Acne Clinic

Why do I get spots occasionally?
Spots are usually caused by hormonal changes in your body. The hormones that cause spots are called androgens, which are really male hormones, but both men and woman have these androgens circulating in their bodies. The androgen levels vary during female monthly cycles and also increase in response to other stimuli, such as stress and certain medications including some oral contraceptive pills. It has been shown that varying levels of stress provokes acne spots. One study of female university students revealed they had more spots after the stress of end of term exams, however, it may take several weeks for the spots to show themselves after periods of stress.

Do I have more male hormones when I am menstruating or when I am stressed?
Yes the levels of male hormones increase compared to your levels of oestrogen during the menstrual cycle. These increase just shortly before you start menstruating, which is why you tend to get extra spots in the few days before the end of the cycle. With some oral contraceptive pills that are low in oestrogen, the male hormones are more active again, causing spots.

Why does squeezing spots make them worse even if I am scrupulously clean with hand-washing?
Spots contain mainly acne bacteria. If you squeeze the spots this tends to force the acne bacteria into the surrounding skin where it may cause more redness and inflammation and often a much larger spot than you had in the first place. So resist squeezing, and instead apply a spot gel up to four times a day.

There are four causes of acne – but what are they?

• The first is when the duct from the acne gland to the skin surface known as the oil duct gets blocked.   Whiteheads and blackheads are caused by a build up of oil beneath the skin surface.
• The oil (sebaceous) gland is also stimulated to produce more oil by the increase of androgens.
• Acne bacteria grow very easily in the warm oil build-up.
• System imbalances affect the skin resulting in redness, painful spots, pus filled spots, and scarring.

How would these different causes be treated without going to a doctor? And how am I going to treat my four causes of acne?
I will separate this into the different causes and then the treatment. Blocked pores including blackheads and whiteheads – here we must unclog the plugged pores, and one of the best approaches for that is to use products with ingredients like Salicylic Acid, which will free up the pores by loosening the stickiness of the skin cells in the pore and thus allowing it to shed more readily. Acne bacteria can be killed with treatments such as antibiotics. Improving blood flow to reduce inflammation can be helped by Niacinamide (Vitamin B3), found in Dr Nick Lowe’s  acclenz™ Blemish Solutions Range. Other approaches include gentle exfoliation, particularly in conjunction with Salicylic Acid will help to exfoliate and remove the contents of blocked pores. The  acclenz™ Purify & Renew Foaming Cleanser can assist in this process.

Is there anything that you can do to stop the oil production?
The surface oil can be reduced by cleansing toners containing ingredients to remove surface oil, such as the acclenz™ Purify & Renew Foaming Cleanser which helps to reduce further bacterial growth. There is some evidence that ingredients such as Niacinamide and zinc are highly effective in reducing the oil production. The most powerful way of reducing oil production is the oral medication, Isotretinoin (Roaccutane). This shrinks the oil glands and produces a complete reduction of oil, leading to remission in most patients. Consult your doctor on this option as it is unsuitable for some people, including pregnant women.

The most common cause of acne is a blockage of the duct between the oil glands and skin’s surface. Sex hormones, predominantly male “androgens”, which are present in both males and females, cause these blockages – particularly in those with a genetic tendency toward acne. The face and upper body are covered with hair follicles which are easily blocked by the hormones over-stimulating the oil glands. Several signs of acne can occur as a result; although this process can take up to 6 months to appear in the form of a blackhead, whitehead, pustule or nodule.

Acne generally appears with the onset of puberty, due to release of the sex hormones, and improves as these hormones settle, generally around the age of 20. A growing number of adults in the UK suffer from adult acne, with at least 10% of women and 3% of men struggling with acne often due to hormonal imbalances caused by stress. The hormone system can thus be regulated through targeted treatment, including birth control which controls androgen production in women. In both sexes, topical and medical treatment and lifestyle changes including stress management can improve or eliminate most acne.

Some acne terms: Blackheads, unlike whiteheads, are open to the surface. Skin cells and bacteria get trapped within these blocked pores, and the result of multiplying bacteria and blockage is a pustule or pimple, which has a pus-filled head and will eventually burst. The pore may shatter as a result of a backlog of material under the surface, and this creates a deep red acne nodule.

Acne sufferers may be frustrated by the inefficacy of some over the counter products, or by the duration of treatment which may be long (up to or over 4 months in general). However, it is important to keep in mind that the condition is treatable, which Dr Lowe emphasises, “You have a medical condition which can be treated- don’t lose hope!”

