I was recently interviewed by Delicious Living magazine for an Oriental medical perspective on the causes and treatment of acne. Here’s the article!

Chinese Herbalist

Acne is an external indicator of an internal imbalance that results from what Chinese medicine calls “trapped heat” within the body. The source and appearance of each type of heat varies, with causes including rapid growth during puberty, emotional issues, and nutritional imbalances. Breakouts result from the body’s attempt to expel trapped heat through all available portals, including the skin.

Diet affects the body’s efficiency and how well these heat-removal mechanisms work. Eating processed foods and refined sugar, which generate heat and inflammation during digestion, is like throwing gasoline on fire for acne sufferers. An unprocessed, easily digestible diet low in dairy, wheat, and fried foods will keep the body clean and balanced with efficient heat-removal processes.

Chinese medicine takes the “root and branch” approach to acne treatment, the root being the internal heat source and the branch the external acne symptoms. Herbalists can prescribe custom multiherb formulas that target the source of heat while topical herbal preparations treat external symptoms. Honeysuckle flowers and skullcap are a herbs commonly found in acne formulas, used for their heat-reducing characteristics. The combination of herbs is essential because it allows the user to target certain issues and areas. Lifestyle alterations, including stress-reduction techniques, regular exercise, and the above dietary modifications, can also enhance the healing process.

–Sharon Sherman, LOM, Empirical Point, Philadelphia, philadelphia-acupuncture.com

Dermatologist

Although acne usually starts in adolescence, it is not uncommon for it to extend into adulthood. Teenage acne generally consists of blackheads and whiteheads on the T-zone—the forehead, nose, and chin. Adult acne tends to be more inflamed, with white and pink bumps appearing all over the face.

Acne is often hereditary, but hormonal fluctuations typically trigger flare-ups. This is why acne often begins with puberty and why some women experience breakouts during menstrual cycles, pregnancy, perimenopause, and menopause. Because of differing hormone levels, male acne tends to be more severe while female acne is more often chronic and on lower parts of the face. For those prone to acne, stress can also trigger breakouts.

Acne begins below the surface and is not caused by dirty skin, which is why washing too frequently or vigorously can cause further irritation. Wash two times daily, adding another wash when exercising or perspiring, or if you have oily skin. Resist the urge to pop pimples, which will lead to greater inflammation and possible scarring. Over-the-counter products that contain salicylic acid or benzoyl peroxide are effective for mild skin issues, while topical retinoids such as tretinoin (synthetic version of vitamin A) peel the outer layer of skin, unclog pores, and prevent future breakouts. A dermatologist can evaluate the type of pimples and triggers to identify the best treatment for you.

–Diane Berson, MD, clinical assistant professor at Weill Cornell Medical College of Cornell University, and board member of the American Acne and Rosacea Society,New York

Psychologist

In psychotherapy, the body and mind are looked at as one interdependent unit. Research shows that approximately 30 percent to 60 percent of people who seek out medical care for skin problems have some kind of underlying emotional issue, and these issues can inhibit an otherwise effective medical regimen. I often see adults still struggling with adolescent skin conditions who have unaddressed emotional issues also stemming from their adolescence.

There is a range of acne triggers, including hormones and genetics, but it is often the emotions that we are not tuned into that come out via the skin. I often tell my patients: If you can feel it in your heart, you don’t have to feel it on your skin. “Avalanching”—when a triggering stressor causes breakouts, which cause more stress and so on—also is possible.

For treatment, mental exercises such as relaxation, imaging, meditation, self-hypnosis, and focus psychotherapy (targeting the specific life issues causing the symptoms) can be effective. Imaging, for example, deals with the body’s ability to translate pictures from the mind into literal reality. Focus and concentration on an outcome, in this case clear skin, helps you achieve the goal. As part of a self-treatment program, these exercises can provide valuable diagnostic information and deeper understanding of emotions behind your condition.

–Ted Grossbart, PhD, senior clinical supervisor, Massachusetts School of Professional Psychology, and assistant clinical professor of psychology, Harvard Medical School, Boston, grossbart.com