Over the years, our doctors have seen and helped many patients with acne issues. Here’s some of our effort to separate facts from fiction. If you need acne treatment, come see us.
What is acne?
Acne is an inflammatory condition of the oil- or sebum producing glands of the skin, resulting in the formation of whiteheads, blackheads and red inflamed bumps (papules, pustules, nodules and cysts) that may contain pus.
Acne can develop on the face, neck, upper back and chest and are the most commonly affected areas of the body.
How does acne form?
For acne to form, it has to go through several stages.
First, increased oil- or sebum production in the glands will lead to clogging of the pores or blockage of the old glands. This causes retention of the sebum and dead skin cells – sebaceous materials, resulting in formation of whiteheads (closed comedones) and blackheads (open comedones).
The retained sebaceous materials in the comedones provide a conducive environment for the bacteria Propionibacterium acnes (P.acnes) to grow and multiply. The body’s immune response to the bacteria leads to inflammation of the blocked pores and the skin around it, resulting in formation of red, sometimes painful papules, otherwise known as pimples. As the inflammation worsens, pus may develop within the papules, leading to larger and more painful lesions such as pustules, nodules and cysts.
While the inflammation may help to clear the bacteria from the skin, it unfortunately also destroys tissue around the sebaceous glands and may result in permanent scarring as part of the healing process.
What causes acne? Why do some people have it and some people don’t?
Genetic factors play an important role in acne, although the exact genes responsible have yet to be identified.
No one knows why some people produce more sebum than others but one theory is that it is due to higher levels of androgens (male sex hormones) which are present in both males and females.
External factors also play a role in causing and/or aggravating acne. These include:
- a hot/humid climate
- picking and squeezing at the lesions
How common is acne?
Acne is extremely common, affecting up to 80% of adolescents and young adults. Acne usually first appears during the teenage years, but it can also begin in the twenties and thirties.
What should I do when I have acne?
Consult your doctor early. Waiting to ‘outgrow’ acne can be a serious mistake, since medical treatment can effectively treat acne and minimize the development of scarring. Acne is not a minor skin problem that can be ignored and left to ‘go away’.
How is acne treated?
There are many effective treatments available for acne. Depending on the severity of the acne, the doctor may prescribe one or a combination of treatments.
1) Cleansers and Toners
The aim of skin cleansing is to remove excess oil, dirt, bacteria and dead cells from the skin surface without irritating or drying the skin. ‘Soapless’ skin cleansers are less likely to cause skin irritation.
Cleansing the face two to three times a day is generally adequate. Avoid over-washing as this may irritate the inflamed skin instead. Avoid scrubbing as well – it may precipitate acne by rupturing the whiteheads and worsening the skin inflammation.
Toners may help to remove excess sebaceous secretions, mildly exfoliate the skin and leave the skin surface feeling stimulated and cool. Some toners may irritate the skin and make the skin more prone to inflammation. Toners are not an essential component of the cleansing regimen.
2) Topical medications
Topical treatments are the first line therapy for mild to moderate acne. They are also used in combination with oral medications for more severe acne. In addition, some topical medication is used to maintenance therapy, to prevent relapses after successful initial treatment.
Available topical medications:
- Benzoyl Peroxide
- Antibiotics such as erythromycin, clindamycin
- Retinoids such as tretinoin, isotretinoin, adapalene
- Sulphur, resorcinol and salicylic acid
3) Oral medications
Oral medications are used to treat moderate to severe acne. It will clear the acne faster in cases where topical medications are inadequate to control the inflammation, or when the risk of scarring is high, such as in nodulocystic acne.
Oral medications consist of antibiotics, hormonal therapy and isotretinoin.
Can acne scars and post-acne redness be treated?
After the acne has resolved, post-acne blemishes may remain, such as redness, pigmentation and scarring. These are more pronounced in poorly treated acne, or after self manipulation like picking and squeezing.
Post acne redness usually occurs after the acne has subsided. This is normal, common and temporary although it may last weeks to months for some patients.
