Acne: What You Need to Know

What is Acne?

Acne vulgaris, widely known as acne, is a common skin condition that affects millions of people worldwide. Its pathophysiology is complex. In a nut shell it involves hormones, keratinisation, sebum and bacteria. An increase in androgen hormones, which occurs at puberty, usually causes an increase in size and activity of the pilosebaceous glands which results in excess oil production and increased bacterial activity. This causes the hair follicles and sebaceous oil glands to be blocked and inflammed.

Acne can appear on the face, chest, back, and shoulders as these are areas with the most sebaceous glands.

Acne not only affects teenagers but can continue to affect people well into their 30's. Acne manifests in different ways because there are different types of acne.

Types of Acne

Acne can present as whiteheads or blackheads, both of which are also referred to as comedones.

• Blackheads, or open comedones, open at the surface of your skin. Oxygen in the air (not dirt) gives the top of these pimples their darker appearance.

• Whiteheads, or closed comedones, form as raised bumps under the surface of your skin. They remain flesh-colored.

Inflammatory lesions, which are more likely to cause scarring of your skin, include:

• Papules. These small, red, raised bumps are caused by inflamed or infected hair follicles.

• Pustules. These small red pimples have pus at their tips.

• Nodules. These solid, often painful lumps develop beneath the surface of your skin.

• Cysts. These large lumps beneath your skin contain pus and are usually painful.

Treatment options

Firstly, it is very important to know whether it is acne or not. If you have comedones (white and black heads) and some pastules and papules, it most likely is acne. However, if someone only has pastules and papules, it may not be acne. It would be best to see your healthcare professional for a confirmed diagnosis.

The most important treatment of acne begins with an appropriate skincare routine.

Your basic skincare regimen should include the following:

• cleansers

• moisturisers

• UVA/UVB SPF skin protection.

Cleansing helps to remove sebum, which reduces inflammatory and non-inflammatory components of acne. Although cleansing is vital, excessive use of cleansers will dry the skin too much and cause irritation. Therefore a gentle soap free cleanser such as QV foam wash( available here), Cetaphil (available here) and CeraVe (conveniently available here) should be used twice daily. La roche posay also has a good starter kit for use in acne prone skin can be acquired via this link:

https://amzn.to/3Wbh0FR

Moisturise daily in the morning with a moisturiser that is suitable for acne prone skin to reduce irritation and dryness. Some examples are qv facial cream, Cetaphil pro acne prone oil-free moisturising lotion SPF25. Use cream formulation if you have dry sensitive skin and gel formulation if you have oily skin.

Sunscreens help reduce redness and inflammation by protecting your skin from harmful UV rays. It reduces exposure to free radicals which worsen acne conditions.

Some common treatments include:

• benzyl peroxide

• salicylic acid

• azelaic acid

• niacinamide

These medications are available over the counter in a variety of forms, including creams, gels, and lotions. They work by reducing oil production, killing bacteria, or exfoliating dead skin cells.

Benzyl peroxide is a good product to start with as it has 3 modes of action; it's anti-bacterial, anti-inflammatory and unplugs pores. You should start with the lowest strength, 2.5%, as it can dehydrate the skin too much especially if you have sensitive skin and is conveniently available for you via this link: https://amzn.to/3LfKtJi

Salicylic acid is a keratolytic and unblocks pores. It helps with exfoliation revealing smoother, healthy-looking skin.

Fomulations with 10-20% azelaic acid also work as good antibacterials and keratolytics, for example, the azelaic acid suspension from The Ordinary.

Niacinamide serum is used in acne creams to reduce inflammation and redness associated with cystic acne and acne Rosacea.. It is used in some combination products with azelaic acid such as Cos De BAHA available here.

If over the counter treatments are not as effective then prescription products should be tried. I want to stress that full benefit of otc medications can be seen after 8-12 weeks so medications should be used for the full duration.

More severe cases of acne can be treated with prescription medications such as antibiotics and retinoids. A retinoid gel/cream, containing 0.1% adapalene ( Differen ) is now available otc and can be used in acne which is mainly comedonal with less inflammation. It can easily be purchased using this link as well : https://amzn.to/4cEEvxG Since retinoids are teratogenic, effective contraception should always be used. Therefore it is not recommended in pregnancy.

Other acne treatments available are laser therapy, chemical peels, and microdermabrasion. These treatments can be used to remove acne scars and improve the appearance of the skin.

Helpful Tips

In addition to medical treatments, there are a number of things you can do at home to help prevent and treat acne. These include:

• Wash your face twice a day: Use a gentle cleanser that is designed for acne-prone skin.

• Exfoliate your skin regularly: Exfoliating helps to remove dead skin cells that can clog pores.

• Avoid touching your face: Germs from your hands can transfer to your face and cause acne. Avoid popping pimples.

• Wear sunscreen: Sunscreen helps to protect your skin from the sun's harmful rays, which can worsen acne.

• Eat a healthy diet: Eating a healthy diet can help to improve your overall health and reduce your risk of developing acne.

• Get enough sleep: Getting enough sleep helps to reduce stress levels, which can also worsen acne.

If you are struggling with acne, it is important to see your health professional who can refer you to a dermatologist if need be.

Here are some additional Advise for managing acne:

• Use oil-free cosmetics and hair products. Oily/ greasy products may aggravate acne due to ingredients with comedogenic activity. eg isopropyl myristate

• avoid smoking - nicotine in cigarettes causes narrowing of blood vessels in the outer layers of the skin, reducing blood flow to the skin which results in dry, dull and pale looking skin. Skin becomes wrinkly due to loss of collagen.

• Manage stress levels.

• keep hydrated

Acne can be a frustrating condition, but it is important to remember that you are not alone. With proper treatment, most people can clear up their acne and achieve clear, healthy skin.