Acne is a very common skin condition that can affect people across all age groups. It happens when your pores become clogged up with oil and dead skin cells. This gives rise to whiteheads, blackheads or pimples. It can also leave behind scars and hyperpigmentation.
Acne is an inflammatory disorder that involves the pores of the skin. This is where the hair follicles and oil glands (sebaceous glands) are found. In normal skin, your pores clear out excess oil and dead skin cells. In acne, the skin cells that line your pores produce too much keratin and the glands make too much oil (sebum). These two factors make it harder for pores to clear themselves and they eventually become clogged up with dead skin cells. Worse still, the excess oil causes an overgrowth of the bacteria p.acnes that feed on sebum. These bacteria are normally present on your skin but if they over proliferate, they end up triggering inflammation. These inflamed and blocked up hair follicles and pores is what gives the appearance of pimples. If untreated, these blocked, inflamed and infected pores may continue to enlarge before bursting. At this stage, the damaged skin begins to heal itself. As a result, you may end up with scarring or post-inflammatory hyperpigmentation.
Acne can develop anywhere on the body. Whilst it’s most commonly found on the face and neck, you can also get it on your back (aka backne), chest, arms, legs, buttocks or groin. There are different types of acne and it is possible to have more than one of the following at the same time:
– Comedonal Acne – whiteheads (closed plugged pores) and/or blackheads (open plugged pores)
– Papular Acne – small red, tender bumps (papules)
– Pustular Acne – or pimples (pustules) which are papules with pus at their tips
– Nodular Acne – large, solid, painful lumps under the skin
– Cystic Acne – painful, pus-filled lumps under the skin
As with most things in life, the triggers for acne are complex. This is an area of ongoing research. We do know for a fact that hormones (specifically Androgens) cause the sebaceous glands to get bigger and make more oil. They also cause excess keratin production by skin cells. This is what triggers blockage of the pores, overgrowth of bacteria, and then leads to inflammation. Androgens are known to increase during puberty. This is why acne is very prevalent in this age group. Women can also experience increased androgen levels during menopause and in conditions like polycystic ovarian syndrome. Medications like corticosteroids, testosterone and lithium can also cause breakouts.
Whilst there is no proof that food or stress causes acne, increased stress and high glycaemic index diets have been shown to worsen it. There is also no solid connection between wearing makeup and developing acne. That being said, cleansing your face properly and using a regular skincare routine can help.
There are a number of ways to treat acne and which one works best depends on the type and severity of your skin. Typically, acne is graded as mild, moderate or severe based on how many lesions you have and their type (comedones, pustules, nodular etc). Mild acne can generally be treated at home using advanced over the counter skincare containing Benzoyl Peroxide, salicylic acid and Retinol or Tretinoin. Moderate acne generally needs prescription-strength skincare such as Tretinoin and at-home prescription skin treatments such as Obagi Clenziderm MD. If you suffer from severe acne, you can try to use prescription skincare such as those we provide for moderate but it is likely you will need additional treatment such as antibiotics and/or oral isotretinoin (Accutane).
Professional in-clinic treatments for all types of acne typically involve chemical peels that reduce inflammation, unclog pores, even out skin tone and smooth skin. Microneedling and laser therapy can be used to treat acne scarring and irregular texture. These treatments are effective but patient selection is important and they require a course of treatments. It is especially important for patients with skin of color to seek an experienced medical professional as these treatments can sometimes trigger post-inflammatory hyperpigmentation.
Prescription skincare remains the mainstay of treating all groups of acne and at home skin systems such Obagi Clenziderm MD and Tretinoin cream are two of the most poular combinations. These treatments when prescribed correctly are as effective as in-clinic treatments but with less downtime. Furthermore, at home skin treatments can also be used to address acne scarring and post-inflammatory hyperpigmentation using systems such as Obagi Nu derm and Obagi-C.
If you prefer to try over the counter skincare for mild breakouts, there are a vast number of options available. Look for skincare products containing Benzoyl Peroxide, Azelaic Acid, Salicylic Acid, Retinol and Vitamin C. These products can help improve breakouts, smooth texture and even out skin tone.