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A year ago, I didn't know what I know now, but I wish that I had. Certainly six, let alone 3 months ago, I didn't know, nor cared how topicals or certain medications worked. I was just glad that they did. Yet, the more I learned, the more connections I found, and the more questions I needed to have answered. As a result, I realized that [b]not only is it important to know the Why's & How's of acne, but also the mechanisms of successful treatment methods[/b]. Since we don't have the FINAL answer in regards to acne, we can learn to work our way backward (treatment to cause) by studying what helps us control, prevent or eliminate our breakouts. So, would everyone agree with me that most definitions of ACNE state that it's a condition of having clogged pores or follicles caused by a combination of the factors below?

[b]Bacteria[/b] ([i]P. Acnes [/i]or some other)

Excess [b]Sebum[/b] (protective barrier & carrier of dirt, protien, blood cells, bacteria, androgens)

[b]Skin cell proliferation[/b] (overgrowth of skin cells)

[b]Hyperkertinization[/b] (build up of skin cells)

Poor [b]Desquamation[/b] (skin cell shedding, exfoilation)

[b]Inflammation[/b] (immune response, irritation)

[b]Hormones[/b] (specifically DHT converted in the sebaceous follicles)


Now, if I left something out please let me know. Otherwise, this would explain why there are a variety of acne treatments on the market. [b]They aim to stop one or more aspects of the above problem either topically or internally[/b]. As such, that is why different methods work better for certain people than for others. In truth, it really does [b]depend[/b] on what [b]your own genetic factors [/b]are when it comes to treating your acne problem.

Now if you read various research articles, other's postings, or saw my post Accutane-Diet post [url="http://www.healthboards.com/ubb/Forum1/HTML/018163.html"]http://www.healthboards.com/ubb/Forum1/HTML/018163.html[/url] then you already know that [b]acne is always hormonal[/b]. Whether you are exhibiting an allergic response, have dry skin, or extreme hormonal imbalance, there are still hormones, enzymes, vitamins (cofactors), etc that are responsible for the proper maintainence and health of your skin. If these are disturbed in some way, then a variety of skin problems will result, such as rosacea, eczema, psoriasis, keratosis pilaris, dandruff, pseudofolliculitis (ingrown hairs) etc. So, how many of you have [b]more[/b] than ONE type of skin problem (includes hair, nails, and hyperpigmentation)? I certainly do...

This made me realize that while a lot of you feel that sebum is the problem, when you think about those that have the above skin disorders, someone with acne that has DRY skin ,or someone that's [b]extremely[/b] oily with no acne, sebum can't possibly be the MAIN culprit, but it can contribute. When you consider that everyone has P.Acnes bacteria on the skin, that particular form of bacteria can't be the culprit either, but it may also contribute. Yet, I absoultely believe that either through their own existence or our bodies trying to attack them, that there are various forms of bacteria that will indeed cause, at the very least, an inflammatory response. Infact, [b]most acne sufferrers are just OVERLY sensitive to the androgens or bacteria they produce[/b] and as such, that would explain why most of you do not have a hormonal imbalance, but STILL have acne.

Therefore, that only leaves[b] Hyperkeritinization / reduced Desquamation [/b]and [b]Skin Cell Proliferation[/b] as the "cause". Why? Well, because of all [b]the dead skin building up due to poor exfoilation was the reason you got the inflammed, clogged oil & bacteria filled pores[/b] in the first place. Indeed, these problems right here are the reason why [b]The Regimen [/b]and the "[b]Acne Cure"[/b] have worked so well for many of us. So as you can see, there's not always a need to use expensive prescriptions. Yet, if you've done enough research on your favorite acne medications or other treatments, you should have found that the more POPULAR and MOST EFFECTIVE do a [b]combination[/b] or ALL of the following:

[b]Prevent DHT conversion[/b]--which enoucrages desquamtion, prevents hyperkeritinization, skin cell proliferation, EXCESS sebum production, and inflammation.

