Acne is a normal skin condition that makes us unhappy.

Acne is a very common skin disorder in the USA, affecting about 85% of adolescents. The number of older people suffering from acne is increasing slowly, affecting 8% of 25-34 year-olds and 3% of 35-44 year-olds. Acne may be normal, but this does not make it any less painful, psychologically, for the people that have it.


What is acne?

Acne is a disease of the follicles where the hair is formed and sebum is secreted. Keratinocytes accumulate and “plug” the pore with sebum, resulting in a microcomedo. Continued accumulation of materials will distend the pore, forming an open comedo, a blackhead. The dark color is the result of keratinocytes, oxidized lipids, and melanin.

Inside the comedo there is little oxygen and lots of sebum, an ideal medium for the acne bacterium, Propionibacterium acnes, to grow and multiply. The activity of the bacteria leads in turn to inflammation and irritation.

Cysts can develop when the contents of the sick follicle (keratinocytes, sebum, and bacteria) spills into the surrounding dermis, producing a pustule (superficial) or a deeper papule or nodule.

What can we do?

First, remember that acne can leave scars, keloids, and changes in pigmentation, so it is important to control acne before it leads to permanent changes in the skin. Second, serious acne should be taken seriously. See your M.D. because some genetic problems show themselves as acne. Only tests ordered by your doctor can tell you whether your acne is “normal” (i.e. caused by the hormonal turmoil of adolescence or the menstrual cycle), or whether it is a symptom of polycystic ovarian syndrome or other health problems that cause an excess in the production of male hormones by young women.

Outside of the ads that try to catch desperate people looking for miracles, there is no easy solution (or cure) for acne. There are no miracles to be found in the real world. The good news is that we know enough about acne to control it, and this is a great achievement.

To control acne:

1) Keep pores open by controlling sebum secretion.

2) Normalize keratinization and prevent the exfoliated keratinocytes from sticking together.

3) Decrease inflammation.

4) Kill acne bacteria.

5) For women, stabilize the hormonal balance using oral contraceptives.

My main sources of information regarding new ingredients are:

  1. The ingredient lists for thousands of products in the market. Reading thousands of ingredient lists is boring, but also re-assuring because it shows that we are still the best.
  2. Scientific publications reporting  how chemicals, synthetic or natural, affect processes related to acne.
  3. Our own clients and forum members who write to me suggesting new actives. This is the way that I “discovered” nobiletin.

The skin care industry continues to introduce “new products,” but whatever the name of the new “miracle” products, it always comes back to salicylic acid and/or benzoyl peroxide. Nothing new under the sun. Usually, there is a “stinging” ingredient (menthol or a derivative) added to make you think that “something” is happening. These stinging ingredients can only make things worse, because stinging has no useful connection with the acne lesion but, at high concentration, they can increase inflammation.

If there is a danger in the usual anti-acne products it is that “fast buck” companies don’t care about the long-term health of their clients’ skin. They will use benzoyl peroxide even though, medium-term, this ingredient will aggravate acne by decimating the natural bacterial flora of the skin, age skin by flushing the skin with a strong oxidant that will promote DNA mutations, and more.

This is why you will find the following actives in our Acne Control Kit:

Anti-inflammatory Oleuropein,  wild yam, niacinamide
Normalize keratinization Salicylic acid, salicin, retinyl acetate
Anti-acne bacteria Nobiletin, Coleus, galangal, granulysin
Decrease sebum secretion Nobiletin, zinc, EGCG
Immune response enhancer Yeast beta glucan
Inhibitor of 5alpha-reductase activity Saw palmetto, zinc, gamma linolenic acid (abundant in borage oil), EGCG

Don’t look among them for the miracle active. They work well together but there are no miracles, just biochemistry.