Acne awareness month
What is Acne?
Acne is a common skin condition categorised by comedones (black heads and white heads) and pustules (pus filled spots). It most commonly affects adolescents but can also develop later in life. It is caused by the thickening of pores preventing the skin from shedding properly and an over production of sebum (oil). The combination of excess oil and a build up of ‘dead’ skin cells block pores creating whiteheads, these in turn become black heads when they are exposed to oxygen (oxidisation). The bacteria that causes acne, Cutibacterium acnes, lives on everyones skin, but the presence of excess oil creates an ideal environment for these bacteria to multiply.
What can be done to help?
It is important to reduce excess sebum on the skins surface without drying out and stripping the skin of all of its natural oils, as people suffering with acne may still encounter dry patches of skin. A good at home skincare routine that focusses on maintaining a healthy skin barrier function whilst effectively controlling excess sebum and reducing acne bacteria is important. I would also recommend a Retinoid (Vitamin A derivative) to aid with cell turnover to reduce the build up of mature skin cells. Azelaic Acid and Niacinamide can help reduce inflammation and improve post-inflammatory hyperpigmentation. Oil free, non-comedogenic products should be recommended for acne patients.
Oral anti-biotics may also be prescribed, usually in the form of Tetracyclines such as Doxycycline and Lymecycline. These are usually given for a period of 3 months and should be used in combination with topical treatments.
Dietary changes may also help, namely adopting a low glycemic index (GI) diet. Processed and sugary foods and white bread, potatoes and white rice may aggravate acne, although no specific diet is recommended by the British Association of Dermatologists.
As per NICE guidelines, those suffering with nodulo-cystic acne or acne conglobata should be referred to a Dermatologist in the first instance, as this type of acne is associated with a high psycho-social impact and is more likely to leave scarring which is associated with negative body image even after the acne itself has cleared. These patients will likely require treatment with Isotretinoin, a tablet form of vitamin A. This medication requires regular monitoring and can only be prescribed in the specialist setting.
What can be done to help improve the appearance of acne scarring?
Scar tissue caused by acne can be raised (hypertrophic) or indented (atrophic). There are several ways we can improve this in clinic.
Microneedling is a collagen stimulating treatment that improves the appearance of acne scarring and post-inflammatory hyperpigmentation (P.I.H). A course of 3 or 6 sessions may be recommended depending on the severity of scarring.
Chemical peels resurface the skin which improves both P.I.H and the appearance of raised or indented scarring.
We can also improve the appearance of stubborn indented scars by subcising these with an aesthetic cannula and placing a small amount of dermal filler under to raise the indented area so this is flush with the surrounding skin. Usually a combination of these treatments yields the best results.
Sources:
https://www.bad.org.uk/pils/acne/
https://www.nice.org.uk/guidance/ng198
