Acne Treatments

Acne is a common skin condition that affects individuals across various age groups, predominantly during adolescence. It’s characterised by the presence of pimples, comedones (blackheads and whiteheads) and in more severe cases, cysts, primarily on the face, back, and chest. This condition not only impacts the skin but can also have profound psychological effects, influencing self-esteem and social interactions.

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Key Points

What is acne?

Acne is a medical and dermatological condition involving the oil glands at the base of hair follicles. It occurs when these glands produce excess oil, leading to clogged pores and the proliferation of bacteria, resulting in inflammation and the formation of pimples or cysts.

Who gets acne?

Acne predominantly affects teenagers due to hormonal changes during puberty, which stimulates oil production. However, it’s not exclusive to this age group as adults, especially women, can also experience acne, often related to hormonal fluctuations, stress, or certain medications.

Clinical features

Clinically, acne presents as a mix of open (blackheads) and closed comedones (whiteheads), inflammatory papules, pustules, and in severe cases, nodules and cysts. It predominantly affects areas with a higher density of oil glands, such as the face, back, and chest. Symptoms include skin redness, tenderness, and in severe cases, scarring.

Diagnosis and differential diagnosis

Diagnosis of acne is primarily clinical, based on the appearance of the skin. A dermatologist may consider other conditions that mimic acne, such as rosacea,  folliculitis, periorificial dermatitis and facial keratosis pilaris. 

Impact and complications

Acne can significantly impact quality of life, leading to reduced self-esteem, social withdrawal, and in some cases, depression. Complications include scarring, persistent red spots and hyperpigmentation, which can persist long after the acne has resolved.

Subtypes and variants

Acne can manifest in various forms, each with unique characteristics and treatment approaches. Here are some notable subtypes and variants.

The most common form, characterised by a mix of lesions including blackheads, whiteheads, papules, and pustules.

A severe and rare form of acne vulgaris, characterised by interconnected lesions and significant scarring. It’s more common in males and often requires aggressive treatment.

A sudden onset of highly inflammatory acne, often accompanied by systemic symptoms like fever and joint pain. It’s less common and can be severe, requiring prompt medical attention.

Triggered by excess pressure, heat, or friction on the skin. The type induced by wearing masks for extended periods of time (Maskne).  Also seen in athletes caused by rubbing of sports equipment and clothing.

Caused by the use of certain cosmetic products that clog pores. It’s characterised by small, rash-like bumps, typically on the face.

Exacerbated by the habitual picking or scratching of acne, leading to scarring and secondary infections.

Occurs in infants aged 2 to 12 months, likely due to hormonal changes. Usually mild, but severe cases should be evaluated by a dermatologist as permanent scarring may ensue.

Appears in newborns, typically within the first few weeks of life. It’s believed to be caused by maternal or infant hormones. Neonatal acne is generally mild and resolves on its own without treatment.

Each subtype of acne may require a different approach to treatment, emphasising the importance of a tailored and individualised treatment plan.

Popularised Acne Terms and Other Similar Yet Distinct Skin Disorders

The term “acne” is widely used in both medical and popular contexts, but its application varies significantly. In popular culture and social media, “acne” often describes various skin issues that may resemble traditional acne or are related to specific triggers and locations. However, it’s crucial to distinguish between these colloquial uses like fungal acne and acne rosacea and certain skin conditions, which are separate disorders and not types of acne in the strict medical sense.

Popularised Terms

These terms generally relate to the location or specific causes of acne-like symptoms.

Acne caused by prolonged wearing of face masks, a form of acne mechanica.

Acne that appears on the back, often due to sweat and friction.

Often folliculitis on the buttocks, commonly mistaken for acne.

Acne on the chest, typically triggered by sweat and heat.

Breakouts linked to stress, exacerbating existing acne conditions.

Acne influenced by hormonal changes, particularly in female adults.

Acne occurring in adulthood, either persistent from adolescence or newly developed.

A colloquial term for acne-like eruptions caused by JAK inhibitor medications.

Other Distinct Skin Disorders

These conditions are often confused with acne but are separate skin disorders.

Despite its name, this condition is not acne but a yeast infection of the hair follicles, presenting with acne-like bumps.

