Acne & acne treatment

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"Acne is directly related to a person's skin type.  As you cannot change your skin type, there is no cure as such for acne.  However, by introducing an ongoing treatment programme using accepted, well researched products acne can be controlled."

Acne is one of the most common skin conditions, affecting most teenagers between 16 and 19 years and up to 20% of adults.  Acne is caused by overactive sebaceous glands that produce an overabundance of sebum (oil) and excessive keratinocyte production (skin cells). 

   courtesy of NIAMS website    

Sebaceous gland activity is governed by our sex hormones: oestrogens (female hormones) suppress sebaceous gland activity while androgens (male hormones) stimulate sebaceous gland activity.

Teenagers are especially susceptible to acne, as the sex hormones are new to the developing teenager, and the sebaceous glands are particularly sensitive to this new hormonal stimulus.

Researchers in the past several decades have identified four components that contribute to the development of acne:

1.          Hormones 

The androgens eg. testosterone, control the size and sebum output of the sebaceous glands.  Severe cystic acne involving the face, back and chest, is more common in males, which is consistent with males having higher levels of testosterone than females.  However, no-one really understands why some people suffer from severe acne with the same blood testosterone levels as others who don't.  Researchers postulate it is due to increased sensintivity of the sebaceous glands to testosterone but the exact cause of this increased sensitivity remains unclear.  Adult Acne appears to be caused by the genetic predisposition (many adult sufferers have a strong family history of acne) or, in females, hormonal imbalance.  This normal imbalance can range from the monthly breakout caused by oestrogen level fluctuations ("premenstrual acne flare"), through to Polycyctic Ovarian Syndrome in which the sebaceous gland is overstimulated by excessive "free" testosterone.  Polycyctic Ovarian Syndrome is the most common cause of Adult Acne in females.

2.          Abnormal desquamation of sebaceous follicle cells

In acne prone skins, keratinocytes exfoliate at an abnormal rate.  These cells fall into the hair follicles, become trapped along with excess sebum and cause clogged pores.  This results in altered keratinization and the production of comedones.

3.          Proliferation of P. acnes bacterium  

While Propionibacterium acnes is found normally within a healthy skin environment, some researchers believe that acne-prone people generate an excess of the bacteria. 

4.          Excessive immune response

    courtesy of NIAMS website    

The body overreacts to what might ordinarily be a small, localised inflammation.  The result is extreme inflammation and pus.

Acne can be broken up into 3 main categories:

Breakout to mild acne - blackheads (open comedones), whiteheads (closed comedones), mild irregular eruptions of several whiteheads and raised bumps (pustules) with red and white pus under the skin.  Confined to the face.

                         

diagrams courtesy of NIAMS website    

 

Moderate to severe acne - regular to constant pustules, many closed comedones with inflammed pores and deep hard nodules (cysts) under the surface of the skin.  These cysts are tender to touch and may even be painful.  Confined to the face.

Severe + acne - everything is erupting at once, whiteheads, blackheads, pustules, papules and cysts on face, neck, chest and back.

Acne is directly related to a person's skin type.  As you cannot change your skin type, there is no cure as such for acne.  However, by introducing an ongoing treatment programme using accepted, well researched products acne can be controlled.  This treatment programme must address:

  • control of excessive oil (sebum) production;
  • exfoliation of excessive keratinocyte production;
  • minimisation of infection by keeping fingers away from blackheads, pimples etc.;
  • minimisation of scarring by extracting keratinocyte plugs and/or infected sebum from clogged pores before they turn into larger inflammed infected sores; and
  • protect the skin from UV radiation using a broadspectrum oil free sunscreen.

The golden standards for the control of acne are alpha hydroxy acids (AHA) such as glycolic acid , hydroquinone and Vitamin A in the form of tretinoin. 

