Quick Facts about acne
- The causes of acne are multi-factorial and different for each person, and therefore acne treatments used vary from person to person
- Acne is a medical problem that should be treated by doctors.
- Acne left untreated can lead to permanent scarring
- The main two modalities of treatment are oral medications and and medical grade skin treatments including skin care and chemical peels
- Using appropriate mineral-make up and sunscreen can also help with acne
- For acne that is resistant to the normal modalities of treatment, laser, photodynamic therapy or oral isotretinoin can be used.
What causes acne?
There are a number of contributors to the formation of acne. Excess oil and sebum production exacerbated by hormonal influences on sebaceous glands, as well as dead skin physically blocking pores can cause acne. A bacterium named Propionibacterium acnes (p.acnes) has also been implicated as a cause of acne. All treatments for acne will address one or more of these issues
There have been no studies showing that acne is caused or exacerbated by your diet, contrary to the usual belief that certain foods can worsen acne.
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- A good cleanser is the first step in acne treatment. Usually, it is best to simply use a gentle cleanser.
- Exfoliants can also help. Exfoliants with beta-hydroxy acids (eg. salicylic acid) have the advantage of having anti-inflammatory properties and are more oil soluble making them penetrate oily skin better than alpha-hydroxy acids.
- Benzoyl peroxide is a good product for reducing active acne lesions and also has anti-inflammatory properties. It is available in varying concentrations. The higher the concentration, the more flaking and irritation to the skin. Therefore, commencement should be with the lower concentrations. The author personally finds that the skin becomes accustomed to benzoyl peroxide in the long term, and tends to have less effect the longer it is used. Also it is possible to develop a benzoyl peroxide allergy.
- Topical retinoids, derivatives of Vitamin A, are also used in the treatment of acne. They remain one of the most effective topical agents in the treatment of acne. Retinoids work by increasing the natural turnover rate of the skin. Therefore there are less dead skin cells at the surface of the skin and less blockages as a result. This property of retinoids also means that skin texture and fine wrinkles also improve. Some retinoids also help to reduce the amount of bacteria causing acne in the skin.
- The downside of retinoids is the initial response of the skin, or the retinoic dermatitis . Skin can usually appear red, flaky, lumpy, and irritated for up to one month after commencement of retinoids. Starting slowly is important to reduce these side effects. Sunscreen is also imperative with the use of retinoids as they can initially exacerbate sun sensitivity. Retinoids should not be used in pregnant mothers, those planning to be pregnant, or those who are breast-feeding.
- Retinoids come in various forms. Retinoic acid, or tretinoin are examples of retinoids and include prescription-only variants such as Stieve-A, and Retin-A. Retinols are another form of retinoid. Cosmedix also has a range of retinols of varying strength. Although more expensive than their prescription-only variants, they have the added property of being c hirally correct. Each molecule has a left and a right-sided version, like a pair of hands. In the case of retinols, the left sided version is more active and less irritating to the skin.
- Cosmedix has more of the left sided version of the molecule and is therefore chirally correct. For those who have more sensitive skin, retinaldehyde serum (another version of a retinoid) can be used instead. Retinaldehyde is purported to have fewer of the adverse side effects of other retinoids with the same benefits. Many of the Osmosis products contain retinaldehyde also. Retinaldehyde has been shown in clinical studies to help reduce the bacteria that cause acne.
This patient presented to Victorian Cosmetic Institute with a long standing history of acne. After a course of Chemical Peels and the Synergie Anti-Blemish at home skin care kit he has been able to stop his breakouts and can now begin repairing his acne scarring.
This male in his twenties presented to Victorian Cosmetic with persistent acne since his teenage years. He had tried several creams, including Proactiv with no real improvement in his skin. The before and after pictures are spaced 3 months apart. The treatment during this period included; commencement of a gentle cleanser, a topical retinoid, topical clindamycin (antibiotic), a short course of minomycin (antibiotic) tablets, and two 20% salicyclic acid peels. There was significant improvement noted over his entire face by him and his close friends and family.
This patient presented to Victorian Cosmetic Institute with concerns her skin breaking out. She had tried many different treatments and products prior to coming to our clinic. Our skin therapist, Dani Feiam, placed her on a simple skin care plan of Synergie Biocleanse and Priotiy B serum. The patient also has LED light therapy treatments. This is her before and after images following her 8th treatment.
Make-up is also implicated in the cause of acne. Foundations, even those claiming to be oil-free can physically block pores and cause acne. This often leads to a vicious cycle of applying make-up to cover acne lesions, and in turn this causes more acne, leading to the use of more make-up. Acne due to make-up use is termed acne cosmetica. Mineral make-up does not block pores, and instead sits on top of the skin.
At Victorian Cosmetic Institute, we recommend Glo-minerals foundations as they have anti-oxidants and anti-inflammatory properties as well as being a mineral make-up. Importantly, they also have a SPF factor to help prevent aging and post-inflammatory hyperpigmentation from acne lesions (see below).
Antibiotics have also been widely used in the treatment of acne. Antibiotics work by reducing the acne-causing bacteria (including Propionobacterium acnes) at the surface of the skin. Antibiotics are most suited to inflamed acne lesions. They do unfortunately also affect the rest of the body as well as the skin, and can result in side effects such as oral and vaginal thrush, diarrhoea, liver function abnormalities, and sun sensitivity. Minomycin has also been associated with hyperpigmentation when used for prolonged periods.