Often mistaken for acne due to its name and some overlapping symptoms, acne rosacea refers to what dermatologist refer to as papulopustular rosacea and is a chronic skin condition characterised by facial redness and sometimes pimple-like bumps. It is distinct from acne vulgaris.

Causes and Triggers of Acne

These conditions are often confused with acne but are separate skin disorders.

Acne can often run in families, similar to other inherited traits. If a person has close relatives who struggled with acne, there’s a higher likelihood they might experience it too.

Hormones, particularly during puberty, play a significant role in acne development. They can increase oil production in the skin, setting the stage for acne. In women, hormonal changes related to menstrual cycles, pregnancy, or conditions like PCOS can also impact skin health.

The skin naturally produces oil, which is typically beneficial. However, excess oil production, combined with dead skin cells, can lead to clogged pores. This is the starting point for common acne manifestations like blackheads and whiteheads.

The bacteria Cutibacterium acne (Previously referred to as P. acnes) is present on everyone’s skin. While usually harmless, an imbalance in these bacteria and specific strains can lead to inflammation and acne. It’s the reaction of the skin to this bacterial imbalance that often determines the severity of acne.

Inflammation is a critical factor in acne, sometimes initiating the process even before a pimple becomes visible. The immune system’s response in certain areas can trigger the formation of acne.

The relationship between diet and acne is an area of active research. Foods with a high glycemic index, whey protein or certain dairy products like skim milk might influence acne in some individuals. This effect varies widely among different people.

External factors like pollution levels or humid climate conditions can affect the skin. These environmental elements might increase oil production or cause skin irritation, potentially leading to acne.

Stress is known to have an impact on skin health. It can lead to hormonal changes that increase oil production, thereby making the skin more prone to acne.

Certain medications and exposure to specific chemicals can trigger acne in some individuals. Changes in skin condition following the start of a new medication can be a sign of this reaction. A relevant example is the category of medications called Jak inhibitors used to treat autoinflammatory and autoimmune conditions which can cause acne-like reactions.

Treatment Options for Acne

Treating acne is a multifaceted approach that varies depending on the individual’s specific type and severity of acne. It often involves lifestyle changes, topical applications, and in some cases, oral medications. The goal is to reduce symptoms, prevent scarring, and minimise the psychological impact. Here’s a detailed look at the various management options available.

Adopting certain lifestyle habits can play a significant role in managing acne. This includes maintaining a good skincare routine to remove excess oil without overly drying the skin, following a balanced diet that may reduce acne flare-ups, and employing stress management techniques to mitigate stress-related acne. Avoid skinny milk, why protein and high-GI foods.

  • Gentle skincare routine.
  • Balanced low GI diet and avoid whey protein and skim milk.
  • Stress reduction techniques.

Topical treatments are often the first-line of defense against acne. These include benzoyl peroxide for its bacteria-reducing properties, retinoids for unclogging pores, topical antibiotics to control bacteria, salicylic acid for its pore-clearing effects, azelaic acid for reducing bacteria and inflammation, and niacinamide for its anti-inflammatory benefits.

  • Benzoyl peroxide.
  • Retinoids.
  • Topical antibiotics.
  • Salicylic acid.
  • Azelaic acid.
  • Niacinamide.

For more severe cases of acne, oral treatments may be prescribed. These include antibiotics for their antibacterial and anti-inflammatory effects, oral contraceptives and anti-androgens to regulate hormones in women, and isotretinoin, a powerful option for severe acne.

  • Antibiotics.
  • Oral contraceptives & anti-androgens
  • Isotretinoin.

Physical treatments like laser and light therapy can reduce oil production and kill bacteria. Chemical peels help in removing the top layer of skin, and professional extraction of blackheads and treatment of whiteheads with fine-wire-diathermy can be effective in clearing clogged pores.

  • Laser and light therapy.
  • Chemical peels.
  • Professional extraction.

Certain practices can exacerbate acne, such as over-washing the face, picking or squeezing pimples, and using harsh scrubs. These should be avoided to prevent worsening of the condition.

  • Avoid over-washing.
  • Don’t pick or squeeze pimples.
  • Steer clear of harsh scrubs.

It’s important to have realistic expectations when treating acne. Treatments can take a minimum of 6 weeks to show results, and consistency is key. Regular consultations with a dermatologist can help in tailoring treatments to individual needs.

  • Patience with treatment.
  • Consistency in application.
  • Seek professional advice.

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