Our advice:
Avoiding products such as milk, ice cream and baked products containing dairy can help lessen acne by reducing your hormone intake. Insulin production also affects hormones, so a low sugar diet in general is advisable; regulate your fruit, sweet, and white carb intake, and fill up on whole grains, vegetables and high quality proteins.

Smoking can increase blackhead acne, and places stress on the bodily systems; quitting smoking will help your skin stay clear and youthful. Stress is also a large factor in acne production, particularly at times such as post-pregnancy and during examinations, and should be avoided through relaxation, meditation and improved wellbeing. ‘Picking’ your spots is not advisable, as it damages the skin further and leads to post-acne scarring.

Touching your face frequently can put “pressure” on the contents of pores, causing them to leak into surrounding areas and form inflamed ‘blind’ nodules. Scarring can be treated by acne pulsed light therapy and laser treatments including the highly effective ‘Isolaz’, offered here at Cranley Clinic. Some birth control pills, such as the ‘mini pill’, do not help regulate hormones and so are not helpful in the treatment and management of acne. Therefore, women who suspect that their hormonal system is the culprit in their acne should investigate hormone-blocking birth control, ideally containing drospirenone (Yasmin is a popular choice). However, the risks of side effects including blood clots and stroke are much increased with these types of birth control and so caution should be taken with use.

Over the counter creams and washes can be helpful in killing skin bacteria and keeping skin clear. The most effective products often contain harsh ingredients, however, so sensitive skin should be careful and usage should be determined by personal irritation tendency. Basic cleansing, Dr Lowe believes products should be gentle and rely on mild yet effective ingredients, unlike many harsh products available which can strip the skin. Exfoliating more than twice a week is not advisable for acne-prone skin, as it may lead to skin irritation and redness, so any exfoliants used should be mild. The Dr Nick Lowe acclenz™ Range provides a comprehensive solution for acne problems. Topical medications obtained from your dermatologist can be useful in opening and emptying plugged pores.

The initial breakout which many patients experience may be disheartening, but is usually a sign of breaking down the plugs which cause acne, and should therefore clear up within a short time. Medicines include adapalene (Differin) and retinoids (Retin A). These may be used in conjunction with an antibiotic regime, such as doxycycline, minocycline or tetracycline, to treat infection. Side effects can occur with antibiotic use including yeast overproduction and increased risk of sunburn; these should be monitored with your doctor. Dr Lowe advises using tetracyclines at night to lessen the risk of sun damage, and patients should use a sunscreen every day, in conjunction with Dr Nick Lowe acclenz™ Oil Control Day Cream; high skin temperatures may also worsen acne, so don’t try and dry out your skin in the midday sun or in the sauna, which can lead to further irritation and redness.

The most effective medical treatment for acne is oral isotretinoin (Accutane), but this can cause several significant side effects and we therefore advocate a low dose regime to start. This medication effectively dries out the oil glands to cease over-production and 70% of those treated see a complete remission of acne as a result. This is not a treatment option for women who are pregnant or trying to conceive, and is usually prescribed after milder treatments have not produced desired results. Your dermatologist can advise you on this option. Supplements may be helpful, such as Oil of Evening Primrose, omega 3 oils, Niacinamide, Panthenol and Zinc, and reported to your doctor who can assess their compatibility with your skin treatment regime.

We frequently combine our non-prescription products with prescriptions both topical (eg. Differin) and/or oral (eg. Antibiotics), along with selected chemical peels and acne extracting Intense Pulse Light therapy. The Anti-Blemish acclenz™ range products, all of which are non-comedogenic so will not block pores, are available at the clinic and in our online shop.

“Stay positive in the knowledge that with my help you CAN achieve the clear skin you have always wanted,” says Dr Lowe.

After 30 years of experience in dermatology, researching and treating the most challenging acne conditions and skin problems, Dr Lowe and his expert team at the Cranley Clinic are confident finding the very best treatment for you and achieving a complexion free of acne.

Dr Lowe says “You have a treatable condition and we now have a way to improve, clear and control problem skin.”

Acne is caused by the testosterone hormone in the blood. This hormone controls the production of sebum, which is the oily substance secreted by the sebaceous glands in the skin. At the same time the dead skin cells that line the opening of the hair follicles are not shed properly causing them to become blocked. An excess production of sebum combined with the blocking of the hair follicles is what causes the formation of spots. These changes in the skin also encourage bacteria to grow on the skin; this can also become trapped in the hair follicles and causes deeper infections and spots.

