Some health challenges are relatively benign. They are a nuisance, an irritation, a “thorn in the side” but they are not life threatening. They can exist for months, years or even for a lifetime without dramatically affecting a person’s life.

Other conditions are disabling. Arthritis can interfere with one’s ability to perform common tasks, especially when the hands are affected. Panic disorder can cause a person to become housebound. Muscular dystrophy can rob one of the ability to walk and function independently.

Still others are life threatening. They can result in death. In the case of a heart attack or stroke death can be immediate. Cancer may result in death in a short period of time, or the course may be protracted. Chronic hepatitis may smolder for decades before a final crisis occurs.

Acne is a condition that is all of the above. In some cases it may be little more than an annoyance. In others it can prevent the sufferer from participating fully in life. At times it can cause so much emotional pain the individual decides to commit suicide rather than face another day.

One fact about acne is undeniable. Unlike many other conditions it is difficult, if not impossible, to hide. The smallest blemish is right out in the open for all to see. This can dramatically affect self-image, the way in which people view themselves. Many sell themselves short and fail to live up to their potential because they do not believe that others will accept them for who they are, rather than what their complexion portrays.

Acne is an extremely common condition, occurring to some degree in 80 % of individuals between 12 and 24 years of age. Although its severity may lessen many people continue to fight acne well into their adult life. Adults are often even more self-conscious than teens about acne lesions. Since the condition is so commonplace during adolescence it is easier to feel accepted or “part of the crowd” than when it occurs in the thirties and beyond.

Acne develops when sebaceous glands, which produce sebum, a mixture of oils and waxes that lubricate the skin, become blocked. Blockage can be due to a build-up of keratin, the fibrous layer of the skin. It can also be due to an excessive production of sebum.

Testosterone, which increases in girls as well as boys during puberty, increases the production of both keratin and sebum, accounting for the prevalence of acne during that phase of life. Sebaceous glands occur in greatest concentration on the face, back, chest and shoulders, the areas of the skin upon which acne is most commonly found.

Acne occurs in two forms. Acne vulgaris, or common acne, presents as blackheads, whiteheads (pimples), or inflammatory lesions. Acne conglobata presents with deep cysts. It is this type of acne that is likely to lead to scarring.

Blackheads form when pores become blocked and sebum is not released properly. Once this occurs bacteria can overgrow and produce whiteheads and inflammation. This is the reason that antibiotics have commonly been prescribed to treat acne. These present both short term and long term risks, however, and should be avoided whenever possible. I see individuals, for example, who have been fighting yeast infections for decades following prolonged courses of antibiotics in their teenage years.

As with most conditions, optimum water intake is desirable. Optimum water stores cause all body secretions to remain thinner than when inadequate water is available. Keratin deposits are less likely to build up in skin that is well hydrated and pores are better able to release sebum if the skin is supple. Sebum will not be dramatically thinned, but even a slight improvement in viscosity may prevent plugging of the pores.

Diet plays a major role in acne management. Refined sugars must be assiduously avoided. Acne is so affected by refined sugar that it has been referred to as “diabetes of the skin.” Intake of refined starches should also be severely restricted. This alone will bring improvement in many cases.

The type of fats available for the manufacture of sebum greatly affects its character. Saturated fats and hydrogenated fats should be avoided to the greatest degree possible. Saturated and hydrogenated fats are solid at room temperature. Most saturated fat comes from animal sources. Hydrogenated fats are usually vegetable oils that have been synthetically modified to give them characteristics of animal fats. For example, most margarines and shortenings contain hydrogenated vegetable oils, fats that are normally liquid at room temperature but have been modified to take on the consistency of butter.

Vegetable and fish oils can provide improvement in sebum quality and diminish the severity of acne. Flax, Evening Primrose, & Borage oils are among the best sources of essential fatty acids. Liquid flax oil from a reputable manufacturer is the most cost effective. The amount to be consumed is one tablespoon per 100 pounds of body weight per day. Capsule forms are available, but 14 capsules must be taken to obtain one tablespoon of oil. Oils derived from the belly fat of fish are also rich in omega 3 fatty acids, the ideal building blocks for sebum of high quality.