[b]Decrease or absorb sebum [/b]---which could prevent hyperkeritinization and inflammation

[b]Exfoliate[/b] --- prevents hyperkeritinization, encourages desqaumation, dissovles sebum oil, reduces inflammation

[b]Kill bacteria[/b]--- which prevents inflammation

[b]Reduce or prevent Inflammation[/b]

Great, so [b]Antibacterial agents [/b](antibiotics, anti-inflammatories, benzoyl peroxide, tea tree oil) reduce inflammation and [b]Exfoilants[/b] (Acids, AHA, BHA, sulfur) encourage healthy skin cell turnover, yet that doesn't help us get to the DEEPER source of our problems. If using the above allows you to control your acne problem then you can stop reading now. Yet, if your acne [b]keeps coming back[/b] and you breakout WORSE during certain seasons of the year, then you may want to keep reading.

[b]If you want to go for the ULTIMATE acne treatment, you want to pick the one that is going to prevent DHT in the follicles[/b]. Now in case some of you aren't familar, DHT stands for [b]5-alpha-dihydrotestosterone[/b]. This is the [b]most produced [/b]and [b]most potent[/b] form of male hormone in our bodies and the cause of several hormonal disorders such as, acne, hirsuitism, hair loss, and prostate problems. With the exception of removing your reproductive organs and adrenal glands [b]there is NO way you can ELIMINATE all DHT[/b]! So please don't even start to obsess over it ;-) However, there are plenty of ways, hence the arguing and confusion, we can reduce and even "normalize" the levels in our system.

So the goal here is to [b]inhibit the conversion of DHT[/b] in our system. As far I as know, there are around 5 - 6 enzymes that are responsible for the conversion of testosterone into this form of "super" testosterone. Usually a drug hits 1 or 2 of these enzymes, like 5-alpha reductase. Since DHT can effect hair follicles, sebum glands, and other tissues in the body, some drugs work better than others based on Gender, Genetic Factors, and your Target Area. Of course, diet, exercise, and/or supplements can do the [b]same[/b] thing and can be equally confusing. ;-)

One of these versatile DHT inhibitor drugs is [b]Spironolactone[/b]. I'm sure you've heard women talk about it, but since we use it internally men usually don't get the opportunity to reap the rewards. This drug can and [b]HAS [/b]been used by both men and women since it's actually a diuretic, used in the the treatment of heart disease, high blood pressure, and has been used to treat hormonal acne for over 20 years. Now, believe it or not, it has been utilized in a TOPICAL form (5% cream or 2% solution) for just as long.

Unfortunately. while the results seemed rather favorable, you can only purchase this on hairloss websites or make your own solution. Since this drug is suppose to be safe and effective for males (and females), even with body acne, I am perplexed as to why it's not very popular. It's effectiveness was proven for many years with 95% success (30% remission and 65% improved) and here's what was found: [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2972662&dopt=Abstract"]www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=29 72662&dopt=Abstract[/url] [url="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2150020&dopt=Abstract"]www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=21 50020&dopt=Abstract[/url]

So like I mentioned above, there is more than one choice when it comes to DHT inhibitors. Since they don't inhibit all the possible enzymes that are used to convert DHT, that's probably why the most severe or sensitive of acne sufferers require a combination or the most "drastic" (i.e. accutane, diet) of methods to achieve clear skin. Below is a list of mainly DIRECT Anti-Androgens and I'm sure you'll recognize a few. ;-)


[b]TOPICAL:[/b]
Finasteride (Proscar, Propecia)
Aldactone (Spironolactone)
Flutamide (Eulexin)
Cypertone Acetate (Cyprostat)
Azelex (Azeliac Acid)
[i]Retiniods[/i]-
RetinA (Tretinoin...13-cis retinoic acid)
Tazorac (Tazoratene)
Differin (Adapalene, retinoid mimicker)
Vitamin A (Retinol)

[b]ORAL[/b]
Finasteride (Proscar, Propecia)
Aldactone (Spironolactone)
Avodart (Dutasteride)
Flutamide (Eulexin, Drogenil)
Diane 35 - (contains cyproterone acetate)
Accutane (Isotretinoin...13-cis retinoic acid)


