Stages of Acne

 
acne with acupuncture and chinese medicine
 

All of us have in one form or another have encounter acne.  Let’s break it down by stages

Acne at 12 to 20

Acne usually starts at puberty.  The surging and fluctuation of hormones becomes a bane of any teenager’s life.  Types of acne ranges from a few pimples during, before or after the menstrual cycle to deep cystic, angry acne on the forehead, cheeks, jawline, neck and/or on the back and shoulders.  At this stage of acne, most common prescription from your doctor would be to go on the pill or Roaccutane.  The pill is used as a band-aid solution to hormonal acne, painful periods, endometriosis, polycystic ovarian syndrome (PCOS), severe premenstrual syndromes and etc.  This is also a stressful period for young boys with surging testosterone hormones that can affect their confidence and emotional well-being. As age progresses, the severity of it usually starts declining.  However, some will persist until adulthood. 

Acne at 20-35

Those that were blessed with clear skin throughout their teenage years then suddenly, acne starts popping out in adulthood are due to fluctuation of hormones caused by stress, lifestyle and diet.  Another type of acne that I commonly see in the stage is women with PCOS.  This type of acne are a continuation from puberty where menstrual cycles are irregular that had not been diagnosed until later stage into adulthood.  In addition, women at this stage are thinking of coming off the pill for fertility purposes or a decision to address issues of hormonal changes that affected you in your teens such as hormonal acne, irregular cycles, painful periods, severe premenstrual syndrome, endometriosis and etc. Coming off the pill may cause the hormones to fluctuate as there is no longer a controlled mechanism derived from the pill. The body often revert back to where it was before you started on the pill. As mentioned before, the pill is often a band-aid solution.

Acne at 45+

This stage of acne is commonly seen in women that are peri-menopause.  In addition to typical peri-menopause symptoms such as hot flashes, day/night sweats, irregular cycles, weight gain, insomnia etc, acne and dry skin may be present.  This is caused by increase in luteinising hormones which increases androgen levels.  In addition, stress and poor lifestyle choices may be a contribution to late onset acne.

What is common amongst the stages of acne is the fluctuation of hormones.  This fluctuation can be due to the imbalances of hormones during teenage years, gyneacological problems (PCOS, Endometriosis etc), stress, emotional challenges, lifestyle and diet.  In Chinese medicine, we look at the body holistically in terms of Yin and Yang.  Yin provides softness and cools the body down and Yang provides energy and warmth to the body.  This delicate balance can often be displaced due to factors outlined above.  Can Chinese medicine and acupuncture re-balance this?  Absolutely!

Chinese herbal medicine and acupuncture can reduce and manage the symptoms and the root cause of acne .  In essence, acne from Chinese medicine perspective is caused by Heat or Damp Heat.  The source of Heat or Damp Heat can arise from hormonal imbalances, emotional factors, stress, poor diet of spicy, deep fried, greasy foods, sugar and etc. Organs that affects acne are Lungs, Stomach, Large Intestines, Small Intestines and Conception vessels.  To determine what may cause the breakout of acne, a detailed consultation is carried out.  From my clinical experience, each person presented with acne have different diagnosis and treatment.  Therefore, the treatment is tailored towards your constitution and overall state of your body and health.  To find out how I can help you reduce and manage your flare ups, BOOK ONLINE for a consultation to begin your journey in rectifying the root cause of your acne.

Acne - Western Medicine vs Chinese Medicine

 
acne

Acne is one of the most common form of skin problem faced by many teenagers and sometimes persist into adulthood for some people.  There are countless of commercial and natural products, and prescribed medications and ointments to help counter the growing rate of people facing acne problems.  There are varying degrees of acne presentation - from big angry red and painful pimples presenting all over the face right to the neck, chest and at the back of the skin to mild small pinkish bumps that are presented on the chin, jawline, cheeks or forehead.  Whatever the presentation is, having acne can be frustrating, embarrassing and it can affect your confidence.  I have listed below the different approach and views by Western and Chinese medicine perspective so that you can be informed with which treatment option is best for you.


