If you think, as many do today, that acne is a recent historical de- velopment brought on by poor diets, pollution, or lack of exercise, think again. Acne has been written about since ancient times, including prescriptions for its treatment.
For instance, ancient Egyptian writings mention that several pha- raohs suffered with acne. Not surprisingly, given their culture, super- stitions were given for the cause of breakouts, such as telling lies, and magic, spells, and charms were offered as treatments. If your experi- ence with acne has been anything like mine, you might feel desperate enough to try magic or a charm or two. In the Ebers Papyrus (dating to c. 1550 b.c.), the word aku-t is cited that was later translated as “boils, blains, sores, pustules, or any inflammatory swelling,” and some of its remedies are mentioned as animal origin preparations and honey.1
In ancient Greece, the earliest description of acne appeared in the writings of the Byzantine physician Aetius Amidenus (mid- fifth century to mid-sixth century).2 The word acne appears to have evolved from the Greek word acme, which means “point or spot.”3 From the historical records, both Hippocrates (c. 460–370 b.c.) and Aristotle (c. 384–322 b.c.) were aware of this illness. Aristotle wrote about this condition in detail.4 The ancient Greeks knew acne as tovoot. According to the meaning of this word in the singular as “the first growth of the beard,” it was associated with puberty. Around a.d. 2, the meaning of acne appeared to be wid- ened to include the highest point of growth and development, and thus puberty. It was recommended that honey be used for softer lesions and a mixture in soap base for harder ones.5
In ancient Rome, acne was often treated with baths, using hot mineral water combined with sulfur to unclog and cleanse pores as well as dry out oils that clogged the skin. A. Cornelius Celsius (c. 25 b.c. - a.d. 50), a Roman encyclopaedist, mentioned in his medical book titled De Medicina: “to treat pimples and spots and freckles is almost a waste of time, yet women cannot be torn away from caring for their looks. But of these just mentoned, pimples and spots are commonly known, although that species of spot is rare which is called by the Greeks semion, since it is rather red and irregular. But pimples are best removed by the application of resin to which not less than the same amount of split alum and a little honey has been added.”
Until the 1800s, people did not discover any more useful treat- ments against acne and have continuously used sulfur because they saw it can dry and exfoliate the skin.
Dr. William H. Schuessler, a nineteenth-century German medical doctor, did studies that led to a list of 12 biochemic cell salts. He concluded that any deficiencies in the body’s cell salts resulted in illness, including acne. He believed it was necessary to restore the correct balance of tissue salts for removing acne blemishes. His cell salt therapies, first discovered in 1873, are still practiced by some homeopaths around the world.
In 1902, doctors used X-rays as a form of acne treatment. This may seem crazy to you, but even today a similar treatment called blue light therapy is used.
In 1920, Jack Breitbart of the Revlon Corporation first developed benzoyl peroxide, which is still used today in the treatment to kill acne bacteria.7 It works as a peeling agent, increasing skin turnover, clearing pores, and reducing the bacterial count. It is typically ap- plied to the affected areas in gel or cream form, in concentrations of 2.5 percent and increasing through 5 percent and up to 10 percent.
In 1930, laxatives were used for treating the condition called “chastity pustules.” Some people thought that virgins could not eliminate toxins from their bodies because they did not have any sexual contact, so they tried using laxatives against acne. Today’s doctors know that having sex has nothing to do with elimination toxins, but they recognize that constipation can be a cause of acne as toxins accumulate in the body.
In 1950, antibiotics were used in treating acne caused by germs Tetracycline, for instance was used with great results, but nowadays it is no longer used as it has lost its effect against some skin germs. Other more powerful antibiotics have taken its place.
In 1960, Tretinoin (the carboxylic acid form of vitamin A), also known as Retin A, was discovered to have a beneficial effect against acne. Later on, the oral isotretionine was made and the battle against acne became easier. These products are still used nowadays with the same effects on acne.
Keep in mind that I am only presenting this as a history of at- tempts to deal with acne. I am not condoning any of them, as all of them have differing degrees of negative side effects that I could never recommend as worth whatever benefit they might bring, especially the next one.
In the 1980s, Accutane (a member of a family of compounds known as retinoids that are related to vitamin A) appeared in the American market. It was considered a breakthrough treatment on serious acne but came with a host of side effects worse than the acne itself and was taken off the market in 2009. Today, its generic knockoff isot retinoin products can have extremely serious side effects—mental health problems, including depression, psychosis, and suicide, and when taken by pregnant women, miscarriage or birth defects—that I’ll deal more extensively with in Chapter Eight.
In 1990, laser therapy made its first steps in treating acne. Lasers work on the premise of exciting compounds called porphyrins, which live inside acne bacteria. When the lasers excite the porphyrins, the porphyrins damage the bacteria wall, effectively killing the bacteria, which should reduce the symptoms of the acne. The process is quite expensive, and researchers suggest that its effectiveness is short-term.8
Blue light therapy was developed for treating acne in the 2000's followed by studies that were done by different medical groups in the United States and Europe. Treatment for acne using blue light therapy involves using a narrow high-intensity light. Machines can be used at home to help acne patients obtain a clear complexion, although its effectiveness shows mixed results similar to laser therapy. Neither are cures.
Microneedling with dermaroller has emerged as a novel treatment of acne scars. Orentreich first described subcision or dermal needling in 1995 for scars, and in 2006, Fernandes developed percutaneous collagen induction therapy with the dermaroller.9
So how much improvement have they made on this issue over the years? We find that each generation seemingly got closer, but have they really? It doesn’t matter if I walk down the streets of Orlando, New York, Paris, London, or Rome, acne is everywhere, and the problem seems to be worse than ever, and it’s not limited to teen- agers. The evolution of acne treatments has also added potentially deadly side effects that show how bad the issue really is—that people are willing to risk their health and even their lives in order to be rid of it by doing some of these treatments.
So did any of them have it right? Do we have it right today? In looking for new ways, have we looked in the wrong places for solutions? We have been looking for ways to treat the symptoms with drugs and drying without looking at treating the issues that cause acne in the first place.