General measures that will help acne include:
- Avoid applying greasy cosmetics, moisturisers or sunscreens to acne prone areas
- Wash the face with warm water and a gentle cleaner to remove oil. If this leaves the face still feeling oily, an over-the-counter acne wash or cleanser that contains salicylic acid, glycolic acid or benzoyl peroxide may be helpful
- Avoid abrasive scrubs, toners and cleansers
- Avoid squeezing and picking pimples as this irritates inflamed lesions and is more likely to lead to scarring
- Avoid hot humid areas and tight clothing in acne prone areas
- Follow a well-balanced, low GI diet combined with regular exercise
- Avoid smoking
Non-prescription topical products
These can be used to treat mild acne and include:
- Benzoyl peroxide lotions and creams
- Azelaic acid preparations
- Glycolic acid preparations
Prescription topical products
Prescription products are usually prescribed by your doctor or dermatologist when non-prescription products have not been effective. These include:
- Topical antibiotics (either alone or combined with benzoyl peroxide) to reduce inflammation in pimples or pustules
- Topical retinoids or Vitamin A creams (either alone or combined with benzoyl peroxide) to help remove the skin plugs and prevent the formation of whiteheads and blackheads
All of the above topical treatments may cause irritation and dryness in some people. Reduce the frequency of application if this happens and stop using the product and see your doctor if severe irritation occurs.
Prescription oral preparations
These may be prescribed by your doctor or dermatologist to suppress acne which is either more widespread or more inflammatory. Oral prescription-only medications include antibiotics (such as doxycycline or minocycline), the oral contraceptive pill and anti-androgens (such as aldactone, cyproterone acetate). The latter two are often most effective in women with adult acne. Oral preparations are usually used in combination with topical therapies.
Treatment of severe acne
People who have large, deep acne spots or those who are not responding to standard oral therapies may need a referral to a dermatologist to consider:
- High dose, long term oral antibiotics
- Oral isotretinoin (Roaccutane®, Orotane®)
- Kleresca®: a new alternative to oral therapy (see below)
Other treatments
Light chemical peels or laser and LED light systems may help mild acne. However, these treatments may not be effective long term and may need to be repeated regularly.
New Breakthroughs
Kleresca® Acne Treatment is a breakthrough BioPhotonic treatment that improves moderate to severe acne. BioPhotonic means that the light produces biological reactions in the skin, including killing bacteria, normalising cellular activity and stimulating the skin’s own repair systems to build-up collagen and reduce the signs of scarring. In clinical trials, Kleresca® Acne Treatment showed high efficacy in people with moderate to severe acne, with 9 out of 10 patients showing an improvement in their skin. This treatment is now available at Inner Sydney Dermatology.
Acne usually starts at puberty when increased levels of sex hormones (androgens) cause an increase in the size and oil production of glands. The face, neck and chest, shoulders and upper back are most likely to be affected by pimples as they have the highest number of oil glands. If the blockage of dead skin cells and sebum stays below the skin you get a whitehead. If the blockage reaches the air, it turns dark and becomes a blackhead. When bacteria gets into the surrounding tissue, it can become inflamed, with small red bumps (papules), white or yellow pus-filled pimples (pustules) or large red bumps (inflamed nodules).
Some people are genetically predisposed to acne. Stress has also been linked to acne, as have hormonal conditions such as polycystic ovary syndrome. Acne can be caused or aggravated by a high glycaemic index diet, oil-based cosmetics, sunscreens or creams, hot and humid environments, working with oil and grease, and some medications, including steroids, certain contraceptive pills and some epilepsy treatments.
The good news is there are effective treatments out there to help most acne sufferers.
Acne myth #1: Only teenagers get acne
While there are many who only experience acne during their teenage years, plenty of adults get acne too. A survey of more than 1000 adults published in the Journal of the American Academy of Dermatology found that 50% of women 20-29 years old, 35% of women 30-39 years old, 26% of women 40-49 years old and 15% of women aged 50 and over reported having acne. Adult acne is more common in adult women than in men, due to ongoing hormonal fluctuations.
Acne myth #2: Acne is not related to diet
We used to think that diet had nothing to do with acne, but recent studies have shown a possible link between high glycaemic index (GI) foods and acne. A high GI diet can aggravate acne because it stimulates insulin production, which affects our endocrine system and hormones.
Acne myth #3: Blackheads are dirt in your pores
Skin cell turnover is a natural process that pushes oil and debris out of our pores, keeping them clean. When this process occurs too slowly, sebum and skin cells build up in our follicles, resulting in a blackhead or whitehead. Blackheads are open, which lead to oxidation of the plugged materials and a black colour. It has nothing to do with dirt. Vitamin A creams (retinoids) help reduce blackheads by increasing skin cell turnover.
Acne myth #4: If you have acne, you need to wash your face more often
Although it’s important to maintain good skin hygiene to remove bacteria, dead skin cells, excess oil and dirt from the surface, over-washing and over-scrubbing can actually irritate the skin and make acne worse. When you wash too much, you strip your skin of it’s natural oils. This dehydrates the skin, so it overcompensates by producing more oil, which can then clog pores and increase acne.
Acne myth #5: Moisturisers cause acne
Dehydrated skin actually produces more pore-clogging oil than hydrated skin. If your skin is dry, apply a lightweight, non-comedogenic moisturizer twice daily. Moisturisers don’t prevent wrinkles (another myth!) so skip this step if your skin is producing enough natural oils itself.
Acne myth #6: Make-up makes acne worse
It’s true that some products can clog pores and make acne worse, but the right makeup can actually improve acne. Powder foundations can absorb oils that would otherwise clog pores. It you prefer a liquid foundation, look for one labeled oil-free or non-comedogenic, meaning it won’t clog pores.
Acne myth #7: Sun exposure helps acne
Although it may feel like the sun is drying up your pimples, at best a tan or mild sunburn only camouflages the breakout. The sun’s ultraviolet rays can damage the skin, releasing free radicals and destroying cellular DNA, which can increase inflammation and lead to premature ageing and skin cancer. Look for a broad spectrum, SPF 50+ sunscreen that is oil-free and non-comedogenic. Some physical sunscreens containing Zinc may actually help kill acne-causing bacteria. A higher SPF sunscreen is not more occlusive and does NOT increase the risk of acne.
Acne myth #8: Toothpaste can heal a pimple
Toothpaste contains a number of ingredients including baking soda, hydrogen peroxide, alcohol, menthol, essential oils and triclosan, which can dry pimples out. However, it can also cause irritation and rashes, so use a product specifically designed for your skin.
Acne myth #9: It’s OK to squeeze pimples
Tempting as this may be, it’s never a good idea. Popping pimples causes trauma to the skin and may actually drive bacteria deeper into the pore, increasing inflammation. More importantly, the trauma to the skin may increase your chance of leaving redness, pigmentation or permanent scarring.
Acne myth #10: Acne is not affected by stress
Although the exact mechanisms by which stress increases acne outbreaks are unclear, it is thought to be linked to chemical reactions, which create hormonal imbalances in the body. For example, during times of stress the stress hormone cortisol is increased, resulting in increased oil production, which can lead to pimples. Stress-induced inflammation may also play a role.
