Acne is one of the most common skin conditions, affecting most teenagers between 16 and 19 years and up to 20% of adults. For many people acne is a real problem. It’s painful, distressing and embarrassing and can significantly affect self esteem.
Acne is caused by excess production of sebum. Sebum is a wax that keeps the skin waterproof. It is produced by the sebaceous glands, which are attached to the hair follicles in the skin. For reasons not understood, acne prone skin produces too many skin cells. These extra skin cells mix with sebum and block up the skin pores. Because sebum is still being produced, it builds up causing swelling, which may then burst out into the surrounding layers of skin. This causes inflammation, pain and redness. Propriones acne bacteria may invade the area, and pus can form.
Acne causes different types of sores and blemishes in the skin. Acne sufferers may have one or more of the following:
Blackheads – these are a collection of dead cells and sebum blocking the pore (the blackness is not dirt, but oxidized sebum).
Whiteheads – sebum builds up behind the blockage causing a lump, which is covered by a thin layer of skin. The sebum stays white as it has had no contact with air.
Papules – the sebum has broken out into the layers beneath the surface of the skin and caused inflammation, so it appears as painful reddish lumps.
Pustules – the inflammation has turned into pus and broken through the skin to form the classic yellow ‘pimple’.
Cysts and Nodules – these are painful lumps caused by inflammation in the skin.
Open Sores – usually pimples that have been scratched or picked.
Scars – pockmarked, sometimes darkened, areas of skin left after large pustules (and sometimes even small pimples) have healed.
Sebaceous gland activity is governed by the sex hormones. The oestrogens (the female sex hormones) suppress the sebaceous glands, whereas the androgens (the male sex hormones) stimulate them. Males and females have both types of sex hormones. During the teen years the blood levels of sex hormones rise, and this is the reason why acne is more common in teenagers.
Adult acne may often be the result of an hormonal imbalance in females, and it is important to have this investigated, particularly if you have other symptoms of an hormonal imbalance such as irregular periods and/or excess body hair.
Acne is best treated with a combination of methods in increasing order of strength dependent upon response and severity of the acne initially.
Mild acne is best treated with exfoliating treatments to reduce the number of skin cells and stop them blocking the skin pores. Exfoliating creams and mild skin peels containing glycolic and salicylic acid are particularly good at controlling mild acne. Microdermabrasion is also very effective in unblocking pores. Benzyl Peroxide, an antibacterial compound found in many over the counter acne preparations is also very effective for mild acne.
Moderate and severe acne needs prescription medications to reduce the risk of permanent scarring. Topical prescription Vitamin A cream ( not the ones from beautician, but doctor prescription only) are the most effective skin creams for moderate acne. These Vitamin A creams suppress the sebaceous glands and help to break the acne cycle. Sometimes antibiotics such are prescribed together with these creams, particularly if there is a lot of inflammation and infection in the skin. These may need to be taken for months either continually or in bursts of a few days a month.
Because oestrogen is a sebaceous gland suppressor, the oral contraceptive pill ( OCP ) is also a very effective treatment for female acne sufferers. There are special OCPs which have been formulated to reduce testosterone levels.
For severe acne, oral Vitamin A is a very effective treatment and may result in long term remission for many patients.
At VISTA Clinic Australia Melbourne we also use special peels (we have own lab of different types and concentrations) at low power to interfere with the overgrowth of keratin and kill the P. acnes bacteria.
In the cases of permanent acne scars, subcision causes remodelling of the skin.
The treatments are used monthly over a cycle of 6 treatments (although good results may occur sooner). This is often combined with microdermabrasion. Treatments cost $350 per session for combination peel and microdermabrasion or $250 for microdermabrasion alone or $150 for peel alone.
For established acne scars we do the above peel/microdermabrasion treatments plus undermine the scars with a needle (subcision). These have a downtime of around 1-3 days and may need to be repeated 2-6 times over a year, but can effect permanent improvements.
As no treatment can 100% fix acne scars in is important to aggressively treat active acne in young people to avoid this skin damage.