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Acne Explained

Acne pimples develop when sebum and dead skin cells plug the hair follicles inside your pores.

Bacterial overgrowth inside hair follicles then triggers inflammation and infection resulting in more severe acne. Acne can last for years, and if you have a family history of acne it may mean you are more likely to develop acne too.

What is acne?

Acne is a progressive, inflammatory skin disease that affects up to 90% of people at some time in their life. Although acne is often thought of as an issue that teens deal with as they reach puberty, and then grow out of, that isn’t always the case.

Adult acne sufferers can develop acne later in life, even if they never had acne in their teen years. Acne is a multifactorial disease - meaning there are many reasons that lead to the development of acne. These include:

  • Excess sebum or oil production
  • Accumulation of dead skin cells
  • Overgrowth of acne causing bacteria C. acnes (also known as P. acnes)
  • Changes in hormonal levels, particularly an increase in androgens
  • Diet: Foods including chocolates, chips, dairy, etc. are known to trigger/worsen acne
  • Stress
  • Skin contact with greasy or oily substances
  • Friction or pressure on the skin
  • Genetics

What are the different types of acne?

When you develop acne it usually starts out being mild with open comedones (blackheads) and
closed comedones (whiteheads).

Blackheads
Whiteheads
Pustules
Papules
Cystic acne
Nodular acne

What is the difference between teen and adult acne?

Adult acne is more common around the chin, and along the jawline while teenage acne usually appears in T-zone (forehead, nose, and chin) and sometimes on the chest and upper back. While teenage acne is primarily caused by an influx of hormones during puberty, hormone production stabilizes after puberty.

Adult acne continues to occur, though mostly in women. Hormonal fluctuations during adulthood such as pregnancy and menstruation typically trigger acne, and acne can also be triggered in adults due to stress or imbalance in androgens in both men and women.

What are the best ways to treat acne?

As acne is a progressive disease, it’s best to start treating acne as soon as the first acne lesions or pimples are visible. How you treat your acne will vary depending on your age, and the type and severity of acne that you have. Self-treatment is possible and can be very successful, many acne sufferers don’t need to seek treatment from a Dermatologist.

Treating and controlling acne early, and sticking to a maintenance routine to prevent new pimples from forming will help prevent acne from becoming more severe. There are many proven acne fighting treatments available, both over-the-counter and prescription medications:

Salicylic acid

This is a beta hydroxy acid (BHA) found in willow bark. It is an aspirin derivative with a strong keratolytic,comedolytic effect. Salicylic acid works to keep the pores clear and hair follicles free from plugs as well as exfoliating the skin surface. Salicylic acid also kills acne causing bacteria and has anti-inflammatory and anti-aging effect.

Benzoyl Peroxide

Although not an antibiotic, benzoyl peroxide kills acne causing bacteria and also has a mild keratolytic effect (prevents plugging of hair follicles) as well as mild anti-inflammatory effect. Benzoyl peroxide has a strong drying effect on the skin, which can help dry up pimples and reduce oiliness of the skin.

Retinoids

Prescribed as creams, gels, and lotions to prevent clogging of hair follicles, for moderate to severe acne. Retinoids include: adapalene, tretinoin and tazarotene.

Azelaic acid

This is a dicarboxylic acid that helps prevent bacterial infection.

Dapsone

This is a sulfone that treats inflammatory acne.

Antibiotics

Prescribed as topical or oral medicines to kill acne causing bacteria and reduce redness from inflammation. Antibiotics for acne include: clindamycin, doxycycline, tetracycline and sarecycline.

Oral contraceptives

A combination of estrogen and progestin may be prescribed for women to help control the hormonal balance.

Spironolactone

This is an anti-androgen that prevents the effect of androgens on oil glands in the skin.

Cortisone

This is a steroid injection that is used to treat nodules and cystic lesions.

Isotretinoin

This is an oral retinoid that is used only for the most severe cases of acne including cystic and nodular cystic acne that have not responded to all other available treatment options.

In addition to acne treatment medications, there are also natural ingredients that help with the inflammation and redness that comes along with acne, for example niacinamide and aloe vera, as well as microbiome based ingredients such as Dermala’s SE Microbiome Complex® which is a patented technology that naturally rebalances the microbiome allowing healthy bacteria to flourish, reduces inflammation, and kills acne causing bacteria C. acnes.