She turned to me and said, "We don't have these kinds of cases anymore." I was surprised at this remark. Only days before, a young, 13 year old boy was brought to me in St. Petersburg by a frantic mother. Both the mother and the dermatologist who accompanied the boy were desperate – he looked like the Elephant Man as a child! Huge, baggy pustules hung from his little cheeks like over ripened fruit. Among those terrible appendages were even more infected pimples; his chest and back were a mass of recent scarring and multiple pustules. It seems that acne has reared its ugly head into the world again. Unfortunately, many popular, acne-fighting drugs are now under international scrutiny due to side effects that include depression, self-esteem issues, and even teenage suicide. Consequently, my United Kingdom medical team was recently involved in a special British Broadcasting Company (BBC) documentary entitled Dying for Clear Skin. The documentary depicted a young boy who killed himself after becoming hooked on a popular acne drug. The documentary also featured another British teenager that we managed to save and now, at age 15, he blogs on the Internet in an effort to try and help other teenagers in the same terrible situation. 
My interest in acne started with my own struggles in the 1950s after everything dermatologists tried on me failed. This is why a fundamental understanding of acne itself is necessary before any kind of treatment can be considered. A drug-free regimen with proper treatment can control nearly any acne condition if it is approached both topically and psychologically. Since acne is hormonally induced, stress factors create more pressure on the hormonal cascade fluxes. This is where psychology plays an important role towards a successful cure or controlled remission.
The word acne comes from the Greek Word akne meaning point. It is a chronic inflammatory disorder of the pilosebaceous gland and is characterized by the comedo (primary lesion) macules, papules, pustules, cystic scars, and/or cuneiform scars. Physiology studies show that, prior to adolescence, the adrenal glands produce dehydroepiandrosterone sulfate (DHEAS). During puberty, other androgens such as testosterone and dihydrotestosterone (DHT) are produced. All of these androgens stimulate the sebaceous gland to secrete more and more sebum. Attempting to dry this excess sebum out, whether by topical treatments or drugs, only exacerbates the glands to pump more sebum in addition to other contraindications.
During puberty, the corneum has a very fast renewal system and new cells pile up on the surface of the epidermis faster than old cells that are naturally exfoliated. This creates a dam-like barrier against the increased oils and, like water behind a dam, the oil flow seeks a way out, usually by congesting in one of the sebaceous glands or hair follicles. This is perceived by the skin's defense mechanisms as a foreign material and, as a result, new cells are created, forming an encapsulation around the sebum which forms a pustule or even a cyst.
A young person usually tries to get rid of unsightly pimples on their face by squeezing them. At this point, P. acnes bacteria enter the picture and full blown acne can spread like wildfire. The primary cause of acne is due to a hormonal imbalance and/or stress. Other factors that may contribute to acne include medications, hot and humid climates, and/or irritating cosmetics.
As a child, my mother would tell me not to eat greasy foods, chocolate and other sweets because it caused acne. The medical field laughed this off in disbelief, but research has since proved this as valid. High-glycemic diets, with a higher carbohydrate and sugar contribution, give rise to increased plasma levels of another substance known as the free insulin-like growth factor (IGF-1). IGF-1 is believed to promote acne in a similar way to insulin, creating follicular obstruction through inducing androgen mediated sebum production. Hyperkeratosis, a thickening of the outer epidermis, blocks the excessive sebum flow to the surface. The encapsulation of new cells around a follicle root overfilled with sebum is known as epidermal hyperplasia (creating cysts) and studies of post-adololescent women ages 20 to 25 found higher levels of IGF-1 in those who suffered from acne.
Acne can also be exacerbated from blood sugar problems and chronic inflammation. We see this more often in on-set adult acne conditions. Glycolic problems trigger hormonal reactions that lead to increased sebum production, blocked pores, and bacterial overgrowth in the stomach as well as in the skin. Consuming a lot of breads, cakes, pastas, et cetera (made from wheat) can also contribute to acne. Gluten may cause damage to the small intestine which could lead to nutritional deficiencies and an increased toxic body load (through leaky gut syndrome).
