Acne is a common skin condition that affects 80% of Australians at some stage during our lives. 20% will develop severe acne with scarring. Whilst most of us will grow out of it, in 5% this will be a lifelong disorder. Acne is a medical skin condition that should be treated by medical practitioners.
What causes acne?
There are 4 major factors that contribute to the formation of acne. In order to treat acne, each of these factors need to be addressed.
- Hormonal imbalances – an excess of androgens or male hormones. This leads to….
- Overproduction of oil (sebum) by the pilosebaceous unit (or commonly known as the pore) Pilosebaceous units contain hair follicles and oil glands.
- Abnormality in the structure of the pilosebaceous units leading to irregular or excessive shedding of dead skin cells inside the pore
- Build up of a bacteria called P.acnes inside the pilosebaceous units
Oil or sebum is produced from the pilosebaceous units or pores found in abundance on areas of or body like our face, chest and back. When things are functioning normally, the sebum smoothly leaves the pores and melts into the skin’s surface to keep the surface moist and smooth. However, in acne patients, there is plugging of the pores with excess sebum and dead skin cells which provides an ideal environment for the proliferation of bacteria (P. acnes) causing irritation and inflammation to the pores. The body’s immune system respond to this inflammation to help with the repair this inflamed areas and pimples form.
What is the treatment for acne?
The mainstay of treatments are medical grade skin care and oral medications. Effective treatment of acne need to address some or all of the factors contributing to acne. Contrary to popular belief, there is no study to show that certain food exacerbate or cause acne.
What is the skin care regimen for acne?
Gentle water soluble cleanser . It is a myth that you can clean away acne with harsh scrubs and strong cleansers. These cleansers only dry up the skin and impairs the intercellular matrix (protective barrier) of the skin which can increase the presence of bacteria and cause a dry tight feeling to your skin. Chemical exfoliation. Use a beta hydroxy acid (BHA -which is salicylic acid) BHA is lipid soluble and can exfoliate inside the pore. It is also an anti inflammatory which will calm irritated skin. Antiseptic +/- antibacterial. Use the lowest concentration of Benzoyl Peroxide at 2.5% to reduce irritation to the skin. Other antiseptic are Azelaic Acid Retinoids. This remain the most effective treatment for acne . It works by normalising the pilosebaceous units. Oil free sunscreen.
What are the oral medications for acne?
Short term antibiotics – to prevent the likelihood of bacteria resistance Oral contraceptive pill – for women only Anti-androgen – for women only Roaccutane – oral form of Vitamin A – for severe acne. This requires management by a dermatologist
What are some other options for acne with Dr Marr?
Medical grade Chemical Peels – alpha hydroxy acid or Jessner’s peel Laser therapy is also an option for those who have not achieved the results desired from skin care or medication, or for those who are looking for a combined approach to their acne treatment to further enhance results.
What is the outlook for acne?
Expect improvement after 2-3 months Acne can be a lifelong condition for some
What about acne scarring?
There are different grades of acne scars and the treatment is dependent on the grade of scarring
What are the different grades of acne scarring?
Grade 1 – flat scarring with areas of hyperpigmentation Grade 2 – mild scarring that is only visible at close distance (50cm). Examples are rolling acne scars Grade 3 – moderate scarring visible at 50cm or more. Examples are more severe rolling acne scars, boxcar scars Grade 4 – the most severe form. Examples are sever boxcar scars, ice pick scars and keloid / hypertrophic scars
What is the treatment for Grade 1 scar?
Grade 1 scar is a problem with hyperpigementation and this is treated with medical skin care with a de-pigmentation crea,