ACNE TREATMENTS
ACTIVES, CLEANSERS, MOISTURISERS AND SUNSCREENS FOR ACNE-PRONE SKIN
The rundown on acne
What is acne?
Acne is a very common skin condition. It can be identified by the presence of blackheads or whiteheads as well as pus-filled spots (pustules). Large pimples called nodules and cysts occur in a smaller percentage of acne suffers.
Acne is most common in the teen years. It can appear as small, red spots on the face, neck, chest or back. Most teenagers will experience acne at some point during their adolescence.
Whilst acne usually disappears by the mid- to late twenties for most people, it can last much longer and persists into adulthood. Acne may also appear in adulthood, skipping the typical teenage onset. Uncommonly, young children may develop blackheads, pustules, or cysts on their cheeks and noses from time to time.
Is it really acne?
A combination of redness, oily skin, pimples with pus, blackheads and whiteheads is the typical look of acne. Sometimes, bigger, more severe bumps (also known as nodules), or cysts (which look like boils) can develop.
The affected skin can feel hot, tender and painful.
Acne can leave scarring on the skin, especially if there are cysts and nodules. These can appear lumpy or raised (known as hypertrophic or keloid) or indented as pitted and atrophic scars (ice-pick, rolling and box car scars). Once a pimple has cleared, it may also cause discolouration such as erythema (redness), hyperpigmentation (darker than your normal skin colour) and hypopigmentation (lighter than you usual skin colour).
There are several conditions that can look like acne but is not acne. These include rosacea, periorifical dermatitis and folliculitis. If you have any doubts whether or not you have acne, see your GP or dermatologist.
Acne and you
A key aspect of having acne is its impact on self-esteem and mood of sufferers. This is something that is not often not discussed openly.
Numerous studies have demonstrated that acne can have a negative psychological effect.
It is important that you talk to your doctor or mental health professional if you have severe acne and feel depressed or anxious.
There are always treatments for acne, no matter how mild or severe.
Acne scarring can often be prevented and improved.
The causes of acne
Our hormones affect the oil-producing (sebaceous) glands. People with acne are especially sensitive to these hormones, even if they are at normal levels. This causes excessive oil production in the glands as well as thickening of the lining of pores. Skin cells that aren't being shed properly become lodged in the pores.
Blackheads and whiteheads are caused by a mixture of oil (sebum) and dead skin cells. The plug of dead skin becomes black due to chemical reactions with the air. Blackheads are not caused by dirt.
The acne bacteria (now known Cutibacterium acnes) lives on all skin types and usually causes no problems. The bacteria can thrive in an environment that is oily, such as in those suffering from acne. The inflammation that follows can cause pus-filled, reddened spots.
What can contribute to acne?
Sometimes, acne can be triggered either by medications for other conditions. Use of anabolic steroids also causes acne.
Dietary factors can have an impact on acne.
High glycaemic diets (e.g. such as sugary foods, white bread, potatoes, rice, etc). Switching to a low-GI diet could reduce the amount of spots. There is some evidence that skinny milk may trigger acne in some individuals. This has not been investigated in detail.
Sometimes acne can be caused by hormone problems. If tested, most acne sufferers return normal hormone levels on their blood work. Females are more likely to experience acne if they have polycystic-ovarian syndrome (a problem with hormones). Females who have irregular periods, hair thinning on the scalp, abnormal hair growth in unwanted areas or other medical problems should speak to their doctor.
Are there any genetic factors that can cause acne?
Acne can run in families but not all people with acne have a family history. Most cases of acne are caused by a combination or genetic, hormonal, lifestyle, and other factors, such as diet, stress, skincare products, and hormones.
HOW IS ACNE TREATED?
Not all acne needs to be treated by a doctor. Early and mild-to-moderate acne can be successfully treated with pharmacy grade and cosmeceutical skincare. If you have been suffering from acne for some time and haven't had success with any over-the-counter treatments or pharmacy-grade treatments, you may need to see your doctor. With any acne treatment, whilst results may be seen within a few weeks, it is suggested that at least a 6 week trial of treatment be tried before switching to a different treatment option.
Topical treatments These are treatments that can be applied directly to the skin and are the best options for mild to moderate acne used either in conjuction with tablets or on its own. There is a wide range of active anti-acne topical treatments available, including creams that contain active ingredients such as benzoyl peroxide, niacinamide, ascorbic acid, lactic acid, glycolic acid, salicylic acid, topical antibiotics, and of course, retinoids. Topical treatments should be applied to the entire skin area rather than as a spot treatment. Some topical treatments can be irritating for the skin. Therefore, it is recommended to first use the treatment on a small portion of the affected area and then apply to the entire area only if there are no reactions. If the skin tolerates the treatment, it may be recommended that you gradually increase the amount of use or the concentration of the product that you are using. If irritation occurs, you should consult a knowledgable pharmacist with an interest in skin or your doctor. Retinoids and other topical treatments can make acne worse for a few more weeks before improving. This is commonly referred to as 'purging'.
Oral antibiotics You may be recommended antibiotic tablets by a doctor. The most common oral antibiotics used in acne are erythromycin, minomycin and doxycycline. They are often used in conjunction with a topical treatments and a good skincare regimen. The recommended duration of antibiotics is at least 6 weeks. They should be discontinued after 3 to 6 months.
Hormonal treatments For females suffering from acne, some forms of the contraceptive pill may be beneficial (whilst others may make acne worse). A hormone blocker (e.g. cyproterone acetate) reduces oil production. It takes about three months for the benefits of the pill to begin to manifest.The contraceptive pill may carry some risks in some individuals. Speak to your doctor if the contraceptive pill is an option for you. Spironolactone can also be an effective option to treat acne in some females.
Isotretinoin This treatment can be effective for treating severe nodulocystic scarring acne. It can have serious side effects, hence it is only be prescribed by a dermatologist in suitable patients. Close monitoring is required in patients taking isotretinoin. Isotretinoin is usually taken for approximately 12 months'. This however depends on the dose that is tolerated and considered to be safe for the individual patient. The most common side effect of isotretinoin is dry lips. Sometimes acne gets worse for several weeks before improving. Improvement is seen slowly. Isotretinoin can cause severe malformations in an unborn baby. Strict guidelines are followed by dermatologists and their patients. Concerns have been raised about the potential for mood alteration in those taking isotretinoin. The vast majority of patients report no mood problems with this treatment, however such risk is always discussed on a case-by-case manner with a dermatologist. Large studies have not identified a causal link between isotretionin and negative mood changes.
Physical treatments. This includes chemical peels, lasers, fine wire diathermy and photodynamic therapy. You can always speak to your GP or dermatologist to see if these forms of treatment are relevant for you.