Acne affects most teenagers and young adults to varying degrees. Without treatment, it will usually clear by age 25 but around 5% of women and 1% of men still require acne treatment into their 30s and 40s.

Adult-onset acne often occurs in women who are undergoing hormonal changes such as pregnancy or menopause and this includes stress as well because of it’s effect on our hormonal system. This disease has a severe impact on the affected person’s quality of life and is often accompanied by social withdrawal, anxiety and depression. The psychological impact of acne cannot be underestimated by medical practitioners.

There is a genetic component to acne as at least half of acne cases are familial. Some studies show that dietary factors could also contribute to worsening of acne but are certainly not the primary cause if it.

What is acne?

It is basically chronic inflammation of the pilosebaceous unit in the skin. This unit consists of a hair follicle and a sebaceous gland that secretes oil for the skin.

How does an acne lesion develop?

1. Excessive oil production within the gland
2. Sebaceous glands responding excessively to normal or elevated levels of testosterone in the blood (males and females).
3. Overgrowth of the upper layer of the skin with then occludes the opening of the pore
4. Increased bacterial growth by Propionibacterium acnes (this is a bacteria which is normally found in the skin but in increased amounts in acne cases)
5. INFLAMMATION! Propionibacterium acnes breaks down the oil in the sebaceous unit and releases fatty acids which induces an inflammatory cascade. Activated immune cells attack the unit which results in rupture of the follicles and further inflammation – basically, an angry, unhappy, flaring skin!

Acne can present in various ways and can affect the face, neck, chest and back. It is graded according to severity and treatment is often guided by this grading system.

Grade 1: Comedomes only (black and white heads)

Grade 2a: Comedomes and inflammatory papules(blind pimples) that are superficial enough to be treated topically

Grade 2b: Papules are deeper and may require oral treatment

Grade 3: All of the above with the addition of pustules(those yellow pimples you can’t stop yourself from squeezing)

Grade 4: Deep nodules and cysts/ abscesses in addition to the above

What treatment options are available to you?

Treatment has to target more than one option for the greatest success at improvement and long term remission. It is best to discuss the most suitable options for your skin with your doctor.

1. Skin care routine:
   • The products you use should effectively remove any sebum build up on the skin and should have active ingredients that chemically exfoliates the upper layer of the skin. The idea that the more you scrub, the better the results is a misnomber – we don’t want inflammation, so we need to calm the skin in a lot of cases first.
2. Chemical peels:
   • Hydroxy acid peels: these should always be applied by a trained professional. Acids commonly used for the treatment of acne are salicylic acid, azelaic acid and mandelic acid.
3. Prescription options:
   • Topical benzoyl peroxide and/or retinoids
   • Oral antibiotics
   • Oral isotretinoin
4. Hormonal treatment
   • Combined oral contraception pills prevent the hormonal surge of the triggers of acne but we often see that symptoms return once the pill is stopped.
5. Light based therapies

We love treating acne here at Elan Healthstyle by approaching treatment aimed at all aspects of acne – causes, worsening precipitants and long term remission.

Skin health has such a wonderful impact on our frame of mind and confidence and treating acne early is so important to prevent further complications such as scarring and post inflammatory hyperpigmentation.

Come see us with your skin concerns!

– Dr Nadine Stewart