Acne sucks for both your physical and mental health.
Outbreaks that won’t go away increase the risk of low self-esteem, anxiety and depression – especially for patients navigating their way through adulthood.
ON THIS PAGE
- 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
- About Dr James Redwood
Pimples 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, and women are more likely than men to experience chronic acne in adulthood. This is due to hormonal changes:
- during your period;
- when starting or 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.
A Few Facts About Acne
Acne typically forms when sebum and dead skin accumulate in and around your pores (hair follicles). Bacteria feast on this sebum build-up, multiply wildly, and cause inflammation. Your immune system then kicks in, swelling the area with pus.
Facial acne is by far the most common. Truncal acne – pimples on your shoulders, chest, and back – usually indicates a more severe form of acne. Around 50% of sufferers have truncal acne, though it’s often underdiagnosed in general practice.
Broadly, there are three types of acne:
1. Mild acne (non-inflammatory acne)
Most people are familiar with mild acne, which includes blackheads and whiteheads. It generally affects 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.
Your GP will refer you to a dermatologist for specialised treatment if required.
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.
I occasionally suggest oral contraceptives for women 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, and 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:
- minocycline tablets/capsules
- doxycycline tablets/capsules
- clindamycin solutions (such as ClindaTech)
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.
However, I don’t recommend trifarotene if you’re pregnant or trying for a baby.
Depending on aspects 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, 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 and can 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 in 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. The same goes if you take certain other antibiotics or have high cholesterol.
