Acne is a skin disease where the skin is not functioning normally. For some is can be a cosmetic inconvenience with skin eruptions whereas for other sufferers it can be a cause of immense psychological distress. The disease process causing acne can be summarised as follows:
In an acne patient the skin is overloaded, the pilosebaceous unit gets blocked. Too much keratin causes a plug this allows the fatty substance sebum to become rancid and this creates an ideal medium or environment for bacteria to grow. Skin affected by acne has collagen that is not functioning in the normal way. The bacteria result in pore damage whereby it becomes enlarged and inflammed. Like any infection, this pushes to the skin surface and causes a pustule.
The various stages are as follows:
Open comedones (blackheads)
Closed comedones (whiteheads)
Papules (small red bumps)
Pustules (white or yellow ‘squeezable’ spots)
Inflamed nodules (large red lumps)
Scarring: In pale skin post inflammatory hyperpigmentation is a pink colour whereas in dark skinned patient it is a dark colour.
Once acne erupts it can cause scarring so it is vital to treat at the comedonal stage.
What is the right stage to intervene?
The correct time to treat acne is when blackheads or whiteheads rear their head. It is important to treat each microcomedone before its first eruption or first spot.
Cleansing your skin:
We recommend a salicylic acid cleanser to control your acne e.g. Obagi Clenziderm which contains 2% salicylic acid which unclogs pores and removes dead skin cells from the surface layers of the skin. Wet your face with warm water, apply a dime sized amount of cleanser to your face. Lather your face and keep the cleanser in contact with your skin for up to 20-30 seconds. You should not use a salicylic acid cleanser if you have a known allergy to aspirin products.
Acne sufferers must avoid occlusive moisturisers as not all moisturisers are suitable. Make sure that your moisturiser is non- comedogenic or oil free e.g. Obagi Clenziderm therapeutic moisturiser or Neostrata sheer hydration.
What is different about obagi?
Obagi products are clinically proven, physician dispensed prescription skincare products which really work. Obagi products correct the skin at a cellular level.
Makeup can be one of the main triggers for acne. The ideal is mineral makeup which you can purchase at the chemist or better still Lycogel breathable foundation.
Sun protection is vital when using products containing retinoids or benzoyl peroxide because these products can make you more sensitive to the sun.
Recommended sunblocks are Heliocare SPF 30 oil free gel or Hamilton Everyday Face.
DO NOT PICK AT YOUR SPOTS!!
If your skin flares with dairy, chocolate or fatty foods, it stands to reason it is best to avoid these foods. However there are no clinical studies demonstrating a definite association.
Topical benzoyl peroxide acts as an anti-inflammatory.
Duac is an example of a combination product which contains benzoyl peroxide and topical antibiotics.
Your face may look red after application this is a normal result. The aim of the treatment is to dry up excess oil and spots so that you do not break out. If however your skin is becoming too dry then reduce the frequency of application to alternate days. It is important to keep your Benzoyl peroxide product in the fridge. Benzoyl peroxide may cause stinging and dryness. Benzoyl peroxide can bleach clothing i.e. dark colours so wash your hands after application.
The CLENZIderm M.D. Systems are the only prescription-strength acne treatment that contain a patented form of 5% benzoyl peroxide (BPO) to penetrate deep into the skin and treat acne where it starts.
The solubilized form of 5% BPO in the CLENZIderm M.D. Systems is 1/10,000 the size of any other BPO product available, so it can treat acne where it starts, at the root.
Topical retinoids e.g. Retin A and Tretinoin
Retinoids deal with abnormal keratinisation and increased sebum production
however it does not affect the p. acnes bacteria.
Tetracycline antibiotics such as lymecycline or minocycline may cause sensitivity to the sun, therefore you need to wear an oil- free sunscreen. Thrush may also occur. Drink 4 glasses of water when you take your antibiotic. Maximum course should be 3 months. Ideally avoid taking your antibiotic at night as it may cause heartburn.
In order to check how your treatment is progressing a reassessment at 6 weeks is necessary.
Salicylic acid peels penetrate into the oil producing glands which cause acne and work by reducing inflammation. Typically a course of three to four peels are recommended. Glycolic acid peels are also helpful, however for active acne salicylic acid peels are superior.
In summary, it is best to treat acne earlier rather than later, which is when the first blackheads and whiteheads appear and before the development of spots and pimples.