Breakout to mild acne can be controlled using a combination of cleansers and creams containing an AHA such as glycolic acid to contol excessive oil production.  Microdermabrasion in combination with an AHA such as glycolic acid to exfoliate excessive keratinocyte production.  Hydroquinone is used to control pigmentation issues associated with acne scars, returning the skins tone to that of the surrounding unaffected skin, giving an even complexion.

Moderate to severe acne can be controlled using the protocols used for the treatment of breakout to mild acne in combination with the single best topical treatment for acne tretinoin (Stieva A and Retin A  being the most common brands).  A mainstay of acne therapy for nearly three decades tretinoin normalises the exfoliation of follicular cells, promotes drainage of existing comedones and inflammatory lesions.  Tretinoin does have side effects such as drying of and redenning of skin in initial treatment of some patients, sun sensitivity and use should be ceased in pregnancy.  Therefore, tretinoin is recommended for use by patients with the more advanced moderate to severe acne.  It should be noted that these side effects are minimal in comparison with oral treatments.  

In addition, tretinoin enhances the penetration of other topical agents - like antibacterial creams or AHAs such as glycolic acid by causing the unplugged follicle to become more accessible.  This inhibits the growth of P. acnes bacteria and minimises the rupturing of comedones into surrounding tissue. 

In conclusion, Breakout to mild acne is best treated using cleansers, creams and micrdermabrasion containing an AHA such as glycolic acid and hydroquinone for pigmentation.  Tretinoin is used in conjunction with the AHA glycolic acid and hydroquinone in the treatment of Moderate to severe acne.  Each addresses the main pathology in acne and help stop the breakout cycle and return skin to a healthy state. 

The Clearskincare Acne Treatment Programme is an effective and affordable topical alternative to oral treatments such as roaccutane, that has minimal side effects, can be used on a long term basis and that improves the complexion, skin texture and tone.  The Clearskincare Acne Treatment Programme is a simple 2 stage programme based around the golden standards of acne control.  The 1st stage involves the treatment of breakout to mild acne using the Clearskincare Acne Pack .  The 2nd stage, for moderate to severe acne, involves the combination of the Clearskincare Acne Pack with tretinoin.

Clearskincare 8% Salicylic Acid Skin Peel are safe homecare skin peels perfect for improving the appearance of oily acne/breakout prone skin by removing excessive oil, decongesting the skin and reducing the appearance of enlarged pores.  This product is the perfect compliment to be used in combination with the Clearskincare Acne Pack.

Sufferers of Severe + acne should see their Doctors immediately and ask for referral to a dermatologist.

 

5.          SOME HANDY HINTS FOR ACNE SUFFERES

Diet

Avoid - refined cereals and grains including bread with enriched or refined white flour, dairy products, any kind of soda drinks - diet or regular, french fries or white potatoes, coffee, sugar and candy.

Eat - baked, grilled, broiled or lightly sauteed (no crumbs) meat, fish, poultry and seafood.  Baked, steamed, broiled (not fried) vegetables, minimise white potatoes.  All fruit excepting acidic fruits like limes, lemons, oranges and grapefruit.  Nuts and seeds in their natural state.  Decaf tea and herbal teas.  Eggs (not fried).  Olive oil.  Breads and cereals made from wholegrains.

Eat sparingly - dark chocolate, decaf coffee, honey, butter, heavy cream.

Skincare products

Use a pH balanced gel cleanser, not soap. 

Do not use/avoid all oily products or moisturisers as your skin already has a build up of oil.  Moisturisers contain oils that trap excessive dead skin cells and sebum in pores, clogging pores and stimulating breakouts.  We have been lead to believe (by clever cosmetic marketing campaigns) that when our skin is flaky, that it is dry and needs moisturising (if you drink water regularly your skin is hydrated!).  The flakiness is dead skin cells, this is a sign that you need to exfoliate your skin.  To control excessive dead skin cell production (flakiness) exfoliate your skin regularly (2 to 3 times a week max). 

Try and keep positive!

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