Western medicine perspective

The most common trigger of acne is due the onset of puberty when the surge of androgen stimulate sebum production and hyperproliferation of keratinocytes.  Other triggers are hormonal changes occurring with pregnancy or menstrual cycle; types of cleansers, lotions and clothing used; and high humidity and sweating. 

Diagnosis of acne is via examination.  Differential diagnosis of acne includes rosacea, corticosteroid-induced acne, perioral dermatitis and acneiform drug eruptions.  The severity of acne is graded as mild, moderate or severe based on number and type of lesions. 

Treatment for acne:

  • Comedones - topical tretinoin
  • Mild inflammatory acne - topical antibiotics and/or benzoyl peroxide
  • Moderate acne - oral antibiotics
  • Severe acne - oral isotretinoin eg. Claravis, Sotret
  • Cystic acne - intralesional triamcinolone

Common side effects of topical ointments prescribed for the skin are:

  • Mild burning, stinging or tingling sensation
  • Mild chapping or slight peeling
  • Mild redness, dryness and itching
  • Mild sensation of warmth or irritation

In addition, doctors are quick to prescribe oral contraceptive pills (OCP) to teenagers to help control/reduce acne.  This seems unnatural as the primary use of the drug is for the prevention of pregnancy.  There is also the question of what long term effects does OCP have on women's fertility and emotional stability.  There are a few interesting studies and articles in the resource section below on the long term effects of OCP on fertility and the emotional impact it has on women.  

Chinese medicine perspective

Acne is caused by an internal imbalance of the body which cause excess Heat and/or Damp that manifest in the face, neck, chest or the back of the skin.

Causes of internal imbalance are often related to:

  • Poor diet of spicy, greasy, damp foods such as junk food, excessive chili consumption, and deep fried food
  • Stressful lifestyle, lack of exercise
  • PMS and other emotional upsets such as anger, irritability and frustration
  • Excessive alcohol consumption

Diagnosis often require:

  • Questioning the function of the body as a whole 
  • Accessing the lesions ie. the severeness of the acne, areas where the lesions are presented ie. chin, jawline, forehead, cheeks, neck or back of the body, and other symptoms such as dry, greasy, itchy skin or painful to touch. 
  • Evaluation of the emotional/state of the mind, lifestyle and diet. 
  • A comprehensive questioning of women's gynaecology and reproductive systems

In Chinese medicine, both the root cause and presentation (acne) are treated at the same time.  There are five differential diagnosis/patterns that can cause acne.  Each pattern are presented differently in terms of lesions and overall internal imbalances.  Therefore, treatments are individualised based on the presenting signs and symptoms. 

Treatments include:

  • Acupuncture and herbal medicine to re-balance internal imbalances
  • External topical ointment, herbal facial wash or herbal masque to tackle acne on the outside
  • Dietary and lifestyle changes to further strengthen the treatment process

There are little to no side effects in treating acne with Chinese medicine.  Some common complaints are the herbal medicine can be a little difficult to digest or the taste can sometimes be off putting.


In conclusion, it is important to be aware of which modality will have the biggest benefit in the long term without harming or upsetting the body's natural system.  Western medicine treatments for acne is often good for a short term purpose however, I question what these drugs do to the body in the long term and the one-size-fits all approach.  Chinese medicine is a natural medicine therefore, progress of treatments does take time.  However, the long term benefits of this individualised treatment which targets both the root cause and the lesions are - 1) the presentation of acne is reduced and 2) future flare ups are minimised and can be prevented.

 

Resources

Balfour, A., 2014.  Why Chinese Herbs Are Great For Treating Acne.

McKoy, K., 2013.  Acne Vulgaris.

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2010.  Acne. 

NPS Medicinewise, 2013.  Oral Antibiotics: An Option In Acne But Consider The Risks

Ryan. M., 2016.  I Stopped Taking The Pill And Changed My Life.

Grigg-Spall, H., 2016.  The Pill Is Linked To Depression - And Doctors Can No Longer Ignore It.

Talukdar, N. et al., 2012.  Effect Of Long-term Combined Oral Contraceptive Pill Use On Endometrial Lining.

Farrow, A. et al., 2002.  Prolonged Used Of Oral Contraception Before Planned Pregnancy Is Associated With A Decreased Risk Of Delayed Conception.