All about Acne and the latest in treatments

Acne can be a real worrying condition for many young people and some older people as well. It can affect your self-confidence and general well-being.

 What cause acne?

This is a very common question.

  1. Hormones

At about the age of 8 years the adrenal glands start to become active and produce androgens (hormones) and the amount produced gradually increases with puberty. The sebaceous glands are driven by these hormones and start to produce more sebum leading to blockages of the sebaceous glands.

Some young women may have polycystic ovarian syndrome (PCO) leading to excess production of androgens which can lead to acne. If you have other symptoms of this condition such as irregular menstrual cycles, excessive hair or infertility you are advised to see your family doctor for further investigations.

  1. Sebaceous gland blockage

The upper part of the hair follicle gets plugged by sebum forming a comedone.

  1. Stress

Adrenal glands produce more androgen hormones when you are under stress. This can lead to worsening of your acne.

  1. Diet

There are a lot of information on which diets make your acne worst. The most likely diets to help improve your skin based on scientific evidence is

  • Low GI diet (low sugar diet with foods that have a glycaemic index below 55)
  • Low dairy diet – there is less evidence than a low GI diet that dairy products can make your acne worst. In my personal experience a lot of teenage patients often tell me that their acne is made worst when they eat a lot of dairy products. Some dermatologists suggests a low fat and low dairy diet.
  1. Microbiome

This is the new hot area of research in not only acne or skin conditions in general but in health research and medicine!

What is the Microbiome?

It is the normal bugs in that part of the body. In acne it is the skin microbiome. When you upset the normal bugs in the skin (balance of all the microbes in the skin microbiome) acne can occur.The bug that occurs in acne is called Propionibacterium acne or P.acne. Believe it or not healthy people with no acne have a slightly higher abundance of P. acne than people with acne!

A closely related bacterial species, Propionibacterium granulosum is more significantly abundant in people with clear skin than in acne patients.

Researchers have examined the functional abilities of P. acne in people with clear skin and acne patients and have found that virulence-related genes involved in production and transport of bacterial toxins were more abundant in acne patients.

By examining the skin microbiome profile researchers are able to predict whether a person is going to develop acne.

If P. acne is thought to be involved in the development of acne why do healthy people with clear skin have more P. acne?

The answer is P. acne offers health benefits to the skin by producing short-chain fatty acids (SCFA) therefore maintaining a low skin pH. SCFA contains antimicrobial properties that contribute to a low pH (acidic pH) which wards off skin pathogens or bugs which leads to acne. Disrupting the normal skin pH (which is pH5.5) is associated with several skin diseases including acne.

This is a new and increasingly expanding area of research. Stay tuned for more information on this exciting area!

What problems can acne cause?

A recurring thread I hear from my patients is low self-esteem. Some withdraw from many activities including refusing to go to school, missing sporting activities, won’t go to the beach or refuses to remove the T-shirt at the beach or cannot go their formal. A lot of my patients ‘feel down’.

How is acne treated?

With mild acne you may be able to improve your complexion with simple over-the-counter preparations but you need to be patient. At least 6-8 weeks is need to see an improvement.

What over-the-counter can I buy for my skin?

Look for products that contain benzoyl peroxide, salicylic acid, glycolic acid (10% or greater) or azelaic acid.

Avoid greasy products. This includes heavy makeup, sunscreens, moisturisers (instead look for lotions rather than creams or ointments).

Wash your face with a gentle cleanser preferably pH5.5 twice daily.

Avoid squeezing your pimples as this can lead to infection, pigmentation and scarring.

If all else fails, see your local doctor and if necessary see a dermatologist who are the experts in skin disorders.

Leave-on prescription product

Your local doctor may prescribe prescription ‘leave-on products’. This includes topical antibiotics with or without benzoyl peroxide to reduce inflammation in the spots. Another topical therapy are retinoids either alone or in combination with benzoyl peroxide to help remove the skin plugs (whiteheads and blackheads). This is called ‘comedolytic treatment’ as it removes whiteheads and blackheads. All of these products can cause dryness and skin irritation so you may need to use them less frequently and more sparingly.

