Acne vulgaris, more commonly known as acne, is a skin condition that affects most people at some point. It causes spots, oily skin and inflammation that can be hot or painful to touch.
Every year, 3.5 million visits to the doctors will be made to discuss skin treatment for acne.
- In puberty, acne is especially common in teenage boys
- Women can be affected in adulthood due to changing hormones
- Poor hygiene and sexual activity are not causes of acne
- Acne affects the face in 99% of cases, the back in 60% and the chest in 15%
Skin plays a role in our self-perception, so experiencing acne on any level can carry emotional strain and affect self-confidence.
But the good news is, there’s lots that can be done, both in terms of self-help measures and medical treatments.
What causes acne?
There are sebaceous glands in the skin that are met on the skin’s surface by hair follicles. They produce a fatty substance called sebum, which keeps hair and skin soft.
When we reach puberty, sebum production increases along with the bacterium propionibacterium on the skin. Sometimes sebaceous glands produce more sebum than needed and that’s when acne develops. This is because the excess sebum and skin residue can clog the hair follicle or the sebaceous gland, or because the bacteria enter it, creating an inflammation or infection.
These changes come about because of an upsurge of testosterone and other hormones during puberty and are especially common in teenage boys. The same effects can also become common in women in adulthood, known as adult acne.
What are the different forms of acne?
Acne vulgaris mostly occurs on the areas of skin where there are more hair follicles found that produce sebum – which is why the face, back and chest are most affected. It can come in different forms.
Types of spots: Non inflammatory acne
Whiteheads — small bumps that are sebaceous glands where the wall of the hair follicle is closed.
Blackheads — small dark dots that occur when the hair follicle is open and sebum and bacteria there have turned black because of contact with air.
Types of spots: Inflammatory acne
Pimples — skin pimples appear as red and swollen bumps that can progress to the types below.
Papules and pustules — these can be hardened, clogged pores surrounded by pink skin, that are usually tender to the touch. Sometimes an infection under the skin’s surface can lead to painful bumps filled with fluid (called pustules) that are yellow or white in colour.
Nodules and cysts — these can be painful to the touch and look red and inflamed.
What is post-inflammatory hyperpigmentation?
Post-inflammatory hyperpigmentation (PIH) appears as a result of damage to the skin, following an inflammatory skin condition like acne vulgaris.
It appears as dark flat spots of discolouration across the face and body. Depending on the person’s skin tone and the level of discolouration, these patches are usually brown or black in colour.
Men and women are equally at risk, and while all skin types can get post-inflammatory hyperpigmentation, it occurs more in people with darker skin tones.
Differences between mild acne, moderate acne and severe acne
White and blackheads mostly, with occasional pimples.
More inflammatory papules and pustules that are less than 5mm in diameter, as well as pimples, blackheads and whiteheads.
Nodules and cysts that are more than 5mm diameter (along with all or some of the above). In very severe cases, these may join together and leak fluid onto the skin’s surface.
Skin treatment for acne
Mild cases of acne can often be treated at home with the help of your pharmacist. For moderate acne that’s not clearing up, talk to a Livi GP about some of the treatments they can offer. In some cases you may be referred to a dermatologist.
From the pharmacy
For mild acne, over-the-counter products are available that may take up to 8 weeks to make a difference. These include creams that can work on the bacteria causing the skin pimples as well as cleansers, gels and lotions that work on recurring mild acne and may also help prevention.
From a Livi GP
If your acne has more sore red pustules or papules, or you develop hard lumps under the skin – nodules or cysts – see a GP. They will be able to recommend a course of treatment that is suitable for you. They’ll rule out other conditions that may mimic some features of acne (like rosacea or a hair follicle infection).
Then they can offer a wide range of prescription treatments. These can include prescription creams, topical and oral antibiotics or birth control pills (if you’re not planning on getting pregnant). The latter can help moderate the hormonal action behind the acne.
It’s usually recommended to try any prescribed treatment for around three months. If your acne isn’t clearing up after that, talk to your doctor about changing your treatment.
From a dermatologist
If acne treatments from your pharmacy and GP are not working, they may refer you to a dermatologist for further treatment.
A specialist dermatologist can also advise you about treatments available for acne scarring (such as post-inflammatory hyperpigmentation).
What about adult acne?
For women, hormonal changes related to age or lifestyle and changes in the skin – sometimes triggered by stress – can bring on acne. In this case, the same treatments above apply.
Though because skin is less resilient, it may be better to avoid harsh stripping products and choose milder exfoliating lotions to encourage cell turnover (like those containing salicylic acid – see above).
There’s a theoretical chance that antioxidants like vitamin C in skincare may help acne scarring by stimulating collagen production. But we need more recent studies on whether this helps active acne. Using topical vitamin C could help reduce redness that may be associated with adult acne.
If you develop erratic periods, increased bodily or facial hair growth, alopecia (excessive hair loss from the head) alongside the acne, you may have polycystic ovarian syndrome (PCOS). This can be diagnosed by a doctor.
How to help acne with lifestyle changes
1. Don’t over-cleanse
Spots are not down to poor hygiene, but this is a myth. If you cleanse too aggressively, you may irritate your skin and treatments may sting. Look for non-comedogenic (this means non-pore blocking) products. Ideally wash twice a day with a gentle cleanser that is pH-matched to the skin and use a non-oily moisturiser. Look for oil-free or water-based non-comedogenic make-up. Never pick or squeeze spots.
2. Stop smoking
More spots under the skin surface (acne inversa) occur in smokers. The toxins in cigarettes and vapes and the blood vessel constriction they promote will not be doing skin any favours in general.
3. Try to manage your stress
Stress can exacerbate any skin condition and research has found that, especially in women, high stress levels can increase the severity of acne. You often can’t avoid it, but you can choose to deal with it better. Try yoga, breathing techniques and meditation.
4. Don‘t wear too much make-up
Water-based make-up is less likely to block your pores and cause acne breakouts. Always remove make-up before bed.
5. Drink plenty of water
Dehydration does not help any skin or inflammatory condition (including acne) so keep well hydrated.
6. Take care of your gut health
A nourishing diet for gut health along with good levels of probiotics (that’s healthy bacteria from fermented foods such as sauerkraut, kimchi and natural yogurt) may play a role in healthy skin.
7. Get enough vitamin D
Vitamin D deficiency means we have less protection from inflammation in the body, which may worsen acne. Make sure you get enough sunshine and vitamin D-rich foods.
8. Eat an anti-inflammatory diet
We’re beginning to understand the influence of nutrition over the different systems in our bodies, including the skin. Although more research into this area is needed, many studies are now suggesting there’s enough evidence to encourage avoiding high glycaemic index foods like sugary foods and carbohydrates. For good skin health, it is preferable to eat a diet rich in fresh fruits, vegetables, lean meats, fish and seafood.