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 on 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 an 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 sea food. 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. An 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 to 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 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 clearing 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 effect sensitivity to the sun and can be used longterm 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-aging 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).
Oral contraceptives may be effective for some women with mild to moderate acne, especially if the symptoms are worse with the menstrual cycle. However, they can take weeks to have a significant benefit and the acne may return in some cases after the tablets are stopped. Family practice Doctors (GPs) typically have significant experience with prescribing appropriate oral contraceptives containing different strengths of oestrogen and progesterone.
Oral Isotretinoin is a vitamin A derivative and may be very effective for moderate to severe acne, however, it has a long list of significant side effects that include birth defects, sensitivity to the sun, thinning hair, very dry mouth and nose, clinical depression, abdominal and joint pains. For these reasons, the Hedox Clinic would only ever recommend this as an absolute last resort after very careful consideration and with close monitoring and never during pregnancy. So far all the people that we have treated in the Hedox Clinic have managed to achieve good results without using this drug.
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 an 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 or 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 !!!
Non-prescription Acne Kit: £89.50
Best for: Mild-to-moderate acne only, treatment and prevention. For moderate-to-severe acne prescription products may be more appropriate.
Obagi CLENZIderm M.D. Daily Foaming Cleanser (£34.50)
Obagi Retinol 1.0 (£57)
- Obagi CLENZIderm M.D. Daily Foaming Cleanser - Helps adjust sebum levels and reduce follicle blockage and clears pores. A light, foaming cleanser specifically formulated with 2% salicylic acid for acne-prone skin and blemish outbreaks, it neutralises the bacteria which cause acne. Calming menthol helps to leave skin feeling clean, calm and fresh by removing excess oil, dirt and other impurities, while soothing inflammation and minimising redness. May be used as part of a system to control or prevent acne.
- Obagi Retinol 1.0 - With minimal irritation, this high concentration Retinol formula minimises the appearance of fine lines and wrinkles. It improves complexion, and smoothens the appearance of uneven skin texture for clearer-looking skin*. Retinol 1.0 can be used in conjunction with other Obagi Systems or as a stand-alone product.
* please see ‘additional information’ section below regarding safety.
|Prior to Retinol use, alert your clinician of any of the following: Prior or existing eczema. Sunburn. Pregnancy or breastfeeding, suspicion of pregnancy or plans to become pregnant or breastfeed.
During Retinol use, you should: Minimise overall exposure to the sun and to extreme cold or wind. Avoid sunlamps, tanning beds and ultraviolet (UV) light. Use SPF30 (minimum), and wear protective clothing including a wide-brimmed hat. If sunburn does occur, desist use of Retinol. Minimise skin washing, scrubbing the affected/treated areas of skin, or using other products with a drying effect, particularly those containing Retinol (unless otherwise indicated by your physician).
Possible Side-Effects:- Skin dryness, Skin irritation, Redness, Excessive flaking or peeling. If you develop any of these symptoms your clinician will determine how to proceed. The advice may range from stopping use for a period of time, to decrease the number of applications, or to stop use completely. Tell your clinician about any side effect that bothers you or does not go away. The safety and efficacy of Retinol has not yet been established in the treatment of patients younger than 12 years of age or in pregnant or nursing women.
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