Science inconclusive on acne causes

East London resident Nonkululeko Ngxata was 17 when she had her first acne breakout.

Still in high school and battling major hormonal changes at the time, Ngxata said she put the problem down to puberty.

Though the acne disappeared as she was leaving her adolescence, it made a reappearance in her early 20s, a situation she likened to an “uninvited population of blackheads which one day came to her face to stay”.

Ngxata tried to attack the acne quickly with a selection of over-the-counter hypo-allergenic products, which included a face wash, toner and cream, but the pimples refused to budge.

Deciding on a different tactic all together, Ngxata then tried new facial products, this time relying on a completely different routine.

“I still used a face scrub, a toner and moisturiser, but I decided to try a cleanser too because I thought the oil was not being properly cleaned off my face,” she said.

“I stuck to this routine for about a year, and although the acne problem didn’t get worse, it wasn’t getting any better either.

“This worried me because the products were really expensive, which made the routine that much harder to maintain.

“I started using makeup to cover my skin but also to try and boost my mood.”

Ngxata said as a last attempt before seeking medical help she turned to a range of herbal products, which promised quick results.

Using natural ingredients such as orange oil and juice from certain plants, Ngxata bought a wash, gel and cream.

Six months later, her acne problem was half what it was at the beginning of the year.

“I’m finally seeing a difference. My face is clearing up for the first time in years. I was so worried, thinking I would enter my 30s with this terrible problem.

“If this product hadn’t worked, I had told myself I was going to see a dermatologist.”

The Oxford Dictionary defines acne as a skin condition characterised by red pimples on the skin, especially on the face, due to inflamed or infected sebaceous glands prevalent chiefly among adolescents.

Guidelines in the treatment of acne published by the American Academy of Dermatology earlier this year define acne as a multifactorial inflammatory disease affecting the pilosebaceous follicles of the skin.

According to the study, acne is a common skin disease, especially in adolescents and young adults.

This condition affects about 85% of teenagers but can occur in most age groups and can persist into adulthood.

The prevalence of acne in adult women is about 12%.

“There is no mortality associated with acne but there is often significant physical and psychological morbidity such as permanent scarring, poor self-image, depression and anxiety. The direct cost of the disease is estimated to exceed $3-billion per year,” the study reads.

Beacon Bay-based dermatologist Dr Rupesh Misra said adult acne tends to show a higher prevalence in women than in men.

Misra said that possible causes could include a reaction to certain medications such as steroids, hormones and diet.

“There are many possible causes of adult acne but these are the most common,” he said. “Women tend to be more prone to outbreaks of acne because of hormones.

“Many women get an acne flair a few days before their period and sometimes after the period too.”

Misra said diet can also play a part in an acne outbreak, with a recent study he had come across showing that chocolate and sugary foods can cause high acne production in adults.

“The study also showed that a high water intake does help to limit the production of acne in the body.

“I usually advise my patients to eat less chocolate and to drink plenty of water.”

In agreement was fellow dermatologist Dr Louis Bok, who said a generally unbalanced diet, mixed with large servings of sweets and dairy products, could be contributing factors.

“An unbalanced diet can play a role, but I think it’s a very small role. Nevertheless, I usually advise my patients to eat a balanced diet and to try and limit the amount of sweets and sugar they consume.”

A nutritionist from the University of the North West, Professor Salome Kruger, said there were two studies recently completed, which had opposing views of the role of diet in the control of acne.

According to Kruger, a randomised controlled trial of Australian males demonstrated significant improvement of acne severity after 12 weeks of adherence to a low-glycemic-load diet, compared to the high-glycemic-load diet control group.

A high-glycemic-load diet consists of refined starches, most breads and sugars found in cold drinks, sweets, chocolate, bread, cakes and starchy foods.

A low-glycemic-load diet consists of unrefined starches such as oats, legumes, dairy foods, vegetables, meat and other protein foods.

Another study has documented the opposing view that weekly consumption of cakes, sweets, and chocolate – foods high in glycemic load – was not associated with a higher risk of acne.

“Each of these dietary factors requires further investigation before recommendations may be made to patients,” Kruger said. “The general recommendation is to include low-GI foods, such as legumes, oats, protein-rich foods, particularly oily fish (pilchards, salmon), fruits, vegetables and dairy foods and to restrict foods high in sugar and refined starches.

“Dairy foods are important sources of calcium, which is important for people of all ages, but particularly for adolescents during a period of rapid bone formation.

“The available evidence suggests that drinking skimmed milk will not have benefits over full-cream or 2% milk in terms of improvement of acne.”

Both Bok and Misra said possible treatment includes topical creams, medications and oral contraceptives.

“I prescribe external treatment for the mild cases of acne and these are usually topical creams. For the more serious or severe cases I usually prescribe antibiotics and retinoids. I generally keep patients on treatment for between three to six months and usually by then there is a distinct difference in the acne,” Bok said.

Ngxata said her journey with acne had been a terrible one during which her self esteem took a huge knock.

“Acne as a teenager is terrible but as an adult it’s awful. It’s hard to face people when you have acne because it always seems like people are focused on your face rather than what you’re saying. I completely isolated myself in fear. It killed my self-confidence,” she said, adding that she never managed to figure out the cause.

“It could be my diet or it could be because I was trying so many different face products at once. At some stage I even blamed the makeup and I took a break from using it. But because I never saw a doctor for it I guess I’ll never really know the cause.” — zisandan@dipatch.co.za