How to Treat Acne?
Following on from my previous blog ‘What causes Acne?’ you can see there are many complex factors to consider when treating acne, and every case is completely different.
Within this blog I will discuss some potential treatment options that are available in the quest to manage this tricky skin condition. A consultation with a dermatologist or skin specialist will help to determine what treatment options are best for you and your skin.
Products
As we now know, a contributor to acne is a build-up of dead skin cells, so, when selecting skincare always be mindful that you want to avoid anything that is going to further inhibit the skin’s capability of shedding these dead skin cells, or potentially lead to further clogging of follicles. Some common skin clogging ingredients that you want to steer clear of are Mineral oil, Shea butter, Coconut oil/ butter, Cacao butter, Soybean oil and other fruit or seed oils, lanolin and Silicones (usually found in make-up’s and SPF’s). It can prove difficult to completely avoid these ingredients as they are generally cheap ingredients for brands to use, and some do have positive benefits for skin, however, if you are reading the INCI list (International Nomenclature of Cosmetics) and you’re seeing a lot of oils listed, then it’s a no-go for you.
I would instead advise to opt for gel-based cleansers, and ensure you are thoroughly cleansing both morning and night. Swap out the creamy moisturiser for a lightweight serum, looking out for ingredients such as Niacinamide (Vitamin B3) that helps to hydrate whilst repairing skin’s barrier function, or antioxidants such as Green tea extract or Resveratrol. I would also recommend exfoliating to help remove the dead skin cells and encourage the natural desquamation process. Exfoliation can be both physical, and chemical. Physical exfoliation is a necessary step in tackling acne, but it must be gentle enough not to further inflame breakouts, the St Ives scrub we all used when we were 15, is a definite no! Some of the chemical exfoliants that can help reduce breakouts are:
Salicylic Acid- This BHA (Beta-Hydroxy Acid) is one of the only acids within skincare that can break down sebum within the follicles.
Lactic Acid – This is a gentle AHA (Alpha-Hydroxy Acid) that works by dissolving the ‘glue’ that hold your skin cells together. Lactic Acid is also humectant, meaning it has the ability attract and trap water.
Glycolic Acid – Another AHA, Glycolic Acid can penetrate slightly deeper than Lactic Acid making this a better option for a more thickened epidermis or to help reduce post-inflammatory pigmentation marks from previous breakouts.
Azelaic Acid- Derived from grains, barley and wheat, Azelaic Acid has a mild exfoliating effect, but in addition has anti-bacterial and anti-inflammatory properties.
The type of exfoliating agent to use, the combination and strength of the ingredients, as well as the frequency in which you use them depends heavily on the type of acne you are suffering from, and the current health of your skin. For example, if your barrier function is quite compromised you will want to introduce actives slowly, as going too strong too soon could further damage your barrier and ultimately worsen acne breakouts. This is why guidance from an experienced skin specialist is imperative in successfully treating acne.
Retinoids
In addition to exfoliation, the number one product I will recommend to anyone suffering with acne is a retinoid. Retinoid is a broad umbrella term for natural and synthetic derivatives of Vitamin A. There are multiple forms of retinoids, some available over the counter and some prescription only, all in varying strengths. Whichever form or strength is used retinoids ultimately convert to a retinoic acid. Retinoic acid has a direct impact on the skin’s cellular turnover; increasing the shedding of old skin cells and formation of new skin cells, thus helping to reduce build up in follicles and congestion.
There are a number of different retinoids available in over-the-counter formulations, mainly retinol, and retinaldehyde. Retinaldehyde being slightly stronger, and also has been shown to have antibacterial benefits.
Due to the potency of retinoids, most users will experience some form of acute inflammation when first incorporating into their skincare regime, this can include redness, peeling and potentially purging. Retinoids should be introduced slowly, and ideally under the guidance of a skincare professional who will be able to coach you through this process, advising which retinoid would suit you best, how much to use, when to use it and what to do when the inflammation sets in.
When you start a new acne-fighting regime you must be prepared to wait to see results. Our skin works in cycles of roughly 4-6 weeks, and it can take up to 4-5 skin cycles to control and heal a chronic skin condition such as acne. It can unfortunately also be a case of ‘it gets worse before it gets better’ as the cellular turnover boosting ingredients can cause any congestion to ‘purge’ resulting in an initial increase in breakouts. As with any skincare regime, the key to gaining results is consistency.
Medical Intervention
If your acne is worsening or causing distress, then it is advisable to seek medical help from your GP or a Dermatologist as they have access to prescription topical or oral medications, some of these are:
Benzoyl Peroxide – Available in various strengths benzoyl peroxide is a topical product usually in the form or a cream or gel. It has strong anti-bacterial properties as it releases oxygen into the follicles, creating an inhospitable environment for the p. Acnes bacteria.
Anti-biotics – There are various anti-biotics both oral and topical that can help clear acne by their anti-bacterial anti-inflammatory effects.
