Acne vulgaris. If ever insult were added to injury, it was in naming this scourge of teenage skin: the common or worse still, “vulgar” acne. I am sure that many of you loyal readers will shudder and quickly skip this column in fear of flashbacks to that horrible adolescent or post-pubertal time when the most consistent self-expression we could muster was through the pores of our poor skin. Zit. A word that hisses so fast through our clenched teeth that it is “said and done” almost before we hear it. If only the pustules were so fleeting. Despite being classified as “a self-limiting” disease, acne can persist throughout life. It never gets any easier to bear.


Dermatology textbooks are the most hideous in the profession. Lesions, growths, pustules, papules, follicles, comedones, warts, tumors – these are the characters that repulse even the most brave-hearted students. For those who survive the pictures, the omnipresence of Latin and Greek terminology would terrify and intimidate those of us who never managed to enjoy reading how all Gaul was divided in three parts or who never learned more Greek than what was necessary to be fluent (fluid?) at fraternity parties. Names like “acrokeratosis verruciformis”, “xanthanoma disseminatum multiplex” and “leukoderma acquisitum centrifugum” are designed to make sure patients really feel they got their money’s worth when leaving the doctor’s office. Deciphering these terms is more challenging than the New York Times crossword puzzle. (The last one translates literally as “acquired spreading from the center white skinned lesion”. Big name for something you had already seen for yourself!)


Behind all the fancy names and hideous lesions in dermatology, more so than practically any other specialty, therapeutic principles how sway. Once your doctor has impressed you by accurately naming the type of acne (acne necrotica vs acne vulgaris vs chloracne vs acne rosacea vs acne varioliformis vs cystic acne vs acne conglobata etc), you need to understand the following paradigms.


While acne involves infectious organisms (Corynebacterium acnes (there they go again!), staph and strep, these critters are more symptomatic than causative. They thrive in an environment that welcomes them, doing little to create that environment in the first place. Therefore, you need to treat the cause, not just the acne on the skin. Sure, you need to clean the skin (hence the myriad drying and peeling agents) but that is futile so long as you ignore the cause.


The common cause is poor diet. If you don’t believe me, let’s take a trudge north to the Canadian Eskimos living along the Arctic rim. You won’t be surprised to learn that acne was unknown among the Canadian Eskimos prior to the 1950’s. We know that because the annual census was done by photographs and the record clearly shows clear skins. They, like most “uncivilized” peoples, did not represent a promising market for pharmaceutical or skin care companies. That changed, however in the 1950’s with the placement of radar towers along the Arctic circle. With modern technology came the construction works and with them came the Hudson Bay Trading Company which introduced to the Eskimos the modern diet consisting of the four main foods groups: sugar, white flour (refined carbohydrates), dairy (including milk chocolate) and a motley crew of food additives/preservatives and coloring agents. Consequently, on this “candy diet”, acne sprouted up on previously unblemished faces all over the frozen north. The proof that diet effects skin is as plain as the (zit on the) nose on your face.


“Why?” you ask. The principle to understand here is that what we eat we need to either utilize or excrete. I need not elaborate on the two primary orifices we use to discharge waste products, but the other two are breath and skin. Yes. Anyone who sweats can understand how important the skin is as an organ of excretion. The Chinese were the first to really appreciate this fact. I first witnessed this relationship in my practice when Ms. J’s chronic and disfiguring acne cleared after we fixed her constipation. In her’s and many more cases since then, what wasn’t being excreted via as feces had to find another way out. One way or another, “we excrete what we eat”.


One explanation might be the following. Imagine toxic food (preservatives etc) being swallowed and digested incompletely to the point where they are circulating in the blood seeking entry into cells. No self-respecting cell has time for red dye number 3, yellow dye #7 or, for that matter, the 12 teaspoons of sugar in each 12 once bottle of soda pop. These unnatural toxins circulating in the blood are identified by our vigilant immune system as being “non-self” and are attacked by white blood cells including macrophages (literally “big eaters”) in a valiant effort to complete the digestion of these indigestible toxins. This gemishe of toxin and immune cells tumbles through the blood, unwelcome at all biological functions and, like Charlie on the MTA, they circulate the 30,000 miles of blood vessels inside your body with nowhere to go. Finally they lodge in a tiny capillary near the skin surface and from there they fester, ultimately to be expulsed in a burst of dead white blood cells (pus) and toxin: voila ZIT, the completion of a complex digestive process which could have been avoided had you taken more care of what you put in your mouth.


Common treatments for acne include ultra violet light, cleansing, drying or peeling agents (sulfur, salicylic acid) intralesional corticosteroids, retin-A, antibiotics, X-ray therapy. But why not try some simple dietary modifications first such as avoiding certain toxic or tough to digest (same thing!) foods. The usual problem foods are all dairy, white or refined sugar and all foods you personally can’t digest thoroughly. In addition, it is very important to drink plenty of pure water. However, beware that certain drugs cause acne including: steroids, estrogens, chloride, fluoride etc.


If your acne persists despite dietary modification, consider adding an adequate amount of clean water, zinc, vitamin A and essential fatty acids. If you’re over 40, odds are your acne is caused by drugs or food allergy. Do not despair though. I have one last story to share.


Mrs. E. called me from Arizona practically crying over the phone. It seems she was preparing to go to a 50th high school reunion and had fallen prey to an advertisement for a miracle wrinkle remover ointment which left her resplendent with the first acne she had experienced since that same 50 year period. “Honey.”, I responded. “I beg your pardon!” she retorted, assuming I was being overly personal. “No. Not you”, I answered. “I mean, try raw honey on your acne”. I then explained how honey has a topical antibiotic effect (it’s enzyme “glucose oxidase” converts to hydrogen peroxide at 20 parts per million) as well as being an (extrememly cheap) alpha hydroxy acid cleanser and finally honey is replete with nutrients for replenishing the traumatized skin. The next day, after trying it on half her face (once burned twice shy) she called me ecstatically to inform me the honey had entirely cleared up her acne. A pause then: “Would it be OK to try it on the other half?”. Two days later she was at her reunion garnering praises for her “youthful” skin.


I tell patients that beauty is not only skin deep. It radiates from our depths. So too does the source of what mars beauty, acne, derive from processes deeper than the skin. So, treat you skin well, honey, but don’t neglect the deeper issues and keep your blood clean also.


To your health!


Bradford S. Weeks, M.D © 1994

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