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ACNE Q & A: Walt's replies to my questions -- a MUST read for acne sufferers!

Posted by KMD on August 31, 2000 at 15:03:54:

Q1) Besides puberty, are women much more likely to suffer chronic adult acne than men? If so, do you know any approximate figures?

A1) Yes and No, in that order. The reason is that women have a lot more responsive hormone system than men and the stress hormones are the reason.

Q2) Women's acne fluctuates with their menstrual cycles, with pregnancy, and with birth control pills. With menopause, it tends to clear up (right?)


Q2 cont) I can't think of similar chronic hormonal triggers that men would experience. What would be some hormonal aggravations for men with chronic adult acne besides that caused by hypothalamic stress overload, which affects both sexes)?

A2 cont) Sexual Dysfunction (SD), obesity, hypertension and the like;

Q3) You speak of acne being caused by "glandular stress." Which specific glands and "stress hormones" are we speaking of? (Endocrine glands... but can you expand on my understanding?)

A3) ALL of the endocrine glands functions are profoundly altered by chronic stress (See MAH, MAS and Hans Selye's works). The sebaceous glands are directly tied to sexual maturation and do not even exist prior to puberty--which is why children do not have body odor.

Q4) You said, "those who have acne beyond puberty have a non-physiological hormone imbalance..." Can you explain what you mean by "non-physiological"?

A4) Physiological is considered "healthy" and non-physiological is considered pathological. The reason I do not call it a disease is because it is just a different level of functioning which can be reverted to "physiological" through wellness.

Q5) Is it true that large pores can also be corrected with SR and wellness? How does THAT work?

A5) Large pores are a function of sexual hormones and their expression. Have you ever seen a child (prior to puberty) with "large pores"? Some of this is genetic so, although the pores can be made less obvious, they will always likely be larger than the average.

Q6) When you speak of the wellness stool, you say "It is the combination of these things that alters the endocrinological causes of acne." But you also state several times that SR is the most important of the three. Can one effectively eliminate acne permanently using ONLY SR?

A6) Yes, IF it has not been around too long (as in an adult 30 years old with acne). It just takes longer and pubertal children are not known for their patience! Even in the 30 year old, SR might be enough to reverse it all by itself. It is just that I tend to only recommend things that work in close to 100% of the cases.

Q7) In what cases would YOU recommend a person (who understands the causes and is practicing SR) take a course of antibiotics for acne? And how long of a course is reasonable?

A7) I would never recommend taking the antibiotics unless the acne had become infected and, even then, I would try hot compresses for a day or 2 first. How long to take the antiboitics would depend upon how long it took to eliminate the secondary infection. If the hot compresses had been continued it would not take more than a very few days of antibiotics to reverse the infection.

Q8) You wrote to RHJ in the archives when he was developing pimples on his nose at age 50 that could be rosacea: "Squeezing lesions on and near the nose is not a good idea because the lymphatic and venous drainage is directly back into the brain and can cause venous sinus thrombosis which is NOT a good thing. The triangular area from the bridge of the nose to the lateral angles of the mouth drain that way (including the chin). We are speaking of the cavernous sinus, which is a network of veins and lymph channels that surround the base of the brain. The reason for their importance is that infection in that area is directly applied to the brain." I had never heard of anything like this before. I assume this applies to acne and not just rosacea.

A8) It applies to ANY infection of this part of the face (even dental infections of the upper arch and sinus infections in that area). ANYONE who understands the anatomy of the head and neck understands this. Fortunately it is a rare complication but every doc knows about it since it is SO dangerous.

Q8 cont) How would a person know if they have venous sinus thrombosis?

A8 cont) They would have a terrible headache, towering fever and brain symptoms. Unfortunately, by the time they have the symptoms saving the person is nip & tuck!

Q8 cont) Are dermatologists aware of this risk?

A8 cont) Of course but most docs have never seen a case and tend to forget a lot of what they learned in medical school as soon as the exam is over.

Q9) Since acne is related to problems with fat metabolism, what other fat metabolism errors or symptoms in or of the body would a person with chronic adult acne be likely to notice? (Oily skin is one, but what else?)

A9) Elevated cholesterol or triglycerides. Obesity. Eczema or psoriasis. Seborrhea & seborrheic dermatitis.

Q10) You mentioned the following: "I have heard of some acne sufferers who have benefited from taking 100mg of zinc twice a day. It is best to take zinc with vitamins C, E, and A, in addition to taking the EFA’s." For this combination for this specific problem, what are the doses you recommend for the C, E, and A?

