What Is It?

Acne is a common chronic disorder of sebaceous glands (oil glands) which causes pimples. When the openings to the oil glands become blocked, there is a build-up of oil and bacteria and subsequent inflammation. Presentation varies from person to person and can include blackheads, whiteheads, pustules and/or nodules or cysts. Acne generally occurs in areas where there is a high concentration of oil glands, i.e. the chest, face, neck, upper back and shoulders. Although acne is most commonly seen in teenagers, it can affect people of all ages. Females and males of all races are affected.

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What Causes it?

Acne is due to a combination of many things including

  • Genetics – inherited factors play a role, with acne being more likely to occur in those that have other affected family members.

  • Hormones – early in life, the body produces androgens (male hormone) and the amount produced increases following puberty. Oil glands (sebaceous glands) respond to androgens by making more oil (sebum). Additionally, some types of the oral contraceptive pill (androgen-containing pills) and pregnancy may aggravate acne.

  • Bacteria – increased numbers of Propionibacterium acnes in the skin contribute to pimples. The presence of this bacteria is not due to being dirty or failing to wash the face – it is specific acne bacteria.

  • Blockage of sebaceous glands – skin cells on the upper part of the hair follicle fail to shed and instead form a blockage around the follicle, causing oil to be trapped in the skin, resulting in the development of comedones.

Factors that aggravate acne include

  • Underlying medical condition such as polycystic ovarian syndrome.

  • Medications such as hormones, antidepressants, anti-seizure medications and steroids can cause or aggravate acne.

  • Occlusive cosmetics.

  • Oil-based hair products.

  • Occlusive clothing and pressure from things such as head bands may aggravate acne.

  • Stress stimulates the adrenal glands to produce more androgens, which increase oil production in the skin.

  • Diet – several studies have confirmed that a low-glycaemic diet (i.e. one low in refined sugar such as consumption of cakes, biscuits, sugar) and high in whole grains, fresh fruits and vegetables and fish) can be helpful for management of severe acne.

How Does Acne Present?

  • Acne is characterised by red bumps, papules, pus-filled bumps (pustules), as well as small black dots – blackheads (open comedones), and small white dots (whiteheads) (closed comedones). While some people mainly develop blackheads and whiteheads, the majority develop red pimples, and many have a combination of acne types. If acne progresses and becomes worse, larger deep and tender lumps may develop, consequently leading to scarring.
  • Acne that is hormonally driven in women, often flares monthly and is more commonly seen in the lower cheeks and jawline.

What Other Problems Can Occur?

Post-inflammatory pigment changes (especially post-inflammatory hyperpigmentation), keloid scars and scars can occur in those with acne. Many patients suffer from low self-esteem and depression due to acne, so it is important to discuss your feelings with your dermatologist at the time of consultation.

How is Acne Diagnosed?

Tests are not usually required to make the diagnosis. However, blood tests may be required in females to exclude underlying causes of acne (polycystic ovarian syndrome).

How is it Treated?

Acne treatment needs to be individualised, depending on the type and severity of the acne that you have, what the precipitating factors may be, your medications and hormonal profile and your general health. Early treatment is encouraged to prevent or minimise scarring. Treatment aims include decreasing the number of pimples and blackheads/whiteheads and to limit pigment changes and scarring of the skin. Acne medicines work in several ways to control acne that include countering the effects of hormones, reducing oil production in the skin and killing bacteria that cause clogged pores and pimples.

The best strategy for management will be by consulting with a specialist dermatologist who can provide many options for treatments to ensure that you get the most aesthetically pleasing results and minimal scarring.

General measures:

  • Avoid harsh scrubbing, exfolients and toners.

  • Consider dietary factors – avoid smoking and excessive alcohol and enjoy a well-balanced diet (low glycaemic-index diet).

  • Washing and cleaning with oil-free products, tepid water and a face cloth to remove oil.

  • Sunscreens/creams/cosmetics should be non-greasy, “non-comedogenic” (meaning they do not block pores).

Mild acne can be treated with oil-free over-the-counter preparations and washes. Topical Vitamin A-derived medications and antibiotics may be needed.

Moderate acne may require oral antibiotics such as Doxycycline, Erythromycin, Minocycline and Trisul. These are used for their antibacterial and anti-inflammatory effects and it usually takes up to two months to see a reduction in your acne. Most patients need to stay on these medications for at least six months. If there is no response to these medications in combination with creams and tablets, oral Isotretinoin should be considered.

Severe, treatment-resistant acne with large papules and scarring usually requires oral Isotretinoin. This medication ideally should be prescribed by a dermatologist.

Hormonally-driven acne determined by blood tests and by the clinical presentation to the dermatologist can be treated with certain types of anti-androgen medications (oral contraceptives), Spironolactone and Cyproterone acetate).

Additional treatments that may be of some benefit in selected patients include pulsed-dye laser for redness and radio-frequency devices for acne scarring whilst on Isotretinoin. Larger, painful acne scars may be injected with corticosteroid injections.

What’s the next step?

If you already have an appointment booked at The Skin Specialist Centre, you can easily add an acne treatment consultation to your booking by calling our friendly team on (09) 524 5011. If you have never been to The Skin Specialist Centre, you can either give us a call on (09) 524 5011 or make an enquiry by clicking on the Enquire Now option below.