The ultimate guide to acne, by a consultant dermatologist

adult acne
#SkinSchool: A dermatologist's guide to acneGetty

My own acne started when I was around 12 years old. It developed around the time of my father’s untimely death which resulted in my personal circumstances changing. I moved to a new country and started a new school, and it was a very difficult time in my life. I can recall moving my hands over my spots and covering up certain parts to imagine what I’d look like without the acne. It impacted me hugely: I didn’t want to socialise, and I became very withdrawn as I found that my self-worth was inextricably tied to my skin. Unsurprisingly, I didn’t make any friends.

I tried absolutely everything in an attempt manage it, but nothing worked. In the end I saw a consultant dermatologist who promptly put me on isotretinoin. It worked, and for the first time in my teenage years I had clear skin. This is what set me on my own path to becoming a consultant dermatologist. I know what it’s like to be in my patients’ shoes and I wanted to reach as many people as possible and catch acne early on so that we can switch it off, prevent scarring and minimise some of the psychological impact it can have.

Unfortunately, my story with acne didn’t end there. I was later diagnosed with a condition called PCOS (polycystic ovarian syndrome). PCOS is a cause of oily skin and my acne returned in my twenties. Since then, I’ve had intermittent treatment for it, as and when needed. I’ve learnt that there is no true cure for acne, but there are absolutely ways in which you can manage it.

All of this had led me to opening my own clinic which specifically caters to acne and acne scarring. Earlier this month we opened the doors to Self, an expert-led dermatology and lifestyle clinic that solves skin challenges, with a particular specialism in acne. I wanted to bring together consultants in dermatology, mental health and nutrition to offer our patients truly holistic support. It’s the place I wish had been available to me as a teen.

Acne causes

The main causes of acne can be broadly categorised into two categories, with the first being hormones. As we hit puberty, our bodies start to produce male hormones known as androgens (in particular, the hormone testosterone). Women also produce androgens, albeit in smaller quantities than men. These androgens act on the oil glands, causing them to increase oil production. At the same time, cells lining the hair follicle become ‘sticky’ and start clumping together in a process known as follicular hyperkeratinization. Ergo, pores become blocked with sticky skin cells and excess oil, and bacterium known as cutibacterium acne (C. acnes) – which lives on the skin – can then colonise these areas, stimulating inflammation and deeper spots.

The second main cause is genetics, which is thought to play an important role in the development of acne, mainly because the size and activity of the oil glands are inherited. Many people who suffer with acne are likely to have relatives that have also been affected by it (though this isn’t always the case; I seem to be the only unlucky member of my family that suffers with spots!).

There are some other causes of acne. These include:

• Cosmetics

• Hairstyling products such as waxes or gels, which contain ingredients like lanolin, beeswax and petroleum jelly

• Medications (for example corticosteroids, lithium, and iodides)

• Medical conditions that can cause hormonal fluctuations (such as PCOS, in which androgen levels are higher than usual)

• Occlusion from wearing headbands, shoulder pads and backpacks

At-home acne treatments

I spend a lot of time trying topical skincare as I like to be able to recommend a variety of products to my acne patients. These are the ones I find myself referring to again and again in clinic as they deliver results:

Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant – This is a fantastic product that gently exfoliates the skin using salicylic acid at a concentration of 2 per cent. Used daily if you have acne, it can help treat existing spots, as well as preventing new ones by helping to unblock pores.

Purifide by Acnecide Microbiome Equalizer – This is a very clever moisturiser that has been specifically designed for acne-prone skin. It’s non-greasy and lightweight but sufficiently hydrates the skin.

Heliocare 360 Gel Oil Sunscreen SPF50/PA++++ – A lot of my acne patients are scared of using sunscreen daily as many formulations out there are greasy in texture. However, it’s paramount that broad spectrum sunscreen be worn on a daily basis, particularly if you are on medication that increases your sensitivity to the sun such as isotretinoin. Thankfully, this one from Heliocare care ticks all the boxes; it’s lightweight and a pleasure to use.

Lancôme Teint Idole Ultra Wear All Over Concealer – Understandably some people will want to cover their spots as best they can. I fall into this category and therefore I try a lot of different concealers and base make-up to ensure that I can give my patients excellent recommendations. This Lancôme concealer is one of those recommendations.

Prescription tretinoin – Retinoids is the umbrella term for vitamin A and its derivatives which include retinol, retinaldehyde, retinyl palmitate, and my personal favourite, a prescription-only version known as tretinoin. I use it at a 0.05 per centage in the evening. It helps to reduce oil production, as well as helping to speed up our skin cell turnover, both of which have a positive effect on acne.

In terms of lifestyle treatments for acne, it's important to note that there are a lot of myths surrounding acne and diet. Of course, a diet that is good for your health is good for your skin, but too often diet is seen as a blunt tool for solving acne, when in fact acne is an incredibly complex issue and diet alone often cannot help.

Professional acne treatments

I undergo several treatments myself in order to manage my own acne and acne scarring. Below are the treatments I personally rate and have on a regular basis, and therefore have available in my own clinic.

Sciton BroadBand Light laser treatment – Acne development is multifactorial and BBL uses a unique three-step process using different wavelengths of light to target various parts of the acne development process:

- First, blue light at around 420 nm is used on the skin to eliminate C.acnes. This step helps reduce and improve the appearance of active acne as well as prevent new breakouts.

- As a second step, yellow/red light will then reduce the inflammation and redness associated with acne. This helps resolve active inflammatory acne and reduce scarring.

- Finally, the skin is treated using visible and infrared light to help complement the results of the first two steps.

The treatment takes approximately thirty minutes, and a minimum of six treatments carried out at fortnightly intervals usually produces the best results. Acne benefit continues for a few weeks following the last treatment carried out and the effects will be maintained until the C. acnes bacterial population returns to its initial concentration; this will happen as it is part of the skin’s microbiome. Some people may find a maintenance treatment will be required within three-to-six months of the initial series of treatments.

Broad band light plays a very useful role in acne-prone women who are trying to conceive or undergo fertility treatments, and therefore have to stop their oral medication and may also discontinue their retinoid use which is commonly used for acne maintenance. For these women options are limited and acne recurrence during this time can lead to distress, shame, anxiety, body image issues, and even depression; not an ideal mental health scenario when thinking about conception. This is where clinic-based broad band light can help.

Dermamelan peel – I have an annual medium-depth peel called Dermamelan. It is fantastic for post-inflammatory pigmentation while helping with reducing oil secretion to prevent future breakouts. It has the benefit of helping to treat photo-damage on the skin from the sun, and will generally give skin a beautiful glow too.

It’s suitable for all skin types and works by combining a variety of different active ingredients including ascorbic, phytic and kojic acid. When applied to the skin they halt the production of tyrosinase which is the enzyme mainly responsible for melanin synthesis. It does all this without increasing the risk of white patches developing on the skin.

Mental health treatment for acne

It’s important to note that acne can affect you mentally: it’s something I experienced myself and so I had to ensure that support for this was available at the Self clinic. I’m proud to have clinical psychologist, Dr Eleanor Chatburn, on our team. Having experienced her own skin issues, she is well placed to help our patients.

If you find that your acne is affecting your day-to-day life, then it’s paramount you seek help as soon as possible. Visit your GP or dermatologist who will be able to point you in the right direction for support.

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