What is Acne?
Acne is a condition where the bacteria Propionibacterium acnes accumulates and may cause a persistent inflammatory reaction of the hair follicles within the skin. Although acne is often seen as an adolescent right of passage for teenagers around the globe it can also affect adults and have a significant impact on confidence and self-esteem, which can impact happiness, relationships and also career. At the Hedox Clinic, we take the treatment of acne very seriously and have successfully treated many patients with highly effective cosmeceutical creams. There are a number of misconceptions regarding the most effective ways to prevent and treat acne. Indeed, in most cases, it is a highly treatable disease and there is no need to give up on finding a way to manage it. In people suffering from acne, influential factors vary from person to person but may affect acne include: genetics, diet, hormones, medications, make-up as well as facial products used. Acne may be classified as either inflammatory or non-inflammatory. Blackheads and whiteheads are considered non-inflammatory, while pustules, nodules and cysts are considered as inflammatory acne.
Best treatments for acne; Hedox Clinic’s Top Tips
How can I treat it?
What we eat is not the only cause of acne but it may be a significant factor in some cases. There are many examples of people with terrible diets and clear skin, but for people with acne-prone skin it is worth paying closer attention to what is on your plate. There are certain food groups that can be a trigger for certain people, but this varies from person to person. If you have moderate to severe acne that is affecting your life then it is worth considering excluding specific food groups or types fin a controlled systematic fashion or a few weeks to see if it has an impact on your acne. Examples include milk and dairy products, white bread/wheat and gluten, sugary foods and drinks, chocolate(!) and seafood. Conversely, the Mediterranean diet may reduce the severity of acne in some people. Ironically, oily/fatty food is not thought to be a major cause of oily acne-prone skin. It is worth considering diet as a factor and what we eat is an important factor in the development of acne for some but not for others.
A good quality face wash is an important foundation in the treatment and prevention of acne. Generally, normal hand soap is not recommended as this can lead to excessive drying or even cracking of the skin and impair its barrier function. The face wash needs to clear away dirt, bacteria, make-up to prevent acne from developing in future as well as preparing the skin for the absorption of other cosmeceuticals designed to treat active acne. A hypoallergenic face wash is typically recommended for acne-prone skin and at the Hedox Clinic, we would recommend Clenziderm face wash, which contains salicylic acid 2%.
Chemical peels using acids applied directly to the skin such a salicylic or glycolic acid are used in some clinics for mild to moderate acne and can be effective for exfoliation as well as neutralising bacteria. However, their effects are typically temporary and therefore they need to be performed in the clinic repeatedly making them a less practical option for many people.
Salicylic acid preparations and other similar acids may be used effectively to neutralise acne-causing bacteria as well as clear dead skin cells and sebum (oil) from the pores to prevent blockages. Salicylic acid is good as a single product for mild to moderate non-inflammatory acne or in combination with retinol and benzoyl peroxide for more severe inflammatory acne. It does not typically affect sensitivity to the sun and can be used long-term if necessary incorporated within a face wash to prevent acne coming back after it has been treated successfully.
Retinoids are different forms of vitamin A and two of the best ones for treating acne are retinol and tretinoin. They prevent plug-formation within the hair follicles by exfoliating dead skin cells and may also minimise scar formation. Retinol may be used alone as a cream while tretinoin is more potent and may be used alone in low concentrations or mixed in with a face cream. When first using topical retinoids you may notice redness or irritation of the skin until the skin becomes used to the product. This means that if the redness of your skin increases it is best to stick with it where possible as it is highly likely to subside over a period of days. As well as being effective for acne retinol and tretinoin may also increase the production of new skin cells and stimulate new collagen formation, resulting in an anti-ageing effect via the smoothing of fine lines. This can improve the texture, tone and youthful appearance of the skin while simultaneously reducing acne. Due to the potency of these products, it is best to start with a very small amount every second day and gradually increase the dose over time to achieve the best results while minimising any redness or irritation.
Benzyl peroxide acts as an antiseptic on bacteria deep within the pores in order to treat and prevent both inflammatory and non-inflammatory acne. Benzyl peroxide also helps to clear the pores of excess dead skin cells and sebum (oil) which can result in blocked pores and large inflammatory cysts. It may be applied 10-15 minutes after cleansing the skin and should be used sparingly to avoid irritation of the skin and may be associated with a degree of sensitivity to the sun. Benzyl peroxide-containing creams are a good choice for inflammatory acne and is a popular recommendation at the Hedox Clinic for moderate to severe acne.
It is vital that a good hypoallergenic non-comedogenic (non-blackhead forming) hydrating moisturiser is used twice daily to help maintain the integrity or barrier function of the skin. This prevents more bacteria from penetrating the skin and counteracts any drying or minor irritation associated with the other acne treatments.
Tablets for Acne
Oral antibiotics such as erythromycin, minocycline or doxycycline may be prescribed in cases of moderate to severe acne to reduce bacteria in the skin, which can in turn lead to reduced inflammation. They may be used alongside topical creams such as benzoyl peroxide. Antibiotics are effective in some but not all cases and it can take months to notice an improvement. Unfortunately some bacteria may develop resistance to antibiotics making them ineffective. In addition, oral antibiotics can cause gastrointestinal side effects such as nausea and diarrhoea as well as having a negative impact on the intestinal flora (the ‘good bacteria’ in the gut).
It can be a significant challenge to treat acute acne but old acne scarring can be even harder to get rid of. A combined approach is essential for the worst acne scarring such as pitting and chronic pigmentation. A series of chemical peels or laser therapy can help to smooth out the texture and to a certain extent the tone of the skin, but can only go so far. Dermabrasion is useful for disrupting the scars with multiple tiny needles so that when subsequent healing occurs the surface may be smoother and more uniform. For the deepest most severe individual pitted scars Subcision with a needle at a highly medical aesthetic specialised clinic may be indicated. Finally, to tackle significant persistent pigmentation, lightening agents such as hydroquinone or arbutin are the most effective method. Hydroquinone is absorbed deep into the skin and blocks the conversion of tyrosine to melanin, which is what gives the skin its colour. In persistent hyperpigmentation, there may be disordered melanin production meaning that too much melanin and therefore pigment is produced. Tretinoin may also help to improve texture and tone via enhanced exfoliation and via the stimulation of the production of new skin cells, which may speed up the effects of hydroquinone.
Just don’t !!!