Acne is a common skin condition that affects most people at some point. It causes spots (white-head pimples, blackheads, red lumps and bumps), oily skin and sometimes skin that’s hot or painful to touch with larger lumps and cystic lesions.
Acne most commonly develops on the:
- face – this affects almost everyone with acne
- back – this affects more than half of people with acne
- chest – this affects about 15% of people with acne
There are six main types of spots caused by acne:
- blackheads – small black or yellowish bumps that develop on the skin; they’re not filled with dirt, but are black because the inner lining of the hair follicle produces pigmentation (colouring)
- whiteheads – have a similar appearance to blackheads, but may be firmer and won’t empty when squeezed
- papules – small red bumps that may feel tender or sore
- pustules – similar to papules, but have a white tip in the centre, caused by a build-up of pus
- nodules – large hard lumps that build up beneath the surface of the skin and can be painful
- cysts – the most severe type of spot caused by acne; they’re large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring.
Why do I have acne?
Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age. Certain hormones (in particular testosterone and oestrogen) cause the grease-producing glands next to hair follicles in the skin to increase in size and produce larger amounts of oil (abnormal sebum).
This abnormal sebum changes the activity of a usually harmless naturally occurring skin bacteria called P. acnes. This bacteria feeds off the sebum. Therefore, with the increased amount of sebum available the number of bacteria increases and it becomes more aggressive and causes inflammation and pus.
The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Unfortunately, simple cleaning the skin doesn’t help to remove this blockage.
Are there other possible causes?
Acne is known to run in families. If both your mother and father had acne, it’s likely that you’ll also have acne. Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women. There is still little evidence that diet, poor hygiene or sexual activity play a role in acne for the vast majority of sufferers.
Who’s affected?
Acne is very common in teenagers and younger adults. About 80% of people aged 11 to 30 are affected by acne. Acne is most common in girls from the ages of 14 to 17, and in boys from the ages of 16 to 19.
Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.
What can I do if I have acne?
These self-help techniques may be useful:
- Don’t wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
- Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
- Don’t try to “clean out” blackheads or squeeze spots. This can make them worse and cause permanent scarring.
- Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin).
- Completely remove make-up before going to bed.
- If dry skin is a problem, use a fragrance-free, water-based emollient.
- Regular exercise can’t improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising, as sweat can irritate your acne.
- Wash your hair regularly and try to avoid letting your hair fall across your face.
- Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions and gels for treating mild acne spots are available at pharmacies. Products containing a low concentration of benzoyl peroxide may be recommended as spot therapy– but be careful, as this can bleach clothing, pillow case and towels.
If your acne is moderate or appears on your chest and back, it may need to be treated with antibiotics plus stronger creams or in female’s hormonal therapy (such as spironolactone or oral contraceptive pill) that are only available on prescription.
And in more severe or treatment resistant cases, especially when scarring is being caused, oral isotretinoin can be used to treat the acne. Isotretinoin is high dose vitamin A which target the oil gland sebum production and shrinks the oil glands down to a more normal size.
All medications can have side effects that need to be discussed with our dermatologist’s when considering the potential role of these for your specific situation.
Do lasers have a role in the treatment of active acne?
Lasers can be used in the treatment of acne. However, their results are short-term treatment requiring subsequent treatments until the patient grows out of their acne. It may only provide partial relief. Currently, the dermatological community does not consider laser therapy a first-line treatment for acne and instead recommends that people try other, more proven acne treatments (see above). However, there are patients who do not tolerate oral tablet based therapies or do not respond. In this setting Laser treatments can be considered as an alternative approach
What Is It?
Lasers are a treatment option performed in a doctor’s office aimed at preventing light-to-moderate acne, although it has shown some promise in the treatment of severe acne (cysts/nodules). Laser therapy tends to work better and have fewer side effects on lighter skin tones and works by concentrating light, which penetrates the skin. Lasers work primarily by targeting three modes of action:
- The P. acnes bacteria produce a protein called porphyrins. When the laser light excites the porphyrins, this damages the bacterial wall, effectively killing the bacteria. Fewer acne bacteria should help reduce symptoms of acne.
- Laser treatment may also reduce the abnormal sebum (skin oil) levels.
- Lasers may have anti-inflammatory properties. Since acne is at its root an inflammatory disease, reducing inflammation can help reduce acne as well.
Laser treatment normally requires three treatments, about a month apart, at the doctor’s office. Your team at LaserCare Dermatology sometimes recommend more treatments and/or more frequent treatments, depending on the dermatologist’s opinion and the severity of your acne.
When to seek medical advice
Even mild cases of acne can cause distress. If your acne is making you feel very unhappy or you can’t control your spots with over-the-counter medication, see your GP.
Also see your GP for a referral to a dermatologist if you develop nodules or cysts, as they need to be treated properly to avoid scarring. Try to resist the temptation to pick or squeeze the spots, as this can lead to permanent scarring. Treatments can take up to three months to work, so don’t expect results overnight. Once they do start to work, the results are usually good.
Complications
Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but it’s more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin. Scarring can also occur if you pick or squeeze your spots, so it’s important not to do this.
There are three main types of acne scars:
- ice pick scars – small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object
- rolling scars – caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance
- boxcar scars – round or oval depressions, or craters, in the skin
Treating acne scarring
After treatment for acne scarring, most people notice a 50-75% improvement in their appearance.
Treatments for acne scarring include:
Dermabrasion
Dermabrasion involves removing the top layer of skin, either using lasers or a specially made wire brush. After the procedure, your skin will look red and sore for several months, but as it heals you should notice an improvement in the appearance of your scars.
Laser treatment
Laser treatment can be used to treat mild to moderate acne scarring. There are three types of laser treatment:
- ablative laser treatment – where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin
- non-ablative laser treatment – where lasers are used to stimulate the growth of new collagen (a type of protein found in skin), which helps to repair some of the damage caused by scarring, and improves the appearance
- vascular lasers – these target the redness of the acne scarring. By removing the redness caused by blood vessels in the scarring, it makes the scars much less visible and helps the natural scar healing process.
Punch techniques
Punch techniques are used to treat ice pick scars and boxcar scars. There are three types of punch technique:
- punch excision – used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin.
- punch elevation – used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so it’s level with the surface of the skin. This makes the scar much less noticeable.
- punch grafting – used to treat very deep ice pick scars. As with a punch excision, the scar is removed, but the wound is “plugged” with a sample of skin taken from elsewhere on the body (usually from the back of the ear).
Subcision
Subcision is a surgical treatment that can be used to treat rolling scars. During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area. The blood clot helps form connective tissue, which pushes up the rolling scar so it’s level with the rest of the surface of the skin.
Once subscision has been completed, additional treatment, such as laser treatment and dermabrasion, can be used to further improve the appearance of the scar.