Q My son, 18, has been suffering from breakouts since the age of 16.
His condition became worse when he was under stress from his studies.
I took him to a traditional Chinese medicine (TCM) practitioner and was told that the cause of his breakouts was gastric juices.
After two weeks of medication, his condition has not stabilised. In fact, he has had new breakouts.
He does not want to burden us further with medication fees.
What is the actual cause and is there a remedy for this? Please help.
A In TCM, acne is probably caused by the dysfunction of the lungs, stomach, large intestines, liver and kidneys.
The lungs govern the skin and defend the body against external pathogenic (disease-causing) factors.
When the lungs are weak - due to a weak constitution and chronic illnesses - external pathogenic factors such as "wind", "heat" and "dampness" can invade the skin. This triggers flushed cheeks, red and itchy pimples, blackheads, whiteheads and heavy breathing.
In TCM, the kidneys control reproduction, growth and development. A balance of yin - which is associated with coldness and moisture - and yang - which is linked to heat and dryness - is required for good health.
Since your son entered puberty, if yin in his kidneys has been insufficient - due to a weak constitution, chronic illnesses and keeping late nights - it will have been unable to nourish the lungs. This will create "heat" in the lungs and trigger acne breakouts with skin redness, a dry mouth, yellowish urine and insomnia.
The stomach receives and digests food. When the stomach is weak - due to the consumption of alcohol, a poor diet and heavy meals, and keeping late nights - the food will stagnate in the stomach, creating "heat". This triggers indigestion, bloatedness, constipation, pimples on the forehead, greasy skin and itchiness.
In TCM, the lungs are closely related to the large intestine, which converts waste material into faeces to be excreted from the body.
If one is constipated, the "heat" in the large intestines will travel up to the stomach and lungs, triggering pimples and papules (solid bumps on the skin).
The liver controls the circulation of qi (energy). A good flow of qi and blood is required for good health.
Negative emotions, such as anger, depression, fear or stress, will cause qi in the liver to stagnate and create "fire". This leads to the outbreak of acne, lumps on the surface of the skin, fullness in the lower abdomen, and pain in different parts of the body.
Chinese herbal medicine (taken orally and applied on the skin), facial acupuncture and cupping therapy can help improve your son's condition by enhancing his organs and dispelling the pathogenic factors.
Cupping involves using fire and cups to create a vacuum on the skin to enhance blood and qi circulation.
Chinese herbal medicine, such as yerbadetajo herb, glossy privet fruit, rehmannia root, common anemarrhena rhizome and oriental waterplantain rhizome, are used to increase the amount of yin in the kidneys.
Gypsum, loquat leaf, honeysuckle flower, wild chrysanthemum flower, dandelion, weeping forsythia capsule, baical skullcap root and Chinese wolfberry root-bark are used to dispel "heat" from the lungs and stomach.
Rhubarb and immature orange fruit are used to dispel "heat" from the large intestine.
Motherwort herb, Chinese thorowax root, turmeric root-tuber and nutgrass galingale rhizome are used to strengthen the liver.
Your son should abstain from alcohol, smoking, coffee, tea, and spicy, sweet and oily food to reduce "heat" in the stomach and lungs.
He should also eat more vegetables and fruit. Cucumbers, carrots, tomatoes, green beans, barley and winter melons can help to strengthen the stomach to reduce the amount of oil on the face and skin inflammation.
Your son should also clear his bowels every morning.
Sleeping before 10pm will help to produce yin in the kidneys and reduce "heat" in the stomach.
Regular exercise and avoiding negative emotions such as stress, depression, fear and anxiety will be helpful in strengthening the liver.
Your son should avoid using his hands to squeeze the acne to prevent further skin inflammation and scarring.
MS LIM LAY BENG, traditional Chinese medicine practitioner at YS Healthcare
Treat acne to prevent permanent scarring
A Your son has acne, a common skin condition in teenagers.
Acne refers to clogged pores (blackheads and whiteheads), pimples and big deep bumps (nodules or cysts) that can develop on the face, neck, chest, back, shoulders and arms.
Teenage acne occurs during puberty, when male hormones called androgens, which are present in both males and females, stimulate the "oil glands" (sebaceous glands) of the skin to enlarge and produce sebum (oily secretion).
The cells lining each hair follicle are shed and clog up the opening of the follicle, forming a comedone. A closed comedone (blackhead) has a dilated opening on the skin surface, which looks black due to the oxidisation of sebum and the presence of the skin pigment melanin. An open comedone (whitehead) does not have a large opening and so, looks white.
A type of skin bacteria, called Propionibacterium acnes, then grows rapidly in the clogged hair follicle.
The bacteria produce irritating substances that cause inflammation, resulting in pimples, cysts and nodules.
Stress and lack of sleep often make acne worse, but the reason is not known.
Contrary to popular belief, acne is not caused by dirt. Washing too often, too vigorously or using harsh cleansers may worsen it.
Doctors can treat and prevent acne effectively and safely. Mild acne can be treated with creams containing benzoyl peroxide, vitamin A derivatives (such as tretinoin and adapalene) or antibiotics (such as erythromycin and clindamycin).
Treatment of moderate to severe acne requires oral medication in addition to creams. They include antibiotics (such as doxycycline, minocycline and erythromycin) and isotretinoin (a vitamin A derivative).
Your doctor can advise your son on appropriate and affordable treatment. Good control of acne will improve his appearance and confidence, and prevent the development of permanent scars.
To prevent acne, wash the face two to three times daily with a gentle cleanser and avoid picking at the face. Have a well-balanced diet, regular exercise and adequate sleep.
DR CHAN YUIN CHEW, dermatologist at Dermatology Associates at Gleneagles Medical Centre
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