Aspects of Acne

In private practice, both in Australia and in London, acne is probably the most common skin problem that I see. So in some ways, it might be easy to stop ‘thinking’ when we, as Dermatologists, treat acne. However, it’s actually VITAL that we don’t do that. Everyone’s skin, face and acne are different, and we need to consider every aspect.

Before we discuss these important aspects and complexities – what are the basics of acne?

Acne is essentially a drainage problem. Our oil glands (sebaceous glands) produce too much oil (sebum). When there is too much oil and the oil gland and related tubing (pore = follicular sebaceous unit) which drains to the skin surface become clogged… the end result is acne. The term acne includes blackheads, whiteheads, papules, pustules and/or cysts. Acne is sometimes also referred to as ‘spots’ which might be used to imply a milder problem, or just whiteheads – but to a Dermatologist, it all means the same thing!

With that basic understanding in mind, you might already be able to start to see some of the different aspects of acne and underlying skin features which we need to think carefully about when formulating a treatment plan for you and your acne. These include:

Your skin type:

Those of you with oily skin will need treatments which lessen oil (sebum) production, as a key aspect of your acne treatment. Overall, this is a main goal in most acne treatment plans. However, it’s not always that simple. Many of you will have especially irritable and sensitive skin which doesn’t tolerate harsh drying acne treatments. Others might have eczema or dry skin, with acne as well… for you we need to balance keeping your eczema prone dry skin, moist; and your acne prone oily skin, dry! It can become a delicate balance and you may have already tried so many unhelpful over-the-counter options or expensive cosmeceuticals.

Your age:

Treatment for your acne will also depend to some degree, on your age. Teenage acne which is mild, might do well with creams and/or short bursts of oral antibiotics. However if you are an adult, you are unlikely to ‘grow out’ of your acne, and so a longer term approach might be needed. There are lots of other reasons why age may alter how we manage your acne.

The type of acne that you have:

Your Dermatologist should look closely at your skin and characterise the type of acne that you have. This enables us to tailor a combination of products and treatments which target the precise processes underlying and contributing to your acne. In short, these include lessening the oil (sebum) production, clearing the secondary inflammation and infection (p. acnes and other bugs), and targeting the overlying skin plugging / blockage problem. Combining and targeting specific treatments according to all of this is vital to a successful treatment plan!

The severity of your acne:

This is an obvious one! Perhaps the most relevant simple point to make here is that a key goal of acne treatment is to clear your acne so that you can feel happy and glowing, and so that we can avoid you developing new or ongoing acne scarring in the longer term. For some people this will be simple and quick, for others with more severe and widespread acne, it might take us a little longer… but we WILL get there.

Diet and lifestyle:

The skin is our largest organ, and it interacts with the rest of our body’s health. A holistic and broad view of skin health is therefore also vital to any successful and lasting management plan for your acne. For example, we know that a diet high in highly processed or sugary foods may contribute to the severity of acne and the success of medical treatment for it. We also understand the complex interactions between stress, hormones, skin health and acne. And in recent years, we are learning more about what is called our ‘microbiome’, which basically refers to all the ‘natural bugs’ which live in our gut lining and on our skin, and the important relationship between these. This is an exciting and important developing area, with great implication in Dermatology, including acne.

It’s a confusing skin care and cosmeceutical world out there, and we can all end up spending a lot of money on products which are either wrong for our type of skin, wrong for our type of acne, or just plain wrong overall! And yet our skin and acne can have such a huge impact on our self-confidence. It’s important!
If you would like to see me about your acne, please get in touch and I’d be delighted to help come up with a personalised plan.

Written by A/Prof Amanda Saracino