Acne

Acne is the most common skin disease, affecting 85% of Australians aged 15–24 years old. Very few people manage to escape their teenage and young adult years without some pimples and blackheads.

Acne often clears spontaneously. For some people, however, Acne is a far more serious problem — with the possibility of permanent physical scarring and significant emotional effects.

What causes acne?

Acne happens when the pores in the skin become blocked. Hormones make the oil glands produce more oil (sebum) and the skin cells become sticky. The oil and sticky cells then block the pore. A common bacteria called P. acnes builds up in the pore causing redness and inflammation. The face, neck, chest, shoulders and upper back are the areas mainly affected because they have the highest number of oil glands. Acne usually starts at puberty when increased levels of sex hormones cause an increase in the size and oil production of the oil glands. A family history of Acne may also increase your chances.

Acne myth busters

Because Acne is so common, it's the subject of much discussion — and many myths.

• No single food causes Acne (though a low GI diet may help)
• You can't wash Acne away — don't over-wash
• Picking your pimples will make them worse and can lead to scarring
• Stress can aggravate Acne-prone skin

Acne treatment advice

Most Acne can be successfully treated — it takes time and patience. The best skin-care routine is to follow these simple steps twice a day:

1. Use a gentle skin cleanser and pat dry
2. Apply your Acne treatment to the entire affected area
3. Finish with oil-free sunscreen during the day. If your skin is dry, add an oil free moisturiser

What really works?

• Mild Acne can often be treated with pharmacy products such as benzoyl peroxide
• Moderate and chronic Acne can be controlled with good skincare and prescription Vitamin A
• Severe Acne that is not responding may require referral to a dermatologist

If you use a moisturiser or make-up, make sure they are oil-free. Look for products labelled 'non-comedogenic' or 'non-acnegenic'. Use a gentle, non-soap cleanser rather than scrubs — irritating the skin can actually produce more Acne. Don't squeeze whiteheads or red lumps, as squeezing increases severity, depth and the risk of permanent scars.

Avoid direct UV light — many Acne treatments make skin more prone to sunburn. Always use an oil-free sunscreen.

Tips for managing acne

Acne in adults

For adults, Acne can be as mystifying as it is embarrassing. Today, approximately one-third of patients who seek medical help for Acne are over the age of 21. Research has shown that people suffering with Acne can experience problems with self-esteem, body image and self-confidence, and may suffer social withdrawal, depression and limitations of their lifestyle.

The Acne cycle

In Acne, the skin's oil glands overproduce oil. Dead skin cells become sticky and clump together, mixing with oil to form a plug that clogs the pore. If the pore wall ruptures, inflammation occurs. The proliferation of P. acnes bacteria leads to further inflammation — resulting in pimples. Large inflamed lesions (nodules or cysts) often lead to severe hyperpigmentation and scarring.

The four components of acne development

• Hormones — Androgens such as testosterone control the size and oil output of the oil glands. Some people have skin that is particularly sensitive to testosterone.
• Abnormal shedding of skin cells — Dead skin cells shed at an abnormal rate, becoming trapped with excess oil, causing clogged pores.
• Proliferation of P. acnes bacterium — Acne-prone skin can generate excess levels of this bacteria.
• Overblown immune response — The body overreacts to localised inflammation, resulting in extreme inflammation.

Isotretinoin (Roaccutane)

Isotretinoin is the only drug that influences all four factors of Acne development. Used for patients with severe cysts and nodules, it is usually prescribed after all other courses of treatment fail. The course of treatment is typically 20 weeks.

Isotretinoin is a teratogen — it will cause birth defects if taken during pregnancy. It is essential that women of childbearing years use reliable contraception throughout treatment and for a period determined by their doctor after treatment ends.

Tretinoin — the most effective topical treatment

The single best topical pharmaceutical weapon against Acne is tretinoin. A mainstay of Acne therapy for nearly four decades, tretinoin normalises the shedding of dead skin cells, promotes drainage of existing pimples and inhibits formation of new pimples and inflammatory lesions.

Tretinoin is one of the components of the Dr P Skincare programme. Used in conjunction with other ingredients, it can help break the breakout cycle and return the skin to a healthy state.

Types of Acne lesions

The microcomedo

Also known as a clogged pore, this is the first and smallest type of Acne lesion. It occurs when the hair follicle walls are just beginning to be stretched by trapped oil. If it does not rupture, it will progress into either a blackhead (open comedo) or a whitehead (closed comedo). Usually, the microcomedo will not cause Acne scarring.

Pimples

Pimples are small round lesions that contain visible pus beneath the surface of the skin. They are inflammatory and often painful. They do not usually contain a lot of bacteria — the inflammation is usually caused by chemical irritation from excess oil. These lesions usually leave scars behind, especially if they are picked or squeezed.

Polycystic Ovarian Syndrome (PCOS) and Acne

PCOS is the most common endocrine problem in women, affecting 5–10% of premenopausal women. One of its most common presentations is Acne (along with irregular periods, excess weight gain and excess hair growth). Women with PCOS have elevated levels of free testosterone, which stimulates the oil glands, leading to acne.

At present, only two compounds suppress the oil glands: prescription Vitamin A (delivered via creams containing tretinoin) and oestrogen (usually via the oral contraceptive pill). For women with both Acne and excess hair, contraceptive pills like Diane 35 ED can have a dual benefit.