Acne

Consult a specialist in acne management (either a specialist GP or dermatologist) if your acne is persistent, not responding to over-the-counter treatments, is affecting your emotional wellbeing, or is causing scarring.

We use a treatment ladder when addressing whiteheads and blackheads (i.e. comedones) starting with more gentle topical treatments and moving deeper into the root cause. Specific treatments we use are:

1. Topical salicylic acid
2. Topical AHAs
3. Topical retinol or prescription vitamin A
4. Prescription anti-androgen cream
5. Physical extraction
6. Diathermy
7. Addressing hormonal sensitivity that drives the sebum production through oral medications
8. Treating the cause of oil gland over activity through medication or laser treatments

Red acne bumps often indicate inflammation. Treatments for this include:

• Anti-inflammatory tablets or anti-inflammatory lasers
• Topical anti-androgen creams
• Vitamin A creams if the skin is not too sensitive
• Anti-hormonal receptor tablets
• Oral vitamin A
• AviClear laser treatments that specifically target the over production of oil

Topical treatments tend to be ineffective for cystic acne. Instead, we recommend:

• Oral vitamin A capsules are the gold standard for treating cystic acne (prescribed by a dermatologist only).
• AviClear laser treatment is an alternative, medication free option, that has a similar mechanism of action to oral vitamin A.
• Anti-androgen treatments can be helpful, but the effects only last for as long as you are taking the medication. The recurrence rate is high when you come off the medication.

It is important to remember anti-inflammatory medication (e.g. antibiotics, anti-inflammatory lasers) only have short term effects.  If you are after a longer term solution for your recurrent acne, your best options are:

• Oral vitamin A (prescribed by your dermatologist only)
• AviClear laser treatments

Anti-androgen treatments, such as combined oral contraceptive pills, tend to only work for the duration you are taking the medication. This can be an option if you require oral contraceptives, or need anti-androgen treatments for hair loss etc., otherwise we would suggest talking with your dermatologist about alternative treatment methods.

All acne falls under the influence of hormones.  Some may have abnormal hormone levels (e.g. PCOS), others may have an inherited sensitivity to the hormone (hormone receptor sensitivity), while others may be on hormonal medication (progesterone based contraception, or a testosterone supplement).

The treatment options for hormonal acne include:

• Addressing underlying abnormal hormonal levels
• Treating hormonal sensitivity
• Addressing any lifestyle triggers (lifestyle habits, skincare, dietary/supplement intake)
• Treating overactive oil glands
• Treating the inflammation associated with acne

Some experience transient acne in response to hormonal changes at puberty that can improve with age. Others have persistent recurrent acne as a result of one or more of the four key factors in acne formation - genetics, hormonal sensitivity, bacterial overgrowth, or autoimmunity. Acne, when not treated, can leave permanent scars. As dermatologists and acne GP specialists, we highly recommend treating and managing your acne early to prevent scarring.  

There are many treatment options for acne that don't require medication. The severity of your condition will determine the best course of action.

• Early acne can be managed with the use of appropriate skincare, prescription vitamin A or anti-androgen creams and extraction.
• Moderate to severe or recurrent acne can be managed with the AviClear laser which specifically targets activity in the oil glands (the same mechanism prescribed oral vitamin A capsules use), achieving long term remission of acne without medication.
• Vascular lasers can be helpful in reducing inflammation and the deeper wavelength of the laser can reduce bacterial load in the oil glands.
• A picosecond laser can be used on certain skin types and tones to help to reduce the chance of post inflammatory pigmentation.
• Photodynamic therapy can sometimes be helpful. This procedure involves the application of a cream that is targeted to and then absorbed by the acne causing bacteria in the oil gland. A light or laser is then applied to activate the cream to destroy this bacteria.
  

It is important to avoid irritation of the skin. Those prone to acne tend to over cleanse and use harsh products on their skin to reduce congestion. Though this may sound like a logical approach, it is usually counterproductive. Excessive use of oil stripping products can actually increase surface dryness, rebound oil production and pore blockage, resulting in both acne and irritant eczema.

Micellar water is best for makeup removal. If you are keen to use a double cleanse method, we recommend using a micellar water to remove the makeup first, followed by a gentle cleanser to clean again.

It’s also important to avoid heavy makeup and oil-based products if you are acne prone. Many people use products such as Bio-Oil and rosehip oil on their skin, which can aggravate acne. Non-comedogenic makeup and mineral makeup are your best option.