Post-acne pigmentation usually occurs with deeper and larger acne lesions. The pigmentation is often aggravated by picking and squeezing and can takes months to clear.
Acne scars, unlike post-acne redness and pigmentation, are permanent, which is why the most important reason for treating acne early and effectively is to prevent permanent scarring.
There are several treatments for post-acne scars, depending on the severity and depth of the scars.
1) Chemical peels
Chemical peels can be used to improve mild acne. Chemical peeling unclogs the pores and clears acne lesions faster. Several sessions may be needed.
Microdermabrasion is a superficial skin resurfacing procedure that exfoliates the skin, resulting in smoother and more radiant skin. It is a mild, low risk, minimally invasive procedure with virtually no discomfort or downtime.
3) Intense pulse light (IPL) therapy
IPL is a light technology which produces a broad band of light of multiple wavelengths that enables it to target different skin lesions at the same time. It is used to treat superficial pigmentation such as freckles, sun spots and fine facial blood vessels. It can also improve skin texture.
4) Non ablative lasers
Non ablative laser technology allows the upper dermis layer of the skin to be selectively treated without damaging the epidermis. The laser procedure can be safely performed with minimal or no anesthesia and carries little risk of complications. The results of non ablative laser treatment are gradual; the patient may see 15-20% improvement.
5) Ablative laser resurfacing
Ablative laser resurfacing using a carbon dioxide or erbium-YAG laser, removes the superficial surface skin layers till the upper dermis layer is reached. The wounded skin is then allowed to heal as the underlying dermal layer remodels itself, thus improving the appearance of the scars. Laser resurfacing can result in 30-40% improvement in acne scars but is associated with downtime. The healing process may take 7-10 days during which time the skin is raw and weepy.
Common myths about acne
Myth: Certain foods make acne worse
Oily, greasy, deep fried food, chocolates, nuts and sweets have been implicated in acne flares. However there is no scientific evidence that diet plays an important role in causing acne. In majority of cases, no dietary restrictions are required.
Myth: Dark foods cause pigmentation after acne
People with acne are often advised to avoid taking dark-colored foods such as soy sauce and coffee to prevent darkening (or pigmentation) of the skin during the healing process. The pigmentation is caused by inflammation, rather than by ‘staining’ by the food and is common after any form of injury to the skin.
Myth: Squeezing the pimples help to unblock pores and improve healing
It is generally not advisable to squeeze the pimples, especially if they are large and deep. Superficial whitish or yellowish pimples may be gently squeezed to remove the purulent content. If excessive squeezing or pressure is required, this may result in greater inflammation and damage to the skin, which will worsen the acne and cause deeper scars.
Myth: Make-up or cosmetics worsens acne
It is possible that greasy or oily make-up worsens acne. It is useful therefore to avoid oil-based make-up, especially occlusive foundations. Use water-soluble oil-free cosmetics that do not promote the formation of comedones, or non-comedogenic.
Myth: Sun exposure makes acne worse
There is no medical evidence to suggest that people with acne should stay away from the sun. However excessive sun exposure may cause more severe post-acne pigmentation. Use a non-oily sunscreen (at least SPF 15) judiciously to minimize sun-related skin problems.
Myth: Facial treatments help to clear acne
Simple procedures that involve cleansing and gentle extraction of blackheads are usually safe. However excessive squeezing of inflamed acne lesions or pimples must be avoided. Facial treatments are generally not essential in the overall treatment of acne.
Myth: Oil blotters are bad for acne
There is no good evidence to suggest that oil blotters make acne worse or that they cause more oil to be produced. The effect of removing excess oil form the skin with blotting paper is temporary; it reduces the ‘shine’ caused by the excess oil on the surface of the skin.
Myth: Antibiotics should be avoided as they are bad for the body
Oral antibiotics may be necessary to control the inflammation of acne that fails to respond adequately to topical treatment. They are effective and have been used with good safety records for more than 30 years without long term harm to the body. The oral antibiotics can be stopped once the inflammatory lesions have been cleared.