Acne
What is Acne?
Acne is a common skin condition characterised varyingly by pustules, blackheads, inflammation, redness and/or swelling. Often a source of embarrassment (particularly in younger patients), acne can be frustrating to manage on one’s own, which is why our experienced consultant dermatologists offer several methods to reduce the appearance of acne. Each treatment plan is customised to meet your individual needs, circumstances and lifestyle.
Explore Topics On This Page
What Causes Acne?
Acne typically occurs due to increased production of oil from the sebaceous glands (oil glands) positioned next to the hair follicles as well as a build-up of old skin around the top of the glands. The build-up of old skin cells blocks the top of the oil gland (“pores”) and traps oil under the skin leading to comedones (“blackheads and whiteheads”). Harmless bacteria that live in our oil glands (most commonly the species Propionibacterium acnes, also called C. acnes) collect in the build-up of trapped secretions. The body’s immune cells (white blood cells) collect around the bacteria to try to eliminate them.
The oil production by the glands is stimulated by hormones, which is why acne tends to start around puberty. In some women, hormone problems, such as polycystic ovary syndrome, may contribute to the persistence of acne. In such cases, appropriate investigation and treatment of the underlying hormone problem can help the acne.
How Can You Treat Acne?
There are several treatment options for acne which can be tailored to each individual’s acne and circumstances. Our consultant dermatologists have many years’ experience in treating acne with all of these options and can discuss with you in detail at your consultation the best option for you and your lifestyle.
Skin Care Review
Because one of the factors contributing to acne is build-up of dead skin cells trapping oil within the oil glands if too many skin care products are placed on top of this it will make the problem worse. Often we find that individuals with acne are applying too many products to their skin in an attempt to clear their acne, but they are only adding to the problem.
Our consultant dermatologists will review your skin care and advise you on how to optimise it to help clear your acne. We can suggested cleansers which can dissolve excess oil, light moisturisers and makeup which do not block pores.
Prescription Creams and Tablets
Creams and lotions containing anti-inflammatory ingredients, vitamin A products (retinoids) or antibiotics can be very helpful, and may be enough to control the acne. For more severe acne, antibiotic tablets can be helpful and are usually well tolerated.
To see their maximum effects, treatment is usually needed for at least a couple of months. In some girls and women, subtle hormone problems (such as polycystic ovaries) can contribute to acne. Treatment of this, usually with an oral contraceptive pill and/or other medication and dietary change, may be helpful.
Microdermabrasion and Hydrafacials
Microdermabrasion and Hydrafacials can help remove part of the top layer of the skin, particularly the excess old skin around the top of the oil glands, which can reduce the blocked pores and the build-up of secretions that cause blackheads, whiteheads and acne.
Microdermabrasion uses crystals to gently exfoliate the skin.
Hydrafacial uses water jets and a patented “vortex” technology to infuse water and salicylic acid into the skin to unblock the pores and clean away the excess oil.
Either Microdermabrasion or Hydrafacial can be useful to add to enhance a skin care plan and are useful to add to other treatments.
Roaccutane®/Isotretinoin
For more severe acne that is unresponsive to prescription creams and antibiotics, Roaccutane®/Isotretinoin tablets can be a very effective treatment. Roaccutane® was the original brand of Isotretinoin to be developed, but other drug companies now also make Isotretinoin.
The average duration of treatment is six months. Almost all patients experience dryness of the skin, lips and eyes and an increased tendency to burn in strong sun. Rarer side effects include liver problems and a change in blood fat levels, but blood tests can monitor for this. Because Isotretinoin can affect the development of unborn babies, women must take adequate contraceptive measures before, during and for at least one month after a course of Isotretinoin.
There has been concern raised as to whether Isotretinoin may contribute to depression in a small number of individuals, but the majority of patients who receive Isotretinoin experience no significant psychologically adverse effects and notice a significant and permanent improvement in their acne.
Isotretinoin also has a significant benefit on reducing scars, so many of our patients who are treated with Isotretinoin for their acne see their scars resolve too, and do not need any additional treatment for scars afterwards.