True or False?

• • Acne can be hereditary. True!
    Acne can be caused by certain drugs (e.g. oral contraceptives, anti-epileptic medicines, steroids). True!
    Acne can be a problem at any stage in life and not just during teenage years. True!
    If left untreated, acne can lead to permanent scarring. True!
    Acne sufferers may experience high levels of stress and depression and seeking effective treatment will provide as many psychological benefits as physical. True!
    Many over the counter general acne preparations are a waste of time and money. True!
    Eating greasy foods can cause and worsen Acne, although you should try to maintain a balanced diet and avoid any foods that you feel do worsen your skin such as milk or chocolate. Latest research indicates that milk or chocolate may be problematic for some acne sufferers as the high milk content may be susceptible to hormones from cows. However, chocolate lovers will be relieved to know that on the other hand, dark chocolate has considerable benefits to encouraging healthy skin because of its high anti-oxidant properties. False!
  • Acne is caused by poor hygiene (but not washing your face or removing makeup will cause bacteria to multiply on the skin and increase or cause other skin problems). False!

Dr Lowe says: “A delay in acne treatment can lead to permanent scarring. Time is of the essence in achieving a clear skin for acne sufferers. If you have a significant or long-standing skin problem, do not waste your time and money in trying ordinary over the counter skin care products, as you may need our specialist help.”

After seeing literally thousands of acne sufferers who have experienced frustration & disappointment with the ineffective choice of over the counter acne preparations available in the UK, Dr Lowe has spent many years researching avidly to find a solution. He is therefore very proud to now have his  acclenz™ Blemish Solutions Range line available online.

At long last you can buy an effective and inexpensive professionally prepared cleanser, moisturiser & repair serum that has been especially developed for acne sufferers and that will effectively and speedily start to resolve your acne symptoms. Promising visibly outstanding results, this cutting edge specialist skin care by Dr Nick Lowe proves that effective acne skincare need not be hard to find or overly expensive.

A Final Word From Dr Nick Lowe: “Give both your appearance and your self-confidence the boost it has been longing for, by ordering my acclenz™ Range today. I promise that the only thing you will regret is that it took me years to produce!”

One of the most common myths is that only teenagers are prone to oily skin and blemishes. Thus unfortunately isn’t the case. Dr Lowe says “50 per cent of women and 25 per cent of men suffer from adult acne. Stress can be one of the leading factors in the development of oily skin or adult acne. Stress releases hormones that the body needs to ‘fight’ the effects of stress – unfortunately these hormones can trigger acne in the same way as in teenagers.

Other factors include changes in the hormonal balance to include: pregnancy, menstruation, hormonal abnormalities and stopping contraceptive medication. Some dairy products can worsen acne from hormones that are fed to cows. Certain medicines, such as the contraceptive pill, anti-inflammatory steroids, some anti-epileptic medications, lithium and related medications, can lead to adult acne being triggered.’

Other skin diseases made worse by stress include some eczemas and psoriasis.

This is a common cause of acne and sometimes increased body and facial hair growth in women. It affects about 5% of the population of adult women. There are a variety of tests that can be done to confirm this diagnosis including very safe scans of the ovaries and blood tests to check on your (testosterone) androgen or male type hormones that are present in both men and women.

The cause of increased hair growth and acne is excess androgen which is mainly produced by the ovaries, but also partly from the adrenal gland which puts out additional hormones including testosterone if you are stressed. There are a variety of treatment options that are successful at reducing or blocking the effects of the excess androgen hormone, including some oral contraceptive pills such as Yasmin. It is important to note that there is a higher risk of side effects with Yasmin than some other oral contraceptive pills. In addition, the tablet called Spironolactone can be taken every morning.

This is also used for blood pressure and as a water tablet, but has been shown convincingly to have anti-androgen hormone blocking effects. This can help adult women with persistent acne related to overactivity of androgens, or acne “sensitive” to androgens. It also reduces the amount of body hair growth.

If you have acne that does not improve with these treatments, you can treat and be treated with:

• Non prescription anti blemish and skin oil reducing products. Try the Dr Nick Lowe Blemish Solutions Range.
• Clinical treatments offered at the Cranley Clinic include: Isolaz, Peels, Microdermabrasion Dermasweep   steam and extraction treatments. If you have embarrassing hair growth on your face, body, legs or arms, our Laser Hair Removal is highly effective.