A number of individuals find that their acne lesions diminish in number and severity when dairy products are eliminated from the diet. Acne sufferers should eliminate milk for at least 4 to 6 weeks. If no improvement is seen and the condition does not worsen upon reintroduction of dairy products into the diet they may be consumed in limited amounts. Elimination of iodized salt may also bring about improvement over time.

Fiber intake should be increased. Pores are one of the body’s routes for elimination of toxins. If proper bowel function is not maintained, toxins will accumulate resulting in a worsening of skin conditions, including acne. Fiber is necessary to maintain efficient bowel function. The main dietary sources of fiber are legumes (beans and peas), crucifers (broccoli, cauliflower, Brussels sprouts, cabbage), bran (whole grains), fruits and vegetables with skin (apples, pears, peaches, potatoes, etc.), nuts, seeds, and berries.

If the diet does not contain enough fiber to promote elimination twice daily a fiber supplement such as psyllium should be added.

Other foods are also beneficial. Almonds, beets, cashews, and Swiss chard provide oxalic acid, which is known to be helpful in managing acne. Foods that are high in zinc are also helpful. These include soy, whole grains, sunflower seeds, and raw nuts.

Since the scalp can be a rich source of oils it is important to shampoo regularly. This is particularly important if the hair is worn over the face. Greasy hair not only adds more oil to the face and shoulders, it can harbor inflammation-causing bacteria.

Sunbathing is often very helpful in clearing and preventing acne lesions. This should be done judiciously, however. Ten to twenty minutes a day is all that is required. Just as bathing in water for a longer period of time will wrinkle the skin, so prolonged sun exposure can damage the skin.

Facial cleansing is the basis of all acne treatment. I do not recommend the use of soap and water as a cleansing agent. A complete cleansing and conditioning system should be utilized. Quality systems will usually consist of four or five separate steps. The one I use has a colloidal cleanser for removal of oil, dirt and make-up, a lathering cleanser for exfoliation and deep cleansing, a conditioner enriched with vitamins A, C, D and E as well as nourishing oils, and a protective lotion that helps moisten the skin, prevent damage from sun and wind, and facilitate sloughing of dead skin.

If inflammatory acne is present improvement can often be obtained by using a topical disinfectant in conjunction with the facial cleansing and conditioning system. This should be in a gel or liquid form as ointments may aggravate the problem. Greasy creams or cosmetics should also be avoided.

A number of nutrients are needed for skin health. Individuals with acne should be on a high potency, broad-spectrum vitamin mineral supplement to provide their basic needs. Additional vitamin A is essential to acne improvement. Prescription acne drugs such as Retin-A and Accutane are actually based upon vitamin A. I recommend that 25,000 IU of vitamin A be taken twice daily until improvement is noted. This level is quite safe for periods up to three months. Once improvement is noted the amount may be decreased to 25,000 IU daily. Beta-carotene, which the body is capable of converting to vitamin A, may be capable of maintaining improvement, but it is generally not sufficient in the initial stages.

Vitamin A should not be taken in these amounts during pregnancy or if using vitamin A based drugs such as those mentioned above. The upper limit of vitamin A during pregnancy is 10,000 IU daily. There is no such limitation on beta-carotene during pregnancy.

Two minerals are particularly important in acne. The first is zinc. Many studies have shown improvement when zinc supplementation is provided. This is probably because zinc is important to fatty acid utilization. Do not exceed 60 mg. from all sources. Chromium, an insulin cofactor is also very beneficial. Up to 200 micrograms may be taken with each meal.

Milk thistle, an herb that supports liver function and helps reduce toxicity in the body can bring about additional improvement as can capsicum (cayenne). Each is taken twice daily. In recalcitrant cases a complete herbal cleanse may be helpful.

Finally, systemic enzymes can be particularly helpful in cases of inflammatory and cystic acne. Typically two or three capsules are taken twice daily, but as many as four or five capsules three times daily may be required to initiate improvement.

Instituting these measures can be extremely gratifying. Just as the problem is clearly visible, so is the solution. As changes are instituted the results are clearly visible. One step builds upon another until there is no longer a need to hide.