What is acne?
Acne is a disorder of the hair follicles and sebaceous glands. Acne begins with blocked pores which become infected and progresses to pimples and/or cysts which can leave permanent scarring.
Acne is very common. 90% of the population are affected by acne at some time. It most often begins in puberty.
An ounce of prevention…….
Treating acne early, and for as long as necessary, is the only sure way to prevent or limit acne scarring. Acne scarring usually results from severe cases of nodular or cystic acne. These types of acne penetrate deeply into the skin where eruption unleashes trapped bacteria that damage surrounding collagen tissue. Scarring occurs when collagen attempts to regrow, but does so in a disorganised manner, disrupting the natural healing process of the skin. Even with treatment, acne scarring can rarely be eliminated completely, which means early treatment of acne is crucial to reducing the long term risk of scarring. A combination of over the counter or prescription acne treatments, good cosmeceutical skin care and cosmetic treatments such as microdermabrasion and/or light peeling, help prevent acne scarring developing for the majority of sufferers.
What causes acne?
During puberty, levels of male sex hormones, called androgens, rise in both boys and girls. Androgens activate the sebaceous, or oil, glands in our skin, causing them to produce more oil, or sebum. Dried oil, dead skin cells, and bacteria accumulate and block to flow of new oil to the surface of the skin, creating collections in the skin which we see as white heads or black heads. When follicles become blocked, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation, pimples and infection.
Other factors playing a role in acne include the following:
- hormone level changes during the menstrual cycle in women
- certain medications (such as corticosteroids)
- oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
- friction or pressure from helmets, backpacks, or tight collars
- environmental conditions (such as humidity)
- Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.
What are the symptoms of acne?
Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands: face, chest, upper back, shoulders, neck
The following are the most common symptoms of acne. However, each person may experience symptoms differently:
- pus-filled lesions that may be painful
- nodules (solid, raised bumps)
Treatment of Active Acne
The goal of acne treatment is to prevent or minimise scarring and relieve symptoms. Which type of treatment you need will be determined by the severity of your acne.
Topical medications to treat acne:
- Benzoyl peroxide: kills the bacteria (P.acnes) and reduces oil production
- Topical antibiotics: helps stop or slow down the growth of P. acnes and reduces inflammation
- Preparations containing Vitamin A stop the development of new acne lesions (comedones) and encourage cell turnover, unplugging pimples
- Azelaic acid: helps stop or slow down the growth of P. acnes and reduces inflammation
Oral medications to treat acne:
- Oral antibiotics. These are often used to treat acne and many patients stay on these medications for some months. They have an excellent safety record in acne patients.
- Hormonal medications. For females, certain contraceptive pills and similar hormones can be useful in controlling acne in selected patients
- Oral vitamin A
This is the most effective treatment for severe cystic acne and is a saviour for many patients with significant acne. It will virtually always control acne, even in cases where other treatments have failed. It can only be prescribed by dermatologists, as it requires their knowledge and expertise to be used correctly. It reduces the size of the sebaceous glands that produce the skin oil, and makes the pores less easily blocked, thereby reducing the development of acne lesions. Like all medications, it has some potential rare side-effects, but has been used for over 25 years in millions of patients world-wide and has an excellent safety record.
Acne Scarring Treatments
Prevention is better than cure. Active acne should be treated aggressively, as above, and for as long as necessary to prevent acne scarring.
Acne scarring can rarely be eliminated completely, but significant improvements can be achieved with persistence. Acne scars come in a variety of forms – including ‘ice-pick’, box car, rolling, raised or hypertrophic, and red or white scars – each of which responds best to a particular treatment. Treatment options include laser, subcision, fillers and skin needling. Treatment of acne scarring almost always requires repeated treatments over a number of months for best results.