A10) First of all the idea is to start with a much larger dose than would likely be needed for maintenance: at least 2000 esterified vitamin C twice a day, 1000 units of (natural)vitamin E once a day & 50,000 units of vitamin A (natural) once a day.

Q11) Anything you want to say about rosacea? All I have found is the venous sinus thrombosis thing and the fact that rosacea is related to acne except rosacea sufferers almost always have C-RS... Other than that, there was nothing in the acne archives.

A11) Although rosacea is (like many chronic conditions) becoming MUCH more common, it still is uncommon. I would just liken it to acne and suggest that the same approach would deal with both except for the differences you already know (C-RS connection).

KMD: "I need some more clarification from you on some of the acne questions. On question #2, I think you may have answered it sort of "backwards" as to how I intended it. I meant to ask what sort of hormonal things might trigger (aggravate) chronic acne in men (as opposed to what other conditions men with acne might also have). You said "SD, obesity, hypertension...". I'm thinking you are telling me that men with chronic acne may also have these sorts of conditions -- in that case women also may have the same. Is that what you were saying? But what I really wanted to know is are there hormonal things with men that are similar at all to what women experience with menstrual cycles, pregnancy, and menopause?"

WALT: It is the imbalance of the entire hormonal network that contributes to acne. This imbalance is similar in males & females. Hormonal imbalance causes different things in the different sexes. We are right now at the stage of understanding this as the person watching lightning in the middle ages was in understanding the potential of electricity. Sorry about that...........

KMD: "On question #7, what would be the exact protocol for the use of hot compresses for acne? Would this be only for acne that is infected, or for any acne? Cystic acne? There were NO mentions of hot compresses in the acne archives."

WALT: It only works for actually infected acne and not for the acne itself. It is pretty easy to tell if an acne lesion is secondarily infected. If you do not think so, I will do my best to describe it. The hot compresses approach is the same for ALL infections of the skin. SO, the description of this available on the glossary and search engine is accurate. If you have ANY trouble finding it, so must many others and I will have to make it more available. Please let me know.

KMD: "Again on question #7, I am confused about your antibiotic protocol. Whenever I was given antibiotics for my infected acne flare-ups in the past, I was always given about a month's supply, because they said something about it takes that long for the antibiotics to really get to this sort of infection. For other infections, the protocol was always a full 10 days, (except sinusitis was longer), but for acne it was about a month. How can the antibiotics reach and eliminate an active acne infection in only "a very few days"? Why are some people placed on ongoing antibiotics for acne long-term?"

WALT: You are confusing the action of antibiotics for the "mechanism" of acne and the action for secondarily infected acne. I would never (now) recommend antibiotics for the mechanism of acne (even though I used to do that routinely 30 years ago--even then no one knew why it seemed to work). I would use antibiotics for a few days for the secondarily infected acne lesion KNOWING that it would have no effect on the acne itself. For the acne "mechanism" it takes at least a month for the effect to show and 3-6 months to find out how much good it will do. THEN, the average person doesn't find out that it will not work forever until they have been on it for a a year or so. Hope this helps.

KMD: "That brings me to another thought on antibiotics. I was always told by doctors and the media (I know, I know) that if we as a population did not take our antibiotics for the entire prescribed course (do NOT stop them early), then the bacteria involved can mutate and become antibiotic resistant. This puts the entire population at risk, as does unnecessary antibiotic use, such as using them for viral infections. This theory makes sense to me, but is it true? What is the REAL story on antibiotics, their proper use, the length of use, etc?"

WALT: Even the first dose can produce "resistant strains"! The way this works is that any bacteria that survive have to be (by natural selection) the most resistant ones genetically. SO, they are the ones who reproduce the next generation which MUST be the most resistant. Over time, the only strains left are the VERY most resistant. Need more?

KMD: "Do you want me to mention anything about the possibility for venous sinus thrombosis in the chapter, or is it too remote a possibility to bother?"

WALT: Don't bother as we would be writing a 5000 page textbook to include even part of the possibilities.

KMD: "Can you explain how altered hormonal function causes sebum to build and clog in the pores and inflict the acne? Can you explain how the pores function in a normal person who never has acne?"

WALT: No one yet can---to my knowledge. We understand so little about how the body works normally that the alterations of that normality is a deep mystery in most cases. What we DO know is that at puberty, the sex hormones cause the body to produce sebaceous glands (which were not present anywhere before that). We have no idea how or why but we do know that it happens. We GUESS that is has something to do with producing the pheromones that attract the opposite sex and that is probably true. We do NOT know that that is the only reason-------let alone the question of HOW it happens.

