Most people develop Acne during adolescence. It is most prevalent in those aged 16 to 18 years. Common reasons being:
- There are higher levels of sex hormones, particularly testosterone at puberty than in younger children. These sex hormones are converted in the skin into a more active form which stimulates oil glands cells to produce more oil. The oil glands, called sebaceous glands, produce an oil like substance called sebum. The more sebum produced, the more build up on the skin surface and more likely it is that Acne will be troublesome. If Sebum and Keratin (dead skin cells) block the skin pores then little bumps on the skin can develop these are called comedones and are often referred to as “blind pimples”, “black heads” or “white heads”. Bacteria and skin debris that accumulate can then cause inflamed acne pimples or pustules. Acne usually becomes less of a problem after the age of 25 years, although there is an increasing occurrence of adult Acne.
Acne Aggravating factors
Some people have particularly severe Acne. This may be because of:
- Genetic factors (family members have bad Acne)
- Hormonal factors (higher levels of sex hormones) due to:
- Disease of the ovaries-including Polycystic ovaries (very common) and ovarian tumours
- Enzyme deficiency (very rare)
- Disease of the pituitary gland
- Disease of adrenal gland
- Psychological stress & depression
- Obesity –more sex hormones are made in body fat
- Environmental factors such as:
- High humidity causing swelling of the skin
- Cosmetics especially certain moisturisers, foundations etc
- Petroleum oils
- Irritation from hats, headbands, chin straps etc
- Certain medications
- Sebum: This oil on the skin is a complex mixture of lipids (fats from skin cells), sweat and environmental material. Sebum is produced by the sebaceous glands, which open out into hair follicles and directly onto the surface of the skin. These glands are found all over the body although are present in greater numbers on the mid-back, forehead and chin.
- Bacteria: Although Acne is not infectious there is an obvious presence of bacteria in Acne troubled skin called P.acnes bacteria, although the severity of Acne is not dependent on the number of these bacteria that are present. P.acnes can produce active enzymes and inflammatory mediators which may contribute to the activity of Acne. Some of these enzymes are able to convert part of the sebum into free fatty acids which cause clumping of the bacteria therefore blocking the sebaceous ducts (pores). Inflammatory mediators then affect surrounding skin and cause inflammation.
Acne management
Acne can be effectively treated although response may sometimes be slow so perseverance and compliance is required.
- Where possible avoid excessively humid conditions such as saunas, unventilated kitchens or tropical vacations.
- Try not to apply irritant oils or cosmetics to affected skin.
- Abrasive skin treatments (scrubs, microdermabrasion etc) can aggravate both comedones and inflammatory lesions.
- Try not to scratch or pick spots.
- There is no proven relationship between particular foods and acne – although a healthy balanced diet including raw foods (fruit, veges, nuts etc) helps provide essential nutrients to the skin. Extra vitamins and minerals have not been proven to help.
Treatment of acne
Mild:
Most people with mild Acne can be treated with topical skincare (gels, solutions and lotions). There is a variety of different topical skin care agents available to suit different skin types of acne.
- Wash affected area twice daily with a mild cleanser and water.
- Acne skin care products should be applied to all areas affected by Acne rather than just put on individual spots.
- Acne skin care products will often work best if applied morning and night.
- Products can often cause dryness, particularly in first 2-4 weeks of use. This is partly how they work and your skin will adjust.
- Avoid applying oily cosmetics such as foundation or sunscreen – use oil free products.
- It may take several weeks or even months to see convincing improvement but persevere!
- Discontinue using product if severe irritation results and see your Dermatologist for advice.
Moderate and severe:
Treatment of moderate to severe Acne usually includes a combination of topical skin care (as above) and an oral medication prescribed by your Dermatologist, often for at least six months.
Common oral medications prescribed include:
- An antibiotic with anti inflammatory properties such as “Doxycycline” or “Erythromycin”.
- Oral contraceptive for females such as “Diane 35/Estelle 35”.
- “Spironolactone” can sometimes be prescribed.
- For resistant or persistent Acne “Isotretinoin” (“Roaccutane”) may be more suitable.
Physical treatments:
- Sunlight is anti-inflammatory and can briefly help. However exposure to UV radiation results in ageing skin and can eventually lead to skin cancer.
- Cryotherapy (freezing treatment) may be useful in controlling new nodules although can scar some skin types.
- Steroid injections may sometimes be recommended to shrink large shoulder nodules.
- Comedones can be expressed or removed by cautery or diathermy.
- Microdermabrasion can help mild Acne – although it can also aggravate some types of Acne.
- Photodynamic Therapy (PDT) is also being used in some cases for treatment of acne and scar improvement, although this treatment is very effective it does have side effects and expected down time.
- Glycolic / Salicylic Acid Peels.
Skin care:
Your consulting Nurse will issue you with an individually tailored skin care regime to suit your skin type and particular to your type of Acne.
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