After years of treating patients from all over Melbourne for problem acne, I understand the daily impact the skin condition can have on your physical and mental health.
Outbreaks that won’t go away carry a heightened risk of low self-esteem, anxiety and depression. This is especially the case for teenagers navigating their way to adulthood, naturally conscious of their appearance to friends and peers.
Pimples, zits and spots impact around 85% of teens and young adults. High levels of androgens and oestrogen hormones released during puberty contribute to increased oil production (sebum) and blocked inflamed pores.
Though less frequent, adults can also have acne-prone skin. Women are more likely than men to experience chronic acne in adulthood. This is often due to hormonal changes, such as during your period, when starting/stopping the contraceptive pill or throughout pregnancy.
Women with problem acne should also be checked for polycystic ovarian syndrome (PCOS) by their GP. Symptoms of this hormonal condition include irregular periods and excess hair on the face, nipples and lower abdomen.
In the following, I’ll take a closer look at:
- Some facts about acne
- Treatment options
- Managing your acne at home
- What you can do about scarring
- Acne and your mental health
- When to seek medical help
A Few Facts About Acne
Acne typically forms when sebum and dead skin accumulate in and around your pores (aka hair follicles). Bacteria feast on this sebum build-up, multiplying like crazy and causing inflammation. Your immune system then kicks-in, swelling the area with pus.
Facial acne is by far the most common. Pimples on your chest and back usually indicate a more severe form of acne.
Broadly, there are three types:
1. Mild acne (non-inflammatory acne)
Most people are familiar with mild acne, which includes blackheads and whiteheads. It’s generally contained to small areas of your face or body and occasionally progresses to moderate acne.
2. Moderate acne (inflammatory acne)
This is when breakouts of papules (tender lumps under your skin) or pustules (papules with visible heads of pus) occur. Moderate acne tends to hang around a bit and can cause scarring or progress to cystic acne if untreated.
3. Cystic/severe acne (inflammatory acne)
Severe acne presents as painful cysts or nodules that form under your skin, somewhat looking like boils. This type of acne has a high risk of scarring. Being the case, I encourage people with severe acne to get to their GP as soon as possible. It’s much easier to treat acne than it is to treat scarring. If required, your GP will refer you to a dermatologist for specialised treatment.
Treatment Options for Acne
Effective treatments are plentiful and largely depend on the severity of your problem skin. My job is to determine the underlying cause of your acne and advise the best course of management.
Essentially, the range of medications and ointments work on one or a combination of the following factors:
- minimising sebum production;
- reducing bacteria;
- regulating hormone levels; and
- unblocking pores.
For women, I occasionally suggest oral contraceptives to treat acne if suspected hormonal fluctuations are to blame. There are obviously other considerations to discuss if we go down this path.
Since most remedies take time to work, I ask patients to persist with their course of treatment. Results will come.
MILD ACNE TREATMENTS
You’ll have every chance of getting blackheads and whiteheads under control by following a daily cleansing routine. Use gentle, non-foaming cleansers followed by a non-comedogenic moisturiser. This type of moisturiser won’t block your pores.
Exfoliating can also reduce pore-blocking dead skin. Chemical exfoliators containing ‘degreasing’ salicylic acid are the best. Use a few times a week rather than daily. Avoid harsh mechanical exfoliators as they can worsen breakouts.
Benzoyl peroxide products such as Clearasil reduce the bacterial load on your skin. Many people find such topical products work wonders on breakouts. Most are available over the counter at your local pharmacy or on supermarket shelves.
If you want to use natural treatments, azelaic acid may suit you. It naturally occurs in grains and acts to limit bacteria and inflammation.
MODERATE ACNE TREATMENTS
If you find yourself in moderate acne territory, you may need GP-prescribed antibiotics in addition to your cleansing regime.
Oral and topical antibiotics work by reducing the amount of skin bacteria while easing painful and unsightly inflammation. Examples include:
I’ve also seen great results with topical retinoid creams which are derived from vitamin A. Retinoids unblock pores, giving complementary acne-fighting solutions a better chance of working.
Depending on aspects such as including the characteristics of your skin, the severity of your acne and other medications you’re taking, your GP may prescribe a combination of treatments. With a bit of persistence, together we’ll find what works for you.
