Hi, my name is Dr Philippa McCaffery, founder and creator of Clearskincare’s skin correction programmes. I am a Cosmetic Physician practicing in Sydney, Australia and my practice specialises in non invasive, effective and affordable solutions for everyday skin problems like acne, aging skin, acne scar, scar and sun damage.
Acne is one of the most common skin conditions, affecting most teenagers between 16 and 19 years and up to 20% of adults. Acne is caused by overactive sebaceous glands and excessive keratin production, leading to excessively oily skin that is prone to blackheads, white heads, pimples and cysts. Sebaceous gland activity is governed by our sex hormones: oestrogens (female hormones) suppress sebaceous gland activity while androgens (male hormones) stimulate sebaceous gland activity.
Teenagers are especially susceptible to acne, as the sex hormones are new to the developing teenager, and the sebaceous glands are particularly sensitive to this new hormonal stimulus.
Researchers in the past several decades have identified four components that contribute to the development of acne:
1. Hormones – see above
The androgens eg testosterone, control the size and sebum output of the sebaceous glands. Severe cystic acne involving the face, back and chest, is more common in males, which is consistent with males having higher levels of testosterone than females, however, no-one really understands why some people suffer from severe acne with the same blood testosterone levels as others who don’t. Researchers postulate it is due to increased sensitivity of the sebeceous glands to testosterone but the exact cause of this increased sensitivity remains unclear. Adult Acne appears to be caused by genetic predisposition (many adult acne sufferers have a strong family history of acne) or, in females, hormonal imbalance. This hormonal imbalance can range from the monthly breakout caused by oestrogen level fluctuations (“ premenstrual acne flare”), through to Polycycstic Ovarian Syndrome in which the sebaceous gland is overstimulated by excessive “free” testosterone. Polycystic Ovarian Syndrome is the most common cause of Adult Acne in females.
2. Abnormal desquamation of sebaceous follicle cells
In acne prone skins, keratinocytes exfoliate at an abnormal rate. These cells fall into the hair follicles, become trapped along with excess sebum and cause clogged pores. This results in altered keratinization and the production of comedones.
3. Proliferation of P. acnes bacterium
While Propionibacterium acnes is found normally within a healthy skin environment, some researchers believe that acne-prone people generate an excess of the bacteria.
4. Excessive immune response
The body overreacts to what might ordinarily be a small, localised inflammation. The result is extreme inflammation and pus.
Acne can be broken up into 3 main categories:
Breakout to mild acne – blackheads (open comedones), whiteheads (closed comedones), mild irregular eruptions of several whiteheads and raised bumps (pustules) with red and white pus under the skin. Confined to the face.
Moderate to severe acne – regular to constant pustules, many closed comedones with inflamed pores and deep hard nodules (cysts) under the surface of your skin. These cysts are tender to touch, may even hurt. Confined to the face.
Severe + acne – everything erupting at once, whiteheads, blackheads, pustules, papules and cysts on face, neck, chest and back.
Acne is directly related to a person’s skin type. As you cannot change your skin type, there is no cure as such for acne. However, by introducing an ongoing treatment programme using accepted, well researched products acne can be controlled. This treatment programme must address:
• control of excessive oil production;
• exfoliate excessive keratinocyte production;
• minimise infection by keeping fingers away from blackheads, whiteheads etc.
• minimise scarring by extracting keratinocyte plugs and/or infected sebum from clogged pores before they turn into larger inflammed infected sores; and
• protect the skin from UV radiation using a broadspectrum oil free sunscreen.
The golden standards for the treatment of acne are alpha Hydroxy acids (AHA) such as glycolic acid, hydroquinone and Vitamin A in the form of tretinoin.
Mild to Severe acne can be controlled using a combination of topical cleansers and creams containing an AHA such as glycolic acid to control excessive oil production. Microdermabrassion in combination with an AHA such as glycolic acid to exfoliate excessive keratinocyte production.
Moderate to severe acne can be controlled using single best topical treatment for acne is tretinoin (Retin A and Stieva A being the most common brands). A mainstay of acne therapy for nearly three decades tretinoin normalises the exfoliation of follicular cells, promotes drainage of existing comedones and inhibits the formation of new comedones and inflammatory lesions.
In addition, tretinoin enhances the penetration of other topical agents – like antibacterial creams or AHAs such as glycolic acid by causing the unplugged follicle to become more accessible. This inhibits the further growth of P. acnes bacterial and minimises the rupturing of comedones into surrounding tissue. Hydroquinone is used to control pigmentation issues associated with acne scars returning the skins tone to that of the surrounding unaffected skin, giving an even complexion.
Therefore, tretinoin is used in conjunction with hydroquinone and the AHA glycolic acid in the treatment of acute acne. Each addresses the main pathology in acne and help stop the breakout cycle and return the skin to a healthy state.
Sufferers of Severe + acne should see their Doctors immediately and ask for a referral to a dermatologist.