ACNE

Acne is a condition which can come on at any age, but is most common during the teenage years. It causes blackheads, spots, and cysts to develop on the face, and often on the back, shoulders and chest. Skin affected by acne is oily, and often red, inflamed, and painful.

Acne varies in severity. Some people only get oily skin and spots on their face and find that it clears up once they are in their late teens. Other people develop large pustules and cysts across their face, back and chest, and are left with scarring. Some people don’t develop acne until adulthood – this is more common in women.

The characteristic symptoms of acne are oily skin and spots; however the precise symptoms vary from person to person. The NHS describes six varieties of spot commonly experienced by people with acne:

  • Blackheads – small black dots

  • Whiteheads – small, raised spots

  • Papules – small bumps that are painful, inflamed, and red in colour

  • Pustules – like papules but with a white centre caused by pus build-up

  • Nodules – large, raised bumps under the skin that are often painful

  • Cysts – large, painful pus-filled lumps

 

The more severe your acne, the more painful and tender it will feel. Nodules and cysts are particularly prone to bursting, which can cause bleeding and lead to permanent scarring.

We get spots when the hair follicles in our skin become blocked with dead skin and sebum (an oily substance that lubricates the skin and hair). In people with acne, glands in the skin produce too much sebum, which means the follicles are always becoming plugged.

If bacteria on the skin infect these plugged follicles, they can become inflamed, developing into painful papules, pustules, nodules and cysts.

Acne is associated with hormone levels. At puberty, the body produces more testosterone (in both boys and girls), which is thought to affect the sebaceous glands.

It’s also believed that female hormones can have an impact on the production of sebum, which is why adult acne is more common amongst women. If you’re a woman who suffers from acne, you might notice that you get flare-ups around the time of your period or during the early months of pregnancy.

If you have moderate and especially severe acne – which is characterised by having lots of papules and pustules, as well as nodules and cysts – you will probably require prescription treatment, and possibly a referral to a dermatologist.

If you only have mild acne – mostly whiteheads and blackheads with a few papules and pustules – you should be able to manage your spots at home with over-the-counter treatments.

Usually, people with severe acne are prescribed a combination of antibiotic tablets and topical treatments (i.e. gels or creams to apply directly to the skin).

It’s not always easy to avoid acne, but there are some things you can do to manage the condition and prevent it from getting worse or causing scarring.

  • Avoid irritation – Wash the affected area with mild soaps or cleansers and lukewarm water, no more than twice a day. Shower after exercising to prevent sweat irritating the skin

  • Resist the urge to squeeze – Squeezing spots can make them worse and cause permanent scarring

  • Remove make-up – Take off make-up before going to bed and try to use non-comedogenic products (these do not block the skin as much as other products)

  • Use over-the-counter treatments – Speak to a pharmacist about your options and make sure you use products as directed

Things you can do to help:  

  • Avoid over washing your face – no more than twice a day.   But having a gentle cleanser/face wash is essential. Based on my experience, the best products have been those meant for sensitive skin.

  • Salicylic acid works well for some people. However, if you have a very sensitive skin, it may cause problems in the long run. Use it short term only.

  • Invest in a good, gentle moisturiser. Dryness of the skin can cause acne to become worse.

  • Adapalene may be helpful for some, but again, this may cause irritation if you have a sensitive skin.

  • Avoid picking spots as this can cause scarring.  

  • Maintain a healthy diet. I know that many health care professionals claim that diet has nothing to do with skin health, but that is simply not true. Avoid all ultra-processed foods, additives, avoid sugar and especially refined oils, such as sunflower/rapeseed oils which are known to cause inflammation. Look after your gut microbiome which will improve skin health

  • If it is possible for you; invest into a skin consultation with a beautician specialised in acne. This will help you understand your skin type and you will get help in finding the best possible skin care products for your skin. Some people have also benefitted from facials designed for acne prone skin.

The different treatment options which can be prescribed by your GP or ANP are: 

- Topical treatments – these will usually contain adapalene and benzoyl peroxide, an antibiotic and/or retinoid (which are good at unplugging pores; however they are contraindicated in pregnancy). These are often prescribed to treat mild to moderate acne. They can cause irritation leading to dryness or redness, which is why they are not always suitable for sensitive skin. For some people, these might work very well when used for a couple of months.  

- Oral antibiotics – These help by killing the bacteria which can cause acne when you have severe acne. You usually take these antibiotics for 1-3 months.

More about hormones

During puberty, acne often is apparent in the so called T-zone which means your forehead, nose, and chin. Hormonal adult acne however, is typically on the lower part of your face, the bottom of your cheeks and around jawline.

Hormonal acne may be caused by changes in the hormonal balance during:

  • menstruation

  • insulin resistance

  • polycystic ovarian syndrome (caused by insulin resistance)

  • menopause

These hormone fluctuations may aggravate acne issues by increasing:

  • overall skin inflammation

  • oil (sebum) production in the pores

  • clogged skin cells in hair follicles

  • production of acne-causing bacteria called Propionibacterium acnes

Sometime oral contraceptives are suggested for this reason, but they will not address the root cause of problems, such as insulin resistance and they may lead to other issues. If you have hormonal acne, try to balance hormone levels by reversing insulin resistance, avoiding inflammation causing foods and manage your stress effectively.

Chronic stress is known to cause hormonal imbalance or make it worse because of raised stress hormone levels. Practicing relaxation techniques such as medication often help speed up the healing of your acne for that reason.

Some simple steps you can take to reduce stress to heal acne include:

  • deep breathing/breathwork

  • meditation or yoga

  • ensuring good sleep

  • maintaining a healthy diet

  • exercising regularly

  • spending a lot of time outdoors

  • talking to a friend, family member, or a mental health practitioner

If you are interested in learning more about how to rewire your brain to heal, you can find more information here.

More about hormonal balance here.