People with gluten sensitivity cannot digest gluten effectively and, as a result, they absorb protein molecules that have not been digested completely. The immune system treats these molecules as invaders and, as it attacks these invaders, the white blood cells release histamine which increases inflammation and insulin resistance in the nearby cell structures. Insulin resistance may lead to blood sugar problems which are directly linked to acne.
It is very difficult to get younger people to change their eating habits, even when faced with acne. In fact, chocolate is often consumed because of the chemicals in the cocoa bean which set off endorphins in the brain, resulting in a feel good sensation. This takes away depression and loneliness for short periods of time. Young people who are depressed generally do not socialize a great deal and will sit at home on the computer or watching television, eating quick-fix snack foods like chips, cakes, cookies, candy and sugary soft drinks. In order to remove these things from your acne client's diet, you must substitute a protein rich, vegetable diet with a daily portion of fruit, preferably blueberries, strawberries and papaya which are rich in enzymes and antioxidants.
There are diet plans and food grading charts for acne clients but these are basic rules for any acne client. The secret is to put them on a time limit. Any young person suffering the mental and physical agonies of acne will agree to a regimen as long as there is a time limit set for results. Many people have taken an antibiotic at some point in their life and are accustomed to a course of dosage, whether it is 10 days or one month. The same principle applies here: if you put an acne client on a topical treatment/home prescriptive regimen along with a food plan for a specific time period, they will see a small improvement in the very beginning. This will give them hope that the skin care regimen will work, helping them to stay on track with your plan. The main culprit of acne is stress. When a person feels stressed, their body releases the hormone cortisol that, once activated, increases sebum production. High levels of cortisol can inhibit collagen production mainly by overriding the enzyme collagenase which determines the amount of collagen proliferation. This can also create insulin resistance in the epidermis.
Psychological stress promotes oxidative stress and inflammation, leading to more pimples and pustules. At this point, the sebaceous glands are full of waxy material and dead cells. This is why it is essential that your client understands there will be a time frame they must recognize before their acne is diminished or 100 percent clear. If your client is using the correct topical treatment and they begin to see results right away, the stress levels coming through their hypothalamus gland down through the hormonal cascade will lessen and chemical homeostasis in the body will begin to take place. Your client will have an internal healing as well as a topical healing, creating results 80 percent faster!

What About Supplements?
There are all kinds of vitamins, herbs and supplements on the market that claim to be cures for acne. Indeed, some combinations are very effective as well as some detoxification systems and body cleansers. However, there are three common supplements that are vital for all acne clients, not only for acne, but for aging skin as well. First and foremost, there are vitamins A and E. Studies have shown that newly diagnosed acne clients have lower levels of these vitamins circulating in their blood streams than those who are acne-free. Vitamin E, a fat-soluble vitamin, actually protects vitamin A and essential fatty acids from oxidation in the body cells while also preventing the breakdown of skin tissue. Carotenoids (vitamin and carotenes) are also beneficial when a variety of them are consumed together. The most important supplement for a client suffering from acne is sea buckthorn oil, loaded with beta-sitosterol which inhibits the enzyme 5-alpha-reductase, thereby blocking the transformation of testosterone into DHT. The ingestion of sea buckthorn oil capsules twice a day can lower testosterone overproduction which is common to acne prone male and females. Sea buckthorn oil is also known for its anti-inflammatory powers. Farmed in many places around the world, this oil is at its most powerful in its purest form.

Topical Treatments and Home Use Recommendations
Cleansing the skin is the most important step toward treating acneic conditions. Soap is not recommended because the alkaline salts used to solidify the oils and surfactants in a bar of soap also solidify the sebum oil in the skin, leading to congestion. Liquid soaps with strong ingredients that strip oil from the skin increase excessive sebum flow by law of compensation. The sebaceous oil gland pumps even more oil to replace sebum that has been stripped away. Benzyl peroxide cleansers may be recommended for short-term use but tend to dry out the skin after a while, encouraging more sebum flow. A good acne cleanser should be sulfate- and paraben-free with a small amount of salicylic acid as a mild, decongesting exfoliate and cleansing agent. Adding panthenol (vitamin B) to a formula that contains antimicrobial properties is crucial to the control of bacterial growth. Panthenol also rebalances sebum production through the increase of coenzyme A which is involved in the metabolism and breaking down of excess sebum.
