Acne
Acne is extremely common in varying degrees of severity. About 9 out of 10 teenagers develop some degree of acne. However, this does not mean it should be ignored. Acne is a distressing condition that can drag on for many years, leaving both physical and significant psychological scarring behind it.
No one should be left with the advice that they should grow out of the condition. Approximately 30% of teenagers continue to suffer with acne into adulthood, and some adults don’t develop the condition until later in life, despite having good skin as teenagers.
Normal skin
Small sebaceous glands lie just under the skin’s surface. These glands make the ‘oil’ (sebum) that keeps the skin supple and smooth. Tiny pores (holes) in the skin allow the sebum to come onto the skin’s surface. Hairs also grow through these pores. During teenage years you start to make much more sebum due to hormonal changes of puberty. Generally, the more sebum you make, the greasier your skin feels and the worse acne is likely to be. Some people make more sebum than others. Acne is often worse in boys than girls.
What is acne?
Although we have sebaceous glands all over our bodies, it is only on the face, neck, chest and back that they are large and produce so much oil that acne develops. Acne can be caused by an ‘over-production’ of sebum by the sebaceous glands. Sometimes the pores that let sebum out get blocked, or plugged. This is due to the skin at the top of the pores becoming thicker, combined with dead skin cells that are shed into the pores and hardened sebum. These ‘plugs’ that block the pores are seen as tiny spots called comedones (black heads and white heads). Sometimes sebum can collect under blocked pores. This appears as small spots, called pimples or papules.
Trapped sebum is an ideal environment for a type of bacterium (germ) called P. acnes to live and multiply. Small numbers of bacteria that usually live on the skin do no harm. However, if a large number develop in trapped sebum the immune system reacts and triggers inflammation. This causes the surrounding skin to become red, the spots to become larger
These inflamed spots heal eventually, but sometimes the skin remains discoloured (hyper-pigmentation) for several months after the inflammation has gone. Commonly a small pitted scar is also left where the inflamed spot was. Unfortunately, these small scars often do not fade completely and can be seen on adult skin.
What makes acne worse?
• Some medical conditions such as polycystic ovaries
• The progestogen-only contraceptive pill may make acne worse
• Hormonal changes linked to a woman’s period can cause acne to flare up
• Thick or greasy make-up may make acne worse. Mineral make-up is the best option available as it is non-comedogenic, oil-free and doesn’t block pores or harbour bacteria
• Sweating heavily or humid conditions may make acne worse by contributing to blocking pores, for example working in a hot kitchen
• Some drugs can make acne worse, such as phenytoin (for epilepsy), some steroid creams (for eczema) and anabolic steroids (used illegally by some body-builders). Never stop a prescribed drug if you are concerned about this, but discuss it with your doctor who may be able to suggest an alternative option.
• The impact of acne can be worse for darker skin types • Stress is thought by some to make acne worse
Some myths about acne
• Acne is not caused by poor hygiene. Excessive washing may actually make it worse • Diet probably has little or no effect on acne
• Acne is not just a simple skin infection. The cause is complex, involving hormones, sebum, overgrowth of bacteria, inflammation etc.
• You cannot ‘catch’ acne – it is not contagious • Acne cannot be cured by drinking lots of water • Sun beds will not help clear acne
How should acne be treated?
The aim of treatment is to clear spots as much as possible and to prevent scarring. There are many different treatment options, depending on individual circumstances and the severity and type of acne. Some treatments can be associated with a relapse of spots after the treatment is stopped. Common treatments include topical (applied to the skin), oral (tablets) and laser treatment.
Mild acne that is not inflamed is very common and you may prefer not to treat it. This usually goes in time, but it can take a long time to clear. The emotional impact even of mild acne can mean early treatment is best for some. Many medical practitioners recommend early treatment of mild acne to prevent it developing into more severe forms. Inflamed acne can scar. If you develop inflammation (redness, red spots, pustules etc) then it is best to treat early to prevent scarring.
Acne treatments nearly always take quite a long time to work, so persevere with any treatment, unless you get side effects, for at least six weeks before deciding if it is the right option for you. The overall effects can take up to four to six months to become evident. Be realistic. Most treatments aim to clear most spots, but it is difficult to get perfect skin with topical or oral medication.
Topical treatments
There are many options available. Below are some of the most commonly used applications for the skin. You can also get combinations of ingredients, which can work better than one ingredient alone. Antiseptic washes, although heavily advertised, are unlikely to help very much. Beware of false-promises. Some very strong, alcohol-laden products can strip the skin of its natural oils, encouraging the sebum to work even harder to replace it. This increased sebum production can exacerbate acne.
Benzoyl peroxide:
This is common and has three actions – it kills bacteria, reduces inflammation and helps unplug blocked pores. It comes in different strengths and can be bought over-the-counter at pharmacies or prescribed by a Doctor. It can bleach hair and clothes, and commonly causes mild skin irritation. These antibacterials are the main ingredients in many advertised acne remedies (e.g. Clearasil Max). Beware of promises of ‘fast-acting’ cures. Most acne treatments take many months to work well.
