Experience From - Tom Hendriks , John Prohira , Mary Gorski , Pat Wellington ,

Tom Hendriks

You're not alone in this, I never related it to (ultra)running, but I also get some outbreak once in a while and despite the fact you outrun me by three years I don't think I'm still in a late stage of puberty. In my opinion it is not related to the exercise but to the stuff you eat. When I eat large quantities of chocolate I'm sure to expect more acne. And guess what, I tend to eat more chocolate after a ultra or marathon then in between. Maybe you also have some foods which cause the acne. Its just a thought.

John Prohira

So many benefits gotten from ultrarunning. Physical, mental and spiritual rewards. Now I can add to them reliving parts of puberty.

It's been a couple of days since finishing the Vermont 100 Mile Trail Run and I'm noticing acne on my forehead, back and shoulders. Perhaps this 45 year old man shouldn't complain about a malady that usually plagues teenagers. This outbreak of the subaceous glands has to be related to the stresses of the run. The same thing happened after the Massanutten this spring. It clears up after a week or two.

Any input on what's going on here? Endocrine system and hormones "out of wack"?

Suggestions on how to avoid this in the future? Remedies and/or diet speeding recovery?

Mary Gorski

John Prohira wrote that he got zits after ultras. Tom Hendriks responded, saying that he thought the outbreaks were related to food.

Just to pipe in my 2 cents -- it seems that stress, mental or physical, can lead to a few unwanted zits. At 36, I'm usually zit-free unless I've done tough racing or training, or had something stressful going on at work or home. For me, the zits are often an indicator of over-training. And no, I don't think it's because I get so busy with my running that I forget to shower... just in case you were wondering.

Now where was that bottle of zit cream I bought when I was 13?

Pat Wellington

John Prohira and Tom Hendriks ask about acne and ultras. Well, boys, the good news is it's not the chocolate! Hooray!

Dr. Geoffrey Redmond, who is President of the Foundation for Developmental Endocrinology, has written a book entitled "The Good News About Women's Hormones." While the book is about women's hormones, the section on acne and hormones I believe would apply equally to men, differing only in the amount of the hormone androgen produced. (Remember our friend Mr.Testosterone is an androgen.) In a nutshell, he states that all acne is hormonal and acne is a response of the skin to hormones. When you consider all the pore clogging stuff that happens to your skin during ultras--sweat combined with sun screen lotion, bug bites, dirt, etc. etc., it makes sense, especially over 100 miles, to try and and wash off whenever possible to prevent bacteria from developing.

In regard to acne and food, he states that acne is not the result of diet. Specifically, greasy cheeseburgers, milk shakes, chocolate, and french fries do not cause acne. This superstition about foods causing acne is not unique to Americans; the Chinese believe acne to result from eating foods that cause too much "internal hot air." Fried foods are included in this group, but so are spicy foods like chili and curry, along with alcoholic drinks. Although there are good reasons for avoiding greasy foods, acne is not one of them. Changing your diet to a low fat one is certainly good for you, but it will not cure your acne.

This is how Dr. Redmond explains it: An androgenic disorder is present whenever a body is excessively affected by the family of hormones known as androgens. Androgens stimulate the pilosebaceous unit, the microscopic structure in the skin that includes the hair follicle and the sebaceous glands. The same structure that makes hair also makes sebum, the oil that appears on our skin in increased amounts, beginning in puberty. Under unfavorable circumstances, sebum cannot escape through blocked pores and a pimple results. The increased sebum production is due solely to the influences of androgens and so ALL ACNE IS HORMONAL. Failure to realize this results in ineffective treatment for acne.

Acne is the leading reason people see a dermatologist. A variety of prescription drugs have been developed for it, and drugstore shelves are filled with non-prescription acne remedies. But acne has been neglected as an endocrine condition. For acne is not merely a skin disorder. It manifests on the skin but is triggered by hormones. The peculiarities of medical specialization have separated doctors trained to treat skin problems from those trained to treat hormonal problems. Acne is hardly mentioned in textbooks of endocrinology but gets extensive coverage in dermatology books.

Why is this? The simple fact that as medical specialization arose, the endocrine nature of acne was not recognized for the hormonal disorder it is. And dermatologists are used to dealing with skin problems, whereas endocrinologists are not. This situation is unfortunate. Hormones cause acne, and treatment directed at the normonal cause is most effective. Knowledge from the two specialities needs to be combined for the benefit of acne patients.

Let us look further at how hormones trigger acne. Skin changes in puberty in both boys and girls are due to the actions of androgens. These hormones act on the sebaceous gland to increase its production of sebum. Without androgens, there is only scanty sebum and no acne. The sebum made by the gland has to get out of the skin surface. Often the skin surface protein, called keratin, is too sticky and seals off the opening of the sebaceous gland, so that fluid accumulates in it. This is a whitehead, or closed comedone. If some skin cells are broken down in the process, their pigment gives the comedone a dark appearance and it becomes a blackhead or open comedone. Despite what your mother told you, the dark color of a blackhead is not dirt but the normal melanin pigment of the skin. Normally, as the skin renews itself, the top plug falls off and the whitehead or blackhead disappears. However, in some people a bacterium called corynebacterium acnes proliferates in the comedone converts the sebum to more irritating substances that lead to inflammation.

Acne thus results from a series of steps, beginning with the action of androgens on the sebaceous glands, causing them to produce more oil. Second, the top of the skin is too sticky and the opening of the pore is sealed off. Bacteria grow, causing the oil to become irritating and increasing the pressure inside the pimple. Finally it breaks inside the skin, causing a much larger pimple and considerable inflammation.

Acne usually involves the skin of the face because this is where the pilosebaceous glands are most sensitive to the oil-stimulating effects of the androgenic hormones. But the skin of the upper chest and back also produces sebum, and some people get acne in these regions.

Everyone's skin becomes oilier with puberty, but not everyone has severe acne. So hormones and oil production are not the only factors involved in acne. Many women with high androgens make more sebum and therefore are more at risk for acne, but some women with high androgens and very little acne. The other factors are the stickiness of the surface protein of the skin and the particular bacteria growing on the skin. In some, an inherited, more active immune system may produce a greater inflammatory response to acne. Because these factors are so important in the occurrence of acne, they have gotten most of the research attention and the standard treatments are directed at these factors. Antibiotics are commonly used because they inhibit the activity of acne causing bacteria. And tretinoin (Retin-A, Ortho) works by making the keratin less sticky. Oral isotretinoin (Accutaine, Roche) works partially in this manner also.

All these approaches have their place, but with the exception of Accutane, which has problems with side effects, they are not adequate against severe acne. While they are effective to the degree of making the acne milder, the degree of improvement is not nearly enough. The limitation of all the non-hormonal approaches is that they do not have any effect until the acne process has already started. The hormonal approach stops excess sebum production and so works better than antiobiotics or vitamin A derivatives applied to the skin. Without androgen action there is no acne.

What does this mean for "ultra-induced acne"? I doubt that hormone treatment is necessary for this type of acne. But I think from the info above, it's important not to let pore clogging dirt and grime build up on your body creating an environment for bacteria to develop and sponge off with clean water if at all possible. (Preferably not a with a sponge from a bucket used for cleaning off the horses as I used at "Down and Up the Ruck a Chuck" one year that was one hairy sponge...)

It would be a whole lot simpler if just not eating chocolate were the answer!