Testimonials
“A life changing experience, after going on medication my skin is acne free. Dr Farrell was very considerate, knowledgable and really helped me. The whole team was friendly and kind. Lots of treatment options were available, and Dr Farrell talked me through each one, explaining the pros and cons. She also suggested skin products that could help. I felt involved in my treatment plan, which is really important. If I have any other problems I will definitely return.”
LED Light Skin Therapy
Many patients with acne notice that their skin improves with sunlight. The blue part of sunlight can be beneficial in acne in that it kills the bacteria without the adverse effects of ultraviolet light. However, excessive exposure to ultraviolet light in sunlight can damage skin and increase the chance of skin cancer and wrinkles. There is evidence that light emitting diodes (LED) producing blue light can be beneficial in treating acne. Red light has also been reported to have an anti-inflammatory effect on the skin and to add to the benefit of blue light. As a result, many of our patients have found success using LED Skin Therapy.
Treatment under either the blue or the red light takes approximately 20 minutes. This treatment is usually done either twice a week with alternating blue and/or red light treatment, or once a week with simultaneous blue and red light exposure. Some improvement can usually be seen after four weeks, and published studies suggest this improvement continues for up to two months after treatment is stopped. Blue and red light is probably not as powerful in dealing with severe acne as Roaccutane®/Isotretinoin but it does not have any side effects, so it is an option for some patients. It is painless and gentle with no known side effects.
It is useful to add into any acne treatment plan. It can also be helpful to bring under control any initial “flares” or “purge” of acne that may occur when new treatments, such as Roaccutane® /Isotretinoin are introduced.
Laser Treatment
The use of pulse dye lasers (585nm and 595 nm wavelength) is reported to be of some benefit to acne. The original brand of pulse dye laser used in some of the earliest published studies was the “N-lite” brand. The pulse dye laser was originally developed to treat red birthmarks in babies and is useful in reducing the redness of inflamed acne and early acne scars. It may also have some effect in reducing bacteria.
The laser setting that we use for acne is very gentle, does not cause significant marks or bruising and helps the redness from the acne fade more quickly. It can be useful to add to any acne treatment plan to reduce the redness of acne spots and reducing the risk of scarring.
We also offer several other lasers/energy based devices which can help acne, particularly the Fotona long pulsed NdYag (1064nm). This goes deeper than the pulsed dye laser and, as well as killing the bacteria, when done often enough, it can shrink the oil glands. It is a gentle treatment which is painless and with no recovery time. However, it is better to avoid doing it repeatedly over the beard area in men, as repeated sessions may reduce hair growth. For the best results at least 8 sessions are needed, and it can be done twice a week initially. As the improvement starts to be seen the frequency can be reduced. It works well when preceded with an exfoliating treatment such as Microdermabrasion or Hydrafacial.
Our consultant dermatologists can discuss the best laser option for you at your consultation.
Photodynamic Therapy for Acne
There has been increasing interest in using photodynamic therapy to treat acne, particularly in the United States. A cream, called porphyrin cream, which is absorbed by the overactive oil glands and temporarily makes the skin more sensitive to light, is applied to the skin for between 30 minutes and three hours. An LED light or pulse dye laser is then used on the skin. It has been suggested that this may cause a more rapid improvement in the acne than LED light or lasers alone, but it is very important to avoid excess light exposure for 48 hours until the effects of the light sensitising cream have worn off.
How Can You Treat Acne Scars?
Dr Farrell also has great experience in treating acne scars and has a wide range of effective treatment available for scar reduction (subcision, localised excisions, pulsed dye laser for redness, microneedling, fillers, Picoway laser, Fraxel Restore, Fraxel Repair and Ultrapulse Alpha) which she can discuss at your consultation.
An individual treatment plan for dealing with your scars can be made, taking into account the type of scars (e.g. rolled, boxed, ice-pick), the severity of and number of scars, your skin type and colour and your lifestyle.
Skin Care Advice
Sometimes all that is needed is a change in the skin care products being used by the patient. Over-use of rich moisturisers can make acne worse, as the oils in the moisturisers contribute to blocking the sebaceous glands. Washes or cleansers containing salicylic acid can be particularly helpful in removing the excess oil and reducing the severity of acne. Glycolic acid products can also be helpful.