Retinoids:
These are based on Vitamin A and are good at unplugging blocked pores. They help a bit with reducing inflammation and are best used for mild or early moderate acne. You need a prescription for retinoids (e.g. Adapalene). Some side effects include:
• Skin redness and skin peeling, which can settle over time • Spots can get worse before they start to improve
• Skin can become more sensitive to sunlight; you need to use a sun cream • Start on a low strength as they can cause burning, irritation and dryness • Don’t use if pregnant or planning to be as they can cause birth defects
Topical antibiotics:
There are various preparations available. They reduce the number of bacteria and reduce inflammation. However, they have little effect on unplugging blocked pores. Therefore, they are usually good for inflamed acne, but the blackheads and white heads are likely to remain.
You will need a prescription. They can cause mild irritation, but generally less than other topical preparations. There are concerns over antibiotic-resistant strains of acne bacteria. This means the beneficial effects may not be very long-lived with the possibility of bacterial resistance.
Azelaic acid:
This mainly works by unplugging blocked pores, so is good at clearing blackheads and white heads. It has some effect on reducing inflamed acne, but possibly not as much as antibiotics or benzoyl peroxide. It is likely to cause less skin irritation.
Antibiotic tablets
Antibiotics work by killing bacteria that contribute to the cause of acne and reduce inflammation. They can work well to clear inflamed acne spots, but have little effect on unplugging blocked pores. Therefore, they may not be appropriate for mild acne. Different antibiotics have different precautions and side effects. Most people will need to take a tablet every day for at least three to six months.
Some general points:
• Tetracycline based antibiotics should be avoided if under 12, pregnant, breastfeeding or trying to become pregnant
• Follow instructions carefully for how to take tablets, eg empty stomach, with water but not milk etc
• Women taking ‘the pill’ may need other contraception for a while
• Some people feel antibiotics should be avoided over concern about antibiotic resistant strains of the acne bacteria
• Can cause an upset stomach, diarrhoea, nausea and vomiting
The pill (a hormone treatment)
The combined oral contraceptive pill may help some women if their acne seems to be partly related to their hormonal changes. For example adult acne, flare-ups during the monthly period and in women with excessive hair growth.
Isotretinoin tablets
Commonly known as ‘Roaccutane’ or ‘oral retinoid’, this reduces the amount of sebum that is made by the sebaceous glands. It often works well and can clear spots even in significant acne. However, it is normally used only in severe cases on the advice of a specialist after other treatments have been tried first. This is due to a risk of serious side-effects such as depression, aggressive behaviour, suicidal thoughts, dry eyes and lips, liver damage, cholesterol changes, skin problems, hair loss, bone problems, affects to vision and birth defects.
Jan Marini product range
The Island Skin and Aesthetic Clinic recommends the Jan Marini product range for acne treatment:
Jan Marini’s Bioglycolic Facial Cleanser
This gentle cleanser and resurfacing agent encourages a softer and smoother skin texture. The glycolic acid assists in giving a thorough deep clean to clear out the pores. Excellent for acne prone skin.
Jan Marini’s Bioclear Lotion
Skin resurfacing properties, especially beneficial for adult acne, acne scarring, large pores and skin texture changes. Rapidly clears existing acne lesions and helps prevent new ones. Texture will become more refined and the size of the pores will appear to significantly diminish. Acne discolouration will lessen.
Jan Marini’s Acne Gels
Revolutionary microscopic sponges continuously absorb excess oil on the skin’s surface. The combination of salicylic and glycolic acids rapids helps clear existing acne lesions and prevents new blackheads and whiteheads. Also excellent as spot treatment for the occasional breakout.
Jan Marini’s Teen Clean
Neat 3-step kit ideally suited to teenage skin. This is designed to target inflammation, kill bacteria and unplug blocked pores. A sun screen is included so the skin is not left vulnerable to sun damage.
Regenlite™ Laser Treatment
This laser has been described by dermatology consultants as the most significant advance in acne treatments for decades. It has full FDA approval for inflammatory active acne following clinical trials and the experiences of consultants such as Professor Chu in his hospital based dermatology clinic. The vast majority of conventional acne treatments focus on the symptoms – helping to reduce the inflammation or infection – but not the cause of acne. The innovative Regenlite™ laser works primarily in three ways:
• Firstly the laser kills the bacteria that causes the infection, which leads to the formation of spots. The whole face is treated, killing bacteria over a wide area to reduce the risk of infection spreading and further break-outs.
• Secondly, the natural wound healing response and dermal collagen production is stimulated. This accelerates the resolution of the spots and lesions, and reduces the appearance of scars.
• Lastly, the laser stimulates the amount of a special type of molecule in the skin, called TGFß. This molecule is uniquely important in the process of limiting the inflammation of the spots and helps prevent the formation of new ones.
Regenlite™ can treat the face and body of people with any skin type. Acne is difficult to treat, and as with most treatments it can take weeks to see significant results. If a recommended course is completed, the laser should have a huge impact on active acne, reducing the risk of developing scarring or pitting. By treating both the symptoms and the cause, it should prevent new acne developing.