Oral prescriptions

These include antibiotics, the oral contraceptive pill (particular brands) and anti-androgens. GPs often prescribe the first two but are not as familiar in prescribing the latter.

Severe acne

What treatments are available for severe acne?

  1. Oral isotretinoin

This medication can only be prescribed by dermatologists. There are many side effects associated with this medication and if you need to be counselled carefully before going on this medication. Not all patients are clear of acne after one course which takes from 9-12 months and may need a subsequent course. In a small percentage of cases the acne may get worst before it gets better. If I suspect this is the case, additional oral medications are given for a several weeks.
If you have a history of depression, or planning to fall pregnant this medication is contraindicated. Some young people occasionally have medical conditions that can be aggravated if they take this medication. This include raised cholesterol or blood fats. A dermatologist may choose another treatment for these reasons.

  1. Kleresca treatment

This is a new an exciting form of treatment for both inflammatory and scarring acne.

A photoconverter gel is applied to the skin where you have acne. It is then illuminated with the LED (light emitting diode) lamp specific for Kleresca treatment. After 9 minutes the gel is removed from your skin.

The research to date shows the additive benefits of the gel and light which significantly stimulate collagen production and possibly reduces the more virulent strains of the P.acne population and show a reduction in sebum.

There are 2 treatments done in-clinic per week for 6 weeks. This treatment can only be done at a dermatologist’s clinic who have the equipment and product.

We are finding this treatment has shown to be as effective as isotretinoin  in a significant number of patients with severe acne without the side effects of isotretinoin. No blood tests are required unlike isotretinoin where regular blood tests are required. See your dermatologist for more information.

Is the treatment painful?

No. The treatment is comfortable. You will feel warmth on your skin during the procedure towards the end of your treatment. There is no stinging and no burning.

What is the advantage of Kleresca over other acne treatments?

This treatment does not involve tablets (which is an advantage for those people who cannot swallow tablets or capsules). The gel does not enter your body and therefore is not absorbed systemically. The treatment targets the pimple forming bacteria in your oil glands.

Unlike isotretinoin, your acne does not worsen before improving.

When do I expect to see improvement with Kleresca?

You should start seeing improvement 6 weeks after finishing Kleresca. Standard Kleresca treatment consists of 2 treatments per week for 6 weeks. However treatments can be ‘stacked’ that is 2 treatments on one day with another 2 treatments 2 days later (4 treatments per week) for a total of 3 weeks. Therefore improvement can be seen as early 9 weeks after starting Kleresca treatment if treatments are stacked. Stacking the treatments saves you time as well. Your two treatments on the one day takes 30 minutes per treatment instead of 45 minutes per treatment.

When can I see maximum improvement?

You should see maximum improvement 6-12 weeks after finishing treatment. At the very latest week 18 after the start of treatment.

How permanent is this treatment?

Increasingly more dermatologists are offering this treatment worldwide. Studies have shown that the treated with Kleresca can remain clear for at least 6 months or longer. I generally review my patients who have had Kleresca at week 12 and week 24 after completion of treatment. A booster can be given at week 24 after completion of treatment if necessary.

Maintenance therapy consisting of one booster may be required in a very small percentage of patients every 6 months.

  1. Other treatments

ALA cream and photodynamic therapy using either broadband light with a filter of 420nm or an LED lamp using 420nm and 630nm combination  can also be used in people with widespread acne on face or back or chest. See your dermatologist for more information.

Microneedling can also be used in mild acne. This procedure is done be our registered nurse.

To find out more about how we can help you with your acne please contact our clinic for an appointment. Our nurse led acne clinic run by my experienced registered nurse, Ezgi can help you decide what is best for your skin and whether you need a referral from your local doctor to see me. If you have mild acne my nurse can simply advise you on what products to use.

As dermatologists we are at the forefront of cutting edge technology and at our practice we participate and find out what the various technologies are and what is appropriate for your skin.