Acne Vulgaris

What is acne?

Acne Vulgaris (acne) is an inflammatory skin condition which is characterised by disorder of the hair follicle and sebaceous gland. This causes whiteheads, blackheads, and inflammatory lesions like; papules, pustules and nodules. This can appear on the face, neck, chest and back which are commonly known as hormonally sensitive areas . Although commonly considered a teenager condition although it affects people of all ages

The formation of acne is multifactorial and are four main contributors for acne to form:

• Increased sebaceous gland activity cause an increase in sebum production.
• Follicular hyperkeratinisation
• Cutibacterium acnes (C.acnes, previously known as Propionibacterium acnes)
• Inflammation

These main contributors can be aggravated by; skin trauma, hormonal changes, diet, stress, insulin resistance, high body mass index, genetics and skin care products.

It is still not fully understood the events which lead to acne to form however it has been postulated that the formation of acne involves both host factors and dysbiosis within the skins microbiome.

How is acne classified?

Acne lesions can present in various ways:

• Closed comedones: Commonly known as white heads. <5mm white or cream coloured dome shaped lesions.
• Open comedones: commonly known as black heads. <5mm opened lesion with a visual opening appearing grey, black or brown. Compromises of keratotic material.
• Papulopustular Acne: Inflammatory lesions superficial papules. Typically these lesions are <5mm
• Nodular Acne: Inflammatory lesions however very deep. These lesions can be very tender to touch. Very large Papules or Nodules.

It is not uncommon for acne to present as all four types or just one type.

Acne can be classified as mild, moderate or severe.

Mild: <30 lesions

• Usually limited to only blackheads and whiteheads
• Usually affects a small area (portion of the face or neck or body)

Moderate: 30-125 lesions

• More widespread affecting a larger area
• Breakouts tend to last longer and often require intervention to assist in clearing.

Severe: >125

• Severe acne can also be considered acne which has the formation of papulopustular and nodular lesions which are causing scarring.
• Breakouts cover majority of an area and can affect more than one body unit.
• May take years to fully clear acne breakouts.
• Untreated severe acne is likely to cause life-long scarring

How is acne treated?

Mild:

• Appropriate skin care
• Topical anti-acne agents
  • Benzyl Peroxide
  • Tretinoin
  • Adapelene
• Nutritional support
• Skin hygiene education
• Chemical Peel
• LED light
• BBL

Moderate:

• Additions onto mild acne treatments
  • Oral antibiotics
  • Oral supplements
  • Oral contraceptives
  • Anti-androgen therapy for women not responding to oral contraceptives
  • Isotretinoin

Severe:

• Referral to a dermatologist for early intervention with Isotretinoin to prevent complications associated with acne.

Skin care for acne

There is not one treatment or advice which is better than the other.  The combination of treatments including those performed at home are recommended.  It should be understood that unfortunately acne cannot be cleared overnight.  Acne lesions usually take 6-8 weeks to mature into a lesion therefore waiting at least 3 months before deciding if a treatment or regime is working or not is advised.

Skin care and skin hygiene are the perfect starting points when self-managing acne treatments., especially because all of these can be done in your own home.  These two factors are also the two mainstays for acne management.

Skin care starts with the choice of appropriate skin care products.  Although the idea of rubbing and scrubbing to ensure your face is super clean and removed all oil present sounds like the perfect way to treat acne prone skin, unfortunately it is the complete opposite.  Acne doesn’t respond well to harsh or chemically rich products.

• Cleanser tips:
  • Gentle soap-free or acne cleansers
  • Avoid facial scrubs with grit-like particles

Although contrary to beliefs that because the skin is overproducing oil, a moisturiser is unnecessary.  Some topical products used during acne treatments may cause a drying effect and a moisturiser can combat these side effects. When choosing a moisturiser it is important to discover what type might be suitable for you.

• Moisturiser tips:
  • Look for “oil-free” and “non-comedogenic” on the label.  This means it is less likely to clog the skin.
  • Sometimes a serum with hydrating properties like Vitamin B or Hyaluronic Acid can provide moisture without being too heavy

Sun protection is another very important aspect of acne skin care.  Some at home topical can cause sun sensitivities which is why it is important to use sunscreen daily.

• Sunscreen tips:
  • Choose an SPF with UVA/UVB protection (Broad Spectrum)
  • Sunscreens are available in a variety of consistencies.  Again look for “oil-free” and “non-comedogenic” on the label.

Sometimes wearing makeup or using camouflage can increase skin confidence. This can help conceal redness, scars and blemishes.

• Makeup tips:
  • When looking towards cover-up look for mineral based products as these allow your skin to breathe and less likely to cause further breakouts.
  • Mineral powders can help absorb excess oil.
  • Some make up brands are starting to incorporate soothing ingredients like Zinc and moisturising ingredients like Vitamin B.

• General skin care tips:
  • Avoid toners as these can further irritate acne-prone skin. Micellar waters are better choice.
  • Using less is sometimes more, more products or more application quantities can cause the skin to breakout.
  • Simple is sometimes best.

You should start to see results within 4-12 weeks.  If you have commenced an acne-friendly skin care regime with uncomplicated products however you are still chasing results, book a consultation with one of our friendly Skinfluencers to educate you on the most appropriate skin care products for your acne.

Skin hygiene for acne

It is not just about the products that you put on your skin, but also how you look after it. These are some simple tips that can enhance your skin care regime at home:

• Cleanse twice daily (once in the morning, once in the evening) with clean hands.  Avoid using loofahs or wash cloths as these can harbour bacteria.
• Avoid using hot water rather warm water.
• Avoid picking or squeezing lesions as this can cause further risk to scarring and introduce other bacteria and pathogens into the skin.
• Avoid vigorous scrubbing or rubbing of the skin. Excessive exfoliation can aggrevate acne.
• Clean makeup brushes weekly.
• Change pillow cases and towels twice weeky. Change bed-sheets weekly.
• Immediately after exercising cleanse the skin to remove oil, sweat or dirt.This can be performed with Micellar waters to prevent a full facial cleanse.
• Keep hair clean and free from covering face.

Complications of acne

Scarring

Unfortunately the nature of acne can affect more than just the superficial layers of the skin which can result in what is known as acne scarring. Sometimes these scars are flat, pitted, red, raised, bumpy, brown or white. Acne scars can sometimes heal themselves over time whilst other times may require some intervention to improve their appearance.

At Skinfluence we offer a range of services and treatments to assist in improving acne scarring.  Different scars require different treatments.  Some treatment options include; laser or non-laser treatments, dermal filler, steroid injection and surgical removal. A consultation with one of our Skinfluencers can determine the best treatment options for you and your acne scarring.

Psychological

Acne can have a serious affect on the mental health for patients.  Patients may avoid social situations, skip school, avoid sports,  or start to retreat from daily activities. At Skinfluence we believe in creating a safe environment for patients where they are safe to disclose their feelings about their skin.  We treat patients as a whole, not just what we can see on the outside.

There is such an increase in pressure placed on the facial appearance of all individuals.  Skinfluence has regular contact with local psychologists to assist patients to discuss their situations.  Alternatively Beyond Blue (www.beyondblue.org.au), Lifeline (www.lifeline.org.au) or Kids Helpline (www.kidshelp.com.au) are excellent services and organisations.