Retinoids- There are quite a few prescription topical retinoids available, Adapalene (brand name Differin) and Tretinoin are the most commonly used. Prescription retinoids are stronger than retinoids you can purchase over the counter and so can generate a stronger inflammatory response in the skin when first using.
Spironolactone- A medication that can act as an androgen blocker, preventing them from then over stimulating the sebaceous glands.
Isotretinoin – (brand name Roaccutane) A powerful oral retinoid that is used to treat severe or persistent cases of acne. Use of Isotretinoin can cause serious side effects and so should only ever be taken under the strict guidance and monitoring of a healthcare professional.
Whilst prescription medications can work to initially clear acne breakouts, most medications cannot be used long-term, and in my experience the acne will return once the course of medication is finished. It is so important to implement the correct homecare practises alongside the use of medication to stand the best chance of preventing the acne from returning.
In Clinic Treatments
Now for my favourite step! To boost the results of your homecare regime monthly, or fortnightly in – clinic facials should be performed by a specialist who is well experienced in treating acne. Within acne targeting facials extractions should be performed, this is when the facialist will use tools or manually extract the blockages in the follicles, helping to clear comedones, and reduce the chance of inflammatory breakouts. This is a necessary evil; however, I must stress that extraction should only be performed by a professional, using the correct amount of pressure, with the correct tools and in a sterile environment. Incorrect extraction can easily worsen breakouts, and potentially cause scarring.
Other professional procedures that may be carried out are:
LED light therapy: using blue light to kill bacteria, and red and near-infrared to boost repair and calm inflammation.
Chemical peels that contain higher strengths of AHA or BHA’s to breakdown sebum and dead skin
High-Frequency creates an oxygenating ‘ozone’ that kills bacteria whilst also stimulating blood flow, encouraging healing
Non -invasive low level laser or IPL for anti-inflammatory and healing benefits.
Almost all acne fighting treatments will require a course of treatments for best results. Once the acne is cleared, your treatment focus can then move onto collagen induction treatments such as Micro-needling or laser resurfacing to treat the scarring and post-inflammatory erythema (PIE). If the scarring is severe them medical treatments such as subcision, or filler may be used to treat the deeper scars.
Lifestyle
Certain lifestyle habits may be contributing to breakouts of acne flare-ups, monitoring your lifestyle in relation to flare-ups will help to identify any triggers. The first thing to try and limit is any inflammation inducing habits, these include alcohol consumption, smoking, consistent high stress levels, and poor sleep. As mentioned in my previous blog your diet or certain foods may be a contributor, but it is never advisable to have a completely restrictive diet. A healthy balanced diet that is rich in antioxidants such as leafy green vegetables, green tea and blueberries, plus Zinc and Omega-3’s which are found in salmon, avocados, pumpkin seeds, nuts and whole grains. Zinc in particular is a great mineral to help combat acne as it regulates sebum production and helps to reduce inflammation, Zinc supplements may be taken if you are not getting an adequate amount from your diet.
As we know there is a clear link between hormones and the development of acne, for women if you have recently started taking contraception and noticed an increase in breakouts, this could be due to the type of contraception you are taking. Speak to your Doctor about switching to a high oestrogen contraception (combined pill) as some contraceptives are progesterone only (mini pill) which can be the cause of an increase in sebum and therefore breakouts. As with any hormone related treatment, it can take time for your skin to respond to the change in hormones, and a reduction in acne may be seen after 3-9 months.
As you can see there are endless products, treatment options and lifestyle changes that can be used to treat acne, and more often than not is a combination of tailored treatment and lifestyle changes that will enable you to successfully manage your acne. As I have mentioned previously, to truly gain clarity on what will work for you, you must turn away from the Instagram ads or shiny marketing material and seek personalised advice from a skincare professional. It is also important to remember that even once you clear the active acne, you must still treat your skin as acne prone; using the correct products, avoiding your known triggers, and having regular extraction facials to prevent congestion build up are required to prevent the acne from returning.
Within my clinic I offer in depth consultations where I take the time to delve into your skin and medical history to discover the root cause of what is going on, I will also thoroughly visually assess the health of your skin so that I can then provide personalised advice on the best course of action for your skin.
One of my go-to facials for active acne or acne prone skin is my ‘Deep Cleanse & Heal’ facial. Within this treatment I use multiple modalities to target the three main causes of acne- oil, dead skin, and bacteria. I will use gentle exfoliating methods to remove dead skin build up, salicylic acid based peels to breakdown oil, extensive extractions to clear blocked follicles, and high frequency to kill p.Acnes bacteria. I will also use an antioxidant mask combined with soothing ice globes to help calm the inflammation that comes alongside acne.
If you are suffering with acne, or struggling with persistent breakouts please don’t suffer in silence, get in touch and schedule a consultation, I’d love to help!