What we DO know is that the secretion (sebum), in some people, gets too thick to easily exit the duct and it is that plugging that produces acne lesions. We do not KNOW how or why that happens but it seems to be related to genetic susceptibility. If the secretion stays fluid there IS no acne in that person.

The recommendation for essential oils is because in those genetically susceptible people the excess of esential oils seems to help the susceptible body produce more liquid sebum even with their genetic susceptibility to producing thick and sticky sebum.

Changing the signals from the hypothalamus TO the glands, practicing SR, is the main way known to change the genetic susceptibility back toward normal--"changing the phenotype".

KMD: "What do you suggest as being helpful for external skin care for acne sufferers WHILE they are busy dealing with the causes? Do you recommend for or against exfoliation, the use of benzoyle peroxide, topical antibiotics, Retin-A, etc? Do you recommend for or against a facial steamer? Water temp for washing, types of soaps or cleansers? Are there specific things that you have found are especially helpful or harmful?"

WALT: Once one has a basic understanding of what I have mentioned above, they can figure out what works best for them. The reason so many of these have survived so long is that they work for SOME people--definitely not for MOST people. For example, the exfoliation helps remove dried sebum from the pore openings and so, for some people would help, etc. ANYTHING that would help dissolve ore soften sebum secretion should help. The problem is that, although the sebum is hardest where it is dried at the opening, the entire duct is plugged with the sticky and thick stuff.

MY best recommendation would be for everyone to give each approach an honest try and see what helps the most. THEN, whether they continue it will be determined upon whether the benefit is worth the bother. NONE of them will resolve acne in the long run. Just getting older resolves it in MOST people.

ALL of the suggestions we have are aimed at those who do not want to wait and to those who HAVE waited and it did not resolve on its own.

KMD: "What is the typical period of time it takes when consistently doing SR before one notices great improvement in the acne condition? I'm thinking 3 months for improvement, and 6-12 months for cure. Is that close?"

WALT: That is pretty close but it is an average. Some begin to notice something in a month but I would NEVER tell anyone that since it is MUCH better to have better than prodicted results than less than. ALSO, with something like acne I would urge anyone doing the SR to combine it with a wellness approach to shorten the time while they are noticing the beneficial side effects of the wellness on their other functions. Many will keep up the program for the side effects long enough to see their acne clear up.

KMD: "On question #10: You said to start with a high dose of those supplements, but can you tell me how long one should stay on this dosage and then what to reduce it to for maintenance (guidelines)? Also, when you say natural vitamin E, are you speaking of fish oil? And when you say natural vitamin A, are you referring to cod liver oil?"

WALT: Cod liver oil has far too much vitamin D in it to be used for this. They have natural vitamin A, that has been separated from the D, but it is more expensive than the symthetic A. However, for this, it is well worth the difference.

The only vitamin E there is in fish oil was placed in there as a preservative (traces only). Natural vitamin E is "mixed tocopherols" and NOT straight "alpha tocopherol".

As for how long to take any dose before changing it: Since the skin replaces itself every 4 weeks, one has to see that their benefits have been stabilized for at least a month LONGER than those 4 weeks before changing the dosage. THEN, they have to wait at least until they see their benefits begin to reverse before knowing that they should not have cut the dose.

KMD: "As far as Accutane, I have seen quite a few almost contradictory comments from you in the archives. Sometimes you will say "Nobody would take Accutane with their eyes open" and once you said that you yourself would probably take Accutane if you had severe acne (while dealing with the causes). Some days you would say that Accutane is dangerous and other days you would say that Accutane is a safe and effective drug when properly prescribed. My overall impression is that you discourage Accutane use, but I am not totally clear on your stand. It seems the side effects can be devastating and permanent."

WALT: I have never heard of anyone having any serious problems from accutane when taken only for a few months (Long enough for the wellness approach to begin showing benefits IF the person is serious about it.) SO, for that long it is reasonably safe.

The circumstance under which I would NOT recommend it is when the individual looks at the accutane as a magic pill and is not willing to put effort into wellness at the same time.

The fact that you have these questions tells me that many others must as well. Perhaps all of your questions--and my answers--should be put (just as is) on the BB for those others?

DONE! And there it is folks!

Re: ACNE Q & A: Walt's replies to my questions -- a MUST read for acne sufferers! (Archive in Acne.)

Posted by Walt Stoll on September 02, 2000 at 07:41:36:

In Reply to: ACNE Q & A: Walt's replies to my questions -- a MUST read for acne sufferers! posted by KMD on August 31, 2000 at 15:03:54:

Thanks, Kathy.



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