CYSTIC ACNE TREATMENTS
As with most GPs, I generally refer patients with severe acne to a dermatologist. These specialists are experts in severe skin conditions who are permitted to prescribe strong medications, such as Roaccutane capsules.
Roaccutane is a type of retinoid that reduces the amount of sebum (oil) your skin produces. The treatment effectively starves bacteria of its energy source while unblocking your pores and reducing inflammation.
Up to 85% of patients notice a dramatic improvement to their skin over 6-12 months.
Unfortunately, the medication comes with potential sides effects, such as:
- Dry, irritated skin.
- Heightened sunburn susceptibility.
- Tiredness and lethargy.
- Acne flare-ups within the first few weeks of taking.
Pregnant and breastfeeding women should steer clear of Roaccutane. Same goes if you’re taking certain other antibiotics or have high cholesterol. Your dermatologist will walk through all of this with you.
Managing Your Acne at Home
In conjunction with the above treatments, there’s plenty you can do at home to help control acne.
Sticking to a cleansing routine is essential. As too is using non-comedogenic make-up, moisturisers and sunscreens that won’t block your pores.
Rumour has it that the sun helps control acne. With little evidence to support this theory, you’re much better off applying 50+ sunscreen every morning before heading outside. Furthermore, many medications make your skin more sensitive to UV ray’s harmful effects, so slip, slop and slap!
Eating unprocessed food rich in nutrients has helped many people. I won’t go as far as suggesting you avoid chocolate or dairy products altogether, just try to up your intake of fresh fruit, vegetables, protein and healthy fats. Drinking lots of water is also a good idea.
Then there are lifestyle factors that you may need to regulate. Reduce stress, exercise regularly, stop smoking, limit alcohol intake and get plenty of sleep. Yep, all the usual suspects.
What to do About Scarring
Acne scarring mostly affects people who have severe acne. Bursting cysts and nodules can significantly damage your skin and create scar tissue.
Picking or squeezing pimples and blackheads can also result in scarring, though the resulting damage often disappears with time.
Dermatologists will happily treat any scarring. The three main options are:
This is where the top layers of your skin are removed via laser or friction. Depending on the depth of scarring, you may need more than one session.
- Chemical peels
As with microdermabrasion, chemical peels remove your upper skin layer. Solutions containing mild acids are applied to the skin, promoting resurfacing and rejuvenation.
- Laser resurfacing
Short bursts of light act to – you guessed it – remove the top layer of your skin. This method is particularly useful in treating stubborn acne scars.
Acne and Mental Health
Feelings of social isolation, low confidence, anxiety and depression can haunt anyone with persistent acne and scarring. Young people tend to suffer more from acne-related mental health issues than adults.
The perceived stigma of being ugly, disfigured or dirty can really affect your quality of life and make you want to hide away from the world.
Parents will do well to look for signs of diminishing mental health in their children. Spending more time alone, wanting to stay home from school or sporting activities, and excessive sleeping are all indicators.
It’s important to take children’s fears about their acne seriously. This way, you have a much better chance of having open, solution-based conversations with them.
A great starting point is seeking help from your GP. Together, the three of us can fast-track strategies involving managing outbreaks and possibly talking with mental health professionals.
In most case, I’ve found simply giving your teenager a voice and a chance to be heard is enough to start the healing.
When to Seek Help from Your GP
It can be hard knowing at which point to seek medical help for acne treatment. With problem skin being so common, you can be forgiven for taking an ‘I’ll just deal with it like everyone else’ approach.
However, you may need to see a doctor if:
- Your acne isn’t getting better after regular cleansing and using over the counter treatments.
- Pimples are unusually large, painful and full of pus.
- Your mental health is suffering.
- You suspect medications and treatments for other conditions are causing breakouts.
- One or both of your parents have severe acne or scarring.
You know yourself better than anyone else, so be guided by your gut as to when to seek help.
Like More Information?
- Better Health
- The Royal Children’s Hospital Melbourne
- The Australasian College of Dermatologists
Dr Tania Nishimura is a senior GP at Doctors of South Melbourne. She holds a special interest in kid’s health and has extensive experience treating young adults for wide-ranging physical and mental health complaints.