Antibiotics such as doxycycline, minomycin, clindamycin, trimethoprim, trimethoprim plus suxamethoxazole (Bactrim), are commonly prescribed for prolonged periods. The author does not believe in the long-term use (greater than 2 months) of antibiotics for acne as their efficacy is low and the potential side effects can be significant. Penetration into the skin can also be minimal. With widespread use of antibiotics for acne, there is increasing resistance of the acne-causing bacteria to the commonly used antibiotics, resulting in a decrease in their effectiveness.
Topical antibiotics are another option for the treatment of acne. Common examples of topical antibiotics include erythromycin (Eryacne gel) or clindamycin (Clindatech lotion). As for oral antibiotics, they require a prescription from a doctor. The advantage of topical antibiotics is they have no systemic side effects, and can have some anti-inflammatory properties.
Particular hormones, in particular androgens, have also been known to increase oil and sebum production and exacerbate acne.
For females, options for controlling the hormones that cause acne include particular variants of the oral contraceptive pill. The variants that are of particular use are the ones containing Cyproterone acetate or Spironolactone.
The trade names of the pill containing these ingredients include; Dianne-35 and Yasmin. Cyproterone acetate and Spironolactone work by helping to switch off the androgenic hormones, or the hormones that increase oil/sebum production and cause acne. Cyproterone acetate (Androcur) and Spironolactone (Aldactone) can also be used without the pill in those females who do not want to be on the pill. It is, however, not compatible with pregnancy, so it is not suitable for those females who are attempting to fall pregnant or who are pregnant.
Roaccutane, or oral isotretinoin, also a derivative of Vitamin A, is the gold standard in the treatment of acne. Prescribed only by dermatologists, it is mostly used for severe forms of acne only, as it has a number of significant side effects. Generally, a six-month course is prescribed, and involves taking a tablet or two each day. The side effects from Roaccutane are the main problem with treatment and include; dry skin, dry eyes, dry lips, cracked lips, hair loss, mood changes, and liver function abnormalities. Pregnancy must be completely excluded during treatment with Roaccutane, as it is known to cause serious birth defects.
Although there are laser treatments for acne, we generally find that they are not particularly effective, and carry unnecessary risk.
<p class="plainText">Recently, there have been advances in the treatment of acne that do not involve drugs with significant side effects, and can be highly effective. <span class="plainTextLink"><a class="plainTextLink" title="" href="/photodynamic-therapy/" target="_blank">Photodynamic therapy</a></span> is such a treatment that targets sebaceous gland activity. Being a localised treatment, it only has localised side effects, ie on the treated skin. There has been some studies showing that it may be as effective as Roaccutane in some cases.</p>
<p class="plainText"><span class="plainTextLink"><a class="plainTextLink" title="" href="/photodynamic-therapy/" target="_blank">Photodynamic therapy</a></span> works by placing a substance called aminolevulenic acid (ALA) on the skin, which cause the sebaceous glands and acne bacteria to make a substance called porphyrins. These porphyrins are then activated with a light source (red or blue LED) or laser, and this produces oxygen free radicals that destroy the sebaceous gland/bacteria.</p>
<p class="plainText">This specifically disrupts the function of the sebaceous glands and reduces their activity and the acne they cause. The results can last up to a year and some people require no further treatments for acne after their initial treatments. The treatment however, can require several days of recovery, with the skin appearing very red and flaky for approximately one week.</p>
<p>Both <a href="/led-phototherapy/">red and blue LED lights</a> can be used alone on the skin to reduce acne. The lights work in a similar manner to photodynamic therapy, however, because ALA is not applied to the skin prior to treatment, it is a much less aggressive treatment. There is usually no recovery time to this treatment, but treatments are required bi-weekly for several weeks.</p>
Injection of dilute Kenacort (corticosteroid) to quickly reduce the size and inflammation of acne cysts.
<p><a href="/sunscreens/">Sunscreens</a> are important to help reduce pigmentation after an acne lesion has passed. However, some sunscreens themselves can cause acne by blocking pores. At Victorian Cosmetic Institute, we recommend Reflect sunscreen from <a href="/store/cosmedix/" target="_blank">Cosmedix</a>. Reflect is a spray on, non-oily sunscreen with Titanium Dioxide.</p>
<p>One of the most serious complications of acne is the scars or marks that remain. <a href="/acne-scarring/">For more information about acne scarring, click here.</a></p>
<p class="plainText">Our team specialise in skin treatments and will be able to give you the proper advice on the right treatment for you. Many of the treatments (both topical and oral) are prescription only and can only be prescribed by doctors, our collaborative environment of skin therapists, nurses and doctors allow for optimum care and service for each of our patients. We have an array of laser / light based therapies also for acne. We have a special interest in acne, and are up-to-date with the latest treatments. The first step is simply contacting us for your initial consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment. <strong> </strong></p>
<p class="plainText"><strong>Making that first phone call can be a confronting task – many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate</strong></p>
<p><strong>Otherwise, you can phone us directly on 1300 863 824.</strong><strong> </strong></p>