[b]NATURAL ALTERNATIVES[/b] (topical and/or oral):
Controlled Diet
Zinc (must be used with B6)
Saw Palmetto
Nettle
Beta SitoSterol
Vitamin A (requires other vitamins and minerals)
EFAs Blend (Essential Fatty Acids - Fish Oils, Omega 3-6-9)
EMU Oil


To tell the truth, there are actually more of them than these above. These are what somewhat directly do this, but if you were to take other supplements or medications, you would be able to indirectly effect your level of DHT. That's why you hear some of us raving about taking [b]B5[/b], ALA (alpha lipoic acid), [b]Digestive Enzymes[/b], Thyroid meds, Avandia, Prednisone, [b]Birth Control pills[/b], etc. There's definately more than one way to treat hormonal imbalance. The trick is knowing what the imbalance is inside of YOU and then proceeding to treat it properly.

Please remember, unless you [b]grow out of acne[/b], you will [b]ALWAYS [/b]have to follow your successful treatment method. Some of these Anti-androgens are more effective than others and depending on your own "blue print", you may need something that is the strongest, the WEAKEST, or a combination of the two, to solve your problems. Some of these are completely safe and "easier" to follow than others. Others produce painful, irritating, or harmful side effects. While others may throw our other vitamins & nutrients out of psync. Fortunately, some of these can be remedied by taking a good multivitamin, fiber supplement, or detoxing to correct any imbalances, but what about the others?

Since they ALL do the same thing, it really is up to you, [b]but don't think that a Pill is MORE powerful than some dietary change, because for some of us it was the other way around.[/b] ;-) Through my own ordeals, I've learned that there is a treatment or combination that is the BEST one for you and your body will let you know if you made the right choice. So think about what your skin concerns are and then choose a product or method that is going to help you eliminate this problem. If it's not [b]right[/b], you'll keep breaking out, so keep testing various methods until you find the one (or combination) that helps you the most, better yet, gets you completely clear. =)

Good luck


[This message has been edited by SweetJade1 (edited 09-02-2003).]

[This message has been edited by SweetJade1 (edited 09-23-2003).]
Hey,
Here's some more information for those interested in finding out ways to get those much needed answers. Obviously, [b]we don't all respond the same [/b]to our hormones. Some people's bodies do other things in response to the hormones that give us acne. Some people actually have NORMAL hormonal levels, but their receptors are [b]extra sensitive [/b]to certain hormones. Whereas, some of us have [b]HIGHER[/b] than normal hormones and/or extra sensitive receptors and our bodies respond accordingly. Perhaps that is why certain diets work better for certain cases. Indeed, that could be why people have gone on diets like a [b]Low Fat diet (fat stores hormones and certain ones increase insulin resistance)[/b] or a [b]Low Carb - No Grain diet (increases insulin sensitivity)[/b] and found that their acne improved, if not cleared 100%! While others discovered that all they needed were some enzymes or liver cleanses and things were perfect for them. =)

I believe that acne can be due to a combination of [b]Environmental[/b](dioxin & other pesticides, toxins, dirty telephones, etc), [b]External[/b] (bad skincare, haircare, etc), and/or [b]Internal[/b] factors. For me personally, my formula was Environmental-5%, External-15%, and Internal-80%. Since this is already so long, I'll just go over one way you could go about discovering if yours is mainly internal:

1. If your problems persist, your BEST bet is to go to a doctor.
a. Think about what your symptoms are. Think about any other problems that you have (vision, dental, stomach, energy, wieght, headaches, muscular, etc), for sometimes these symptoms may be related to a specific disorder. Also look back on your famiy's history and see if they can recall any problems or specifc disorders. Do they have anything similar to what you have?

b. If you have some idea as to what the problem is than seeing a specialist, such as an Endocrinologist, Gastroenterologist, Allergist, or Naturopath would be to your advantage.


2. You need to find out if you have an allergy, intolerance, a hormonal imbalance, or some nutrient defiency by having the appropriate tests run. Sometimes the tiniest thing really can make [b]that[/b] much of a difference.

