Acne is one of the most common skin conditions in the world, affecting adolescents and adults, especially in females, even if they didn’t have teenage acne. How we treat acne has evolved over the years as we learnt more about the skin and its various conditions.
Acne isn’t caused by a lack of hygiene or ‘dirty’ skin – so no amount of cleansing, scrubbing or exfoliating will get rid of it. In fact, this can inflame skin and make everything worse! Acne is simply a medical condition that needs a medical solution.
Acne doesn’t just affect your face – it can appear on your chest and back (and sometimes your upper arms) as these areas have loads of sebaceous glands.
What Is Acne?
Acne is not a cosmetic condition, but a chronic inflammatory disease, and can be anything from clogged pores (also called comedones, which can be open (blackheads) or closed (whiteheads), papules (small red bumps on the skin) and pustules (like papules but filled with pus) to very large, painful, inflamed and swollen nodules and cysts (‘blind pimples’). Redness, hyperpigmentation, scarring, and pain are also common.
It all starts with a clogged pore. Acne sufferers produce excess oil (‘sebum’) and the skin cells lining their pores don’t shed properly, instead collecting in the pore. The sticky skin cells and oil mix together in the pore, creating a microscopic blockage called a microcomedone.
Acne bacteria (Cutibacterium acnes, which used to be called Propionibacterium acnes) feed on sebum, gathering in large numbers around this oily plug, signalling the body to start producing chemicals that ramp up inflammation.
The inflamed plug gradually enlarges to form a visible comedone. Eventually the pore bursts and bacteria and oil leak into the surrounding tissue, creating even more inflammation, and causing other acne lesions like papules, pustules, nodules and cysts.
Are Hormones To Blame For Acne?
Excess sebum production (‘seborrhoea’) is caused by hormones. The hormones involved are called ‘androgens’, and include dihydrotestosterone (DHT) and testosterone. Both males and females produce androgens, either in their adrenal glands, testes or ovaries or converted from precursor chemicals in the skin, hair follicles, sweat glands and sebaceous glands.
Teenage acne occurs due to the natural increase in androgen hormones during puberty, but adult acne is more common than you think – it can flare during menstruation (it’s thought that this is because less oestrogen is available to suppress androgens), and pregnancy.
Because of its hormonal basis, dermatology treatments for acne can include anti-androgen drugs such as oral contraceptives, spironolactone and cyproterone acetate (Androcur). Vitamin A can also reduce sebaceous gland activity.
Ways To Treat Acne
From over the counter (OTC) remedies to custom formulated prescription treatments, there are a number of ways to treat and prevent acne from returning. When browsing the shelves you will find acne cleansers and acne treatment skincare aimed at unclogging pores (usually with salicylic acid and glycolic acid) and killing bacteria (benzoyl peroxide, which also has a pore unclogging effect). These often don’t fully clear breakouts because they don’t target all the factors that cause acne – oil, sticky skin cells, bacteria, and inflammation.
Clinically formulated treatments can be found through telehealth providers whose doctors can customise the best acne treatment product for you – one that targets all the acne-causing pathways to help you manage acne (and post-inflammatory hyperpigmentation at the same time). With video consultations and direct delivery of your treatment to your door, there is no need to visit an acne dermatologist or wait in line at the pharmacy!
The Best Acne Cream Ingredients
AZELAIC ACID
A naturally-occurring acid derived from rye, wheat and barley (although typically made in a lab from vegetable oils), azelaic acid acts as an antioxidant, anti-inflammatory, anti-bacterial and depigmenting agent.
The anti-inflammatory action of azelaic acid, combined with its antibacterial and pore unblocking functions, makes it a great treatment for mild-moderate acne, especially when combined with a prescription retinoid.
NIACINAMIDE
Niacinamide (also called Vitamin B3) has anti-inflammatory, skin barrier lipid regulating, sebum-regulating, depigmenting, antimicrobial and photo-protective effects (phew!) when applied topically. It is very well tolerated – so well in fact that you will find it in many cosmetic products.
TAZAROTENE
Tazarotene produces similar effects to tretinoin, but it has a more selective action than tretinoin, only binding to specific nuclear retinoic acid receptors (RARs). In practical terms, this means that tazarotene decreases acne papules and open comedones (blackheads) at a more rapid rate than tretinoin.
Finding The Right Acne Cream For Your Skin
Treating the different types of acne can take many forms, from peels and toners to creams and serums. With over the counter remedies, while they are easily accessible in drug and beauty stores you will not see the same results that you would get if you were prescribed acne treatment from a doctor or dermatologist. Consulting a medical professional will take away most of the guess work, as well as the trial and error that is common when attempting to treat and prevent acne.
