Acne is a common skin condition that is often overlooked and under managed, in the belief that it is a temporary affliction that will resolve itself with time. Whilst there is a small amount of truth in this, acne often remains problematic for years, and the pigmentation and scarring that sometimes occurs can last for a life time.
What is acne?
Acne is a disorder of the pilosebaceous unit. This is essentially a structure that contains a hair shaft and a sebaceous gland, that makes sebum. Sebum is a substance we need to lubricate and waterproof our skin. It is currently thought that acne develops after a variety of processes that narrow or block this structure. This causes a build up of sebum within the structure leading to some irregular lumps and bumps on the surface of the skin. This is commonly known as comedonal acne. The blocked glands can then become inflamed resulting in pustules. These can then progress to cause rupture of the structure with inflammation extending to surrounding tissue with resultant scarring and nodules.
What causes it?
The main causes are hormonal changes and a bacteria called Propionibacterium acnes (P. acnes) The hormonal changes are easily seen as androgen levels increase in puberty, resulting in an increased sebum production and an increase in acne lesions. This can also be seen in who start or change their contraception.
The bacterial role is complex. P.acnes (the bacteria) is thought to increase the stickiness of some of the cells in the gland, resulting in blockage and comedone formation. It is also thought to be responsible for secreting enzymes that contribute to comedone rupture and the tissue injuries that result in scarring and pigmentation.
How can we treat acne?
Topical treatments
The first line treatments are usually skin preparations such as benzoyl peroxide. Benzoyl peroxide is effective in reducing the bacteria, and also helps “unstick” the stuck cells in the blocked comedone and promote it’s recovery. Antibiotics can also be used, either in creams applied to the skin or in tablet form. Retinoid creams have a number of actions that help normalise the skin cells and are effective in the management of acne.
Phototherapy
If initial treatment is not effective it is worthwhile adding phototherapy to the treatment regime. LED phototherapy uses low energy light to stimulate a variety of cellular responses that can destroy the bacteria, as well as suppress inflammation and pigmentation. LED phototherapy is very effective, particularly when combined with topical treatments. It is currently recommended to have treatment blocks of 10 or more sessions, two or three days in-between sessions.
Chemical Peels
Chemical peels are solutions that are applied to the skin and allowed to soak through the epidermis for a set time, before being neutralised. Some chemical peels such as Salicylic peels or Pyruvic peels have been shown to be particularly effective in the management of active acne, with reduction in the number and severity of lesions with a course of treatments. 6 treatments or more may be required with one or two weeks in-between treatments.
What about Scarring and Pigmentation?
The long term consequences of inflammatory acne can include pigmentation changes and facial scarring. Both acne scars and pigmentation can be improved with skin resurfacing treatments such as dermaroller, chemical peels or laser resurfacing. The treatments vary in term of the downtime required, the number of procedures required and the outcomes. In general terms laser resurfacing is considered the gold standard treatment with fewer sessions required and better outcomes, however there may be up to a couple of weeks of recovery after each treatment. Dermaroller also gets excellent results but will typically require more treatments. There is less downtime with a dermaroller, often the skin is just a little red for a few days. Chemical peels can get good results depending on the depth of the peel. The deeper the better, up to a point, but deeper peels have longer downtime. You need to discuss your options with your doctor and decide on what treatment works best for you, in terms of the outcome desired, the downtime tolerable and the number of sessions you can commit to.
We hope this short article answers some of your questions. If there is anything you would like to know more about please contact us here and we will be happy to answer your enquiry.
Simon Ravichandran