3. Based on those results you'll be prescribed maybe Accutane, Birth Control, an Anti-Androgen, or some other specific drug. Or maybe you'll be advised to take a certain vitamin or to change your diet.

4. There's usually more than one way to treat a problem, so if the above fails, you should try a different doctor, formulation or technique.
a. Many vitamins and supplements "cure" acne, but which ones are right one for you?

b. The same should be asked of herbs. These have medicinal properties and as such, you should pick an herb that will do what you need it to do, based on your [u]specific[/u] internal problem. In other words, find an herb that has the same suggested use as the prescription drug your doctor put you on and see if it will help or if you can replace the drug with it. For example, Spironolactone's equivalent would be Saw Palmetto or BetaSitosterol.

c. Diet (headache anyone?) There are between 30 - 50 special diets out there and if we included our own unique diets, the list would be even longer. NOT all of these are designed to cure acne, but SOME of them have proven to be far more successful than [b]anything[/b] else! Once again this is very much so depends on how [b]YOUR[/b] body works, what it needs, and what your specific internal problem is. The most successful diets that I'm aware of are:

[b]Non-Processed/Refined Diet[/b]-- General Health, Insulin-Hormonal Imbalance

[b]Organic/Whole Foods Diet[/b]--General Health, Allergies, Intolerances, Toxin/Chemical/Hormone Sensitivities

[b]Vegetarian/Vegan Diet[/b]--General Health, Intolerances, Toxin/Chemical/Hormone Sensitivities

[b]Low Fat Diet[/b]- General Health, Toxin/Chemical/Hormone Sensitivities

[b]Low Carbohydrate/Sugar Diet[/b]--General Health, Allergies, Intolerance, Autoimmune Disease, Insulin-Hormonal imbalance

[b]Mucous Free Diet[/b]-- Intolerance, Autoimmune Disease, Insulin-Hormonal imbalance

[b]Gluten-Free Diet[/b]--Allergies, Intolerance, Autoimmune Disease, Neurological problems, Insulin-Hormonal imbalance

[b]No Grain Diet[/b]-- Allergies, Intolerance, Autoimmune Disease, Neurological problems, Insulin-Hormonal imbalance

[b]Paleolithic Diet[/b]--General Health, Allergies, Intolerance, Autoimmune Disease, Insulin-Hormonal imbalance, Neurological Problems, Toxin/Chemical/Hormone Sensitivities

[b]"Evil" Lectin Free Diet[/b]--Intolerance, Autoimmune Disease, Neurological problems, Insulin-Hormonal imbalance

[b]Elimination Diet[/b]--(Ex: Wheat, Diary, Iodine, Spicy Foods, MSG, Pork, etc) Allergies, Intolerance, Autoimmune Disease, Toxin/Chemical/Hormone Sensitivities

These are just generalized catagories, but there are PLENTY of books or websites, that use the above in some sort of dietary program, such as the Specific Carbohydrate Diet (SCD). You just have to figure out [b]which[/b] applies to you and what program fits your lifestyle and is the [b]MOST effective[/b] for [b]you[/b]. Yes, sometimes that does requres a bit of "trial and error", so just because one diet didn't work for you, it doesn't mean that NONE of them will.

5. Are there any specific foods or drinks you find that you consume the most?
6. Are you drinking enough water to flush toxins, hydrate, increase energy?
7. Are you getting enough sleep to decrease stress, balance hormones, improve healing?
8. Are you exercising to improve circulation, decrease stress, regulate hormones, etc?

9. Have you tried other alternative methods such as
a. Therapy--Counseling, EFT, Hypnotherapy
b. Detoxing--Colon Cleanses, Fasting, Parasite Cleanses, etc
c. Eastern Medicine-- Accupuncture, Ayurveda, etc

I personally didn't really go through the method like that, but it resembles what I learned and experimented with during the past 10 years. Personally, so far Soda, Cherries, and Gluten Grains (or all grains) break me out.

Good luck





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