Aloe vera is well known for its reduction of erythema and inflammation. However, one of the most important ingredients used in many acne products is the present formulation of BIOCENCE™, developed by Alan Lord. I became familiar with the ingredient while researching alternative preservatives to replace controversial parabens. The components of BIOCENCE include four natural, common ingredients – tea tree extract, castor seed oil, thyme and rosemary, all known for their natural, antibacterial and healing properties. It kills nearly everything on contact, depending upon what percentage is used in any formulation. I have had independent laboratories use it on every type of bacteria known, from gram positive to gram negative, and have even put it with viruses of all types, including E-coli.
My experiments for acne products included a cleanser and a spray mist. Acne skin desperately needs protection against transepidermal water loss (TEWL) to keep moisture in skin where sebum is being minimized and to keep the fire of inflammation controlled. It made sense to include a high percentage of this ingredient in a water spray mist along with a small amount of salicylic acid. To seal in the water, a transdermal cream formula would be needed as well. Keep in mind that, in areas of broken pustules or cysts (or areas where cuneiform scars may be developing), extra collagen production is needed to rebuild weak tissue to the point where scarring does not happen. Adding ascorbic acid to the formula helps instigate new collagen fibers through the fibroblast cells; krameria trianda root extract helps control the stress hormone associated with acne and is rich in natural lycopene (known as a super-antioxidant); and a zinc/magnesium ascorbyl phosphate combination that not only controls excess sebum but helps rebuild compromised tissue. I would formulate the cream base with safflower oil that is loaded with essential fatty acids and vitamin A, fractionated to occlude the water molecule into the skin and combine it with dimethicone, an unmodified silicone that does not block pores but helps maintain a protective water barrier.
Next, I would add allatoin and beta glucan, known for their calming and soothing properties. Additionally, they get rid of topical infections by stimulating the Langerhans cells to reach out those long-armed dendrites and macrophages and destroy any invasion of free radicals and bacteria that attack acneic skin. The Langerhans cell is our skin's immune defense system and the polysaccharides beta glucan enhance Langerhans cell strength to an unbelievable level. I have seen first, second and third degree burns actually start to heal over in less than 24 hours with a liberal application of a gel with beta glucan as the prime ingredient.
Last but not least, teenagers need a secret weapon to control their unexpected breakouts – rather than having to squeeze them, spreading the infection to other parts of the face and/or body. This can be accomplished with a simple, non-petrolatum salve that contains powerful reubecients such as cassia, clove and capsicum cayenne pepper. Cassia and clove create pseudo heat when applied to a swollen pustule. This immediately stimulates the capillaries, causing the skin to heat up. The hardened sebum in the pustules starts to liquefy and the increased blood circulation carries off the toxins. Capsicum is also high in enzymes which are utilized by the endocrine system, releasing hormones into the blood stream which, in turn, regulates functions like metabolism and mood.
Once a day, the client would simply cleanse their skin, pat it dry, and apply a small dot of the salve onto the top of the pustules. Usually within 24 hours, the pustules simply flush out and become flattened or dry up and drop off the skin without any pinching or extracting.
For 40 years, I have dealt with every sort of acne condition known to man. As a result, I believe that having the most effective protocol for treating acne, such as professional skin revision treatments, a full home prescriptive regimen, or taking various supplements, will prove beneficial for clearing your client's acne.

Danné Montague-King is a worldwide leader in the field of skin rejuvenation. He was one of the first biochemists to recognize the power of enzymes to hydrate and tighten the skin and the benefit of vitamin C therapy for collagen in human skin. Montague-King is a tireless educator who annually travels throughout the world conducting lectures and training for professionals and consumers. As a journalist, he is a regular contributor to many of the world's most important professional journals including Australian Beauty, Beauty New Zealand, DERMASCOPE Magazine, Health & Beauty, Irish Beauty, Les Nouvelles Esthetique, Professional Beauty, and Shjkonnet og Helse.