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!”
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.