber. Several population studies suggest that eating more fiber and less meat and processed foods can help keep your complexion clear.

There's no guarantee that eating more fiber will improve your complexion. But you have plenty of other health reasons to increase your fiber intake. So start replacing animal-derived and processed foods with plenty of whole grains, legumes, fruits, and vegetables. If this dietary change also helps control acne, so much the better.

Keep an eye on iodine. Large doses of iodine can aggravate acne, according to Joseph PizzornoJr., N.D. We Americans get most of our iodine from iodized salt. Cutting back on salt-laden foods-especially snack foods like potato chips, crackers, and pretzels-may help control breakouts. Other high-iodine foods include beef liver, turkey, asparagus, broccoli, and white onions.

Supplements

Zap breakouts with zinc. About a dozen studies have analyzed zinc supplementation as an acne treatment. Most suggest that zinc has significant benefit. In one study, people who took 135 milligrams of zinc every day for 12 weeks saw 85 percent of their blemishes disappear.

Zinc works by reducing blood levels of the male sex hormone dihydrotestosterone (DH1). DHT is believed to trigger even more breakouts than other androgens. Dr. Pizzorno suggests taking 50 milligrams of zinc a day until your blemishes clear up. But check with your doctor first since zinc dosages over 30 milligrams should only be taken under medical supervision.

Herbal Medicine

Become acne-free with tea tree. When the British explorer James Cook first arrived in Australia in 1777, he found the native aborigines treating skin infections with the crushed leaves of the tea tree. As modern science has discovered, the oil released by crushing tea tree leaves is a powerful antiseptic that can help battle acne.

Tea tree oil is available in most health food stores and some drugstores. Read labels and choose a product that contains 100 percent pure oil, advises Andrew T. Weil, M.D., director of the program in integrative medicine at the University of Arizona College of Medicine in Tucson.

Tea tree oil is intended for topical use only. It should never be ingested. And if it irritates your skin, stop using it.

Home Remedies

Poke prudently. Generally, dermatologists discourage squeezing blackheads and popping whiteheads. These practices have long been suspected of aggravating acne and increasing the likelihood of scarring. "But everyone squeezes their pimples;' says Alan P. Brauer, M.D. "Saying 'don't do it' is ridiculous. Just do it gently. Wash your hands first, and maybe dab the blemish with rubbing alcohol before and after to keep it disinfected."

Wash gently. Excessive scrubbing with harsh cleansers does little to clear up acne. Worse, it may dry, chap, and irritate your skin, leaving your skin more vulnerable to the side effects of topical acne treatments.

Instead, wash your face twice daily with a mild soap such as Ivory, advises Anne Simons, M.D. Choose a bar that doesn't contain moisturizing oils, which can clog your pores. There's no need to spend money on expensive acne soaps. These aren't particularly effective anyway because you wash off the medication as soon as you rinse your skin.

Use minimal makeup. Many cosmetics manufacturers have developed products that they say won't contribute to acne. Even so, women with especially sensitive skin may get blemishes when using certain cosmetics. If you're a woman who's prone to breakouts, your best bet is to wear as little makeup as possible. Read labels and choose products that are water-based rather than oil-based. You may have to experiment with different brands until you find some that don't provoke pimples.

Learn not to lean. Avoid resting your cheek or chin on your hand, which can irritate your skin enough to trigger a breakout. For the same reason, try not to cradle your telephone receiver between your head and shoulder.

Over-The-Counter Drugs

Pick the best product for you. No less than 50 over-the-counter acne treatments are currently on the market. If you were to compare their labels, you'd notice that all of these products have one of four active ingredients: benzoyl peroxide, salicylic acid, sulfur, or sulfur-resorcinol. Benzoyl peroxide works by opening pores and killing the bacteria that contribute to acne. The other three ingredients break down the plugs that lead to blackheads and pimples.

As of now, all four active ingredients have been deemed safe by the Food and Drug Administration (FDA). But reports that benzoyl peroxide might promote tumor growth have prompted the FDA to investigate the chemical compound further.

No one acne treatment works the same for everyone. For this reason, the American Pharmaceutical Association suggests that you try several different products and see which one gives you the best results. Always follow the package directions for proper use. If you develop redness, irritation, or a rash from a particular product, stop using it immediately.

Other Good Choices

Homeopathy

Fight pimples from the inside out. Several different homeopathic medicines have proved effective in clearing up acne, according to homeopath Dana Ullman. He recommends Silicea for whiteheads, Hepar sulfuris for pimples that are painful to touch, Kali muriaticum for pimples that produce thick white pus, and Graphites for pimples that produce yellowish pus. To find out which of these medicines would work best for you, consult a homeopath.

Chinese Medicine

Cool off, dry out. Chinese medicine attributes acne to excess Heat, which contributes to skin inflammation and infection, and excess Dampness, which produces the pus inside pimples. Acne and other skin problems also are closely linked to the Lung and Large Intestine organ networks, according to Efrem Korngold, O.M.D., L.AC.

The typical Chinese recommendation for acne involves cooling Heat, drying Dampness, and supporting the Lung and Large Intestine. Dr. Korngold recommends eating more cooling foods such as raw fruits and vegetables and avoiding heat-generating foods such as spices, meats, and anything fatty or greasy. He also prescribes herbs that cool Heat and dry Dampness. These include sarsaparilla, honeysuckle, forsythia, rhubarb, and sophora. To find out which of these herbs would help you most, consult an oriental medicine doctor.

Target the large intestine. The United Nations World Health Organization endorses acupuncture as a treatment for acne. If you're interested in acupuncture, you need to consult an acupuncturist. But for a self-care alternative, try acupressure. Simply apply steady, penetrating finger pressure to each of the following points for 3 minutes.

• Large Intestine 11, located at the outer end of your elbow crease on the thumb side
• Large Intestine 4, located on the back of your hand where the bones of your thumb and index finger meet

Ayurvedic Medicine

Gravitate toward gugulipid. An extract of the Indian mukul myrrh tree, gugulipid­sometimes called guggul-appears to heal acne. In one study, Indian researchers gave 30 people with moderate to severe acne gugulipid three times a day for 6 weeks. Three-quarters of the study participants got either "good" or "excellent" results from the herb. If you want to try gugulipid for yourself, you'll need to consult an Ayurvedic physician.

Naturopathy

Apply heat to unplug pores. Warm water can help open your pores, allowing oil and dead skin cells to flow out more freely. Dr. Weil suggests applying a comfortably hot compress to the affected skin three or so times a day. Be aware, though, that high humidity can actually aggravate acne in some people. If your blemishes seem to be getting worse instead of better, stop using the compresses.

Medical Measures

For an especially severe or stubborn case of acne, you may need a prescription acne treatment to clear up your skin. Dermatologists may recommend benzoyl peroxide gels or topical retinoids such as tretinoin (Retin-A) and adapalene (Differin). Other prescription drugs include isotretinoin (Accutane), antibiotics, alpha hydroxy acids, azelaic acid (Azelex), and triphasic oral contraceptives.

Red Flags

If you experience a sudden eruption of severe acne, consult a doctor promptly. It may signal a potentially serious medical condition that has affected your body's hormone production.

Also, see your doctor if your blemishes look like welts and the surrounding skin appears red and feels hot to the touch. This form of acne, called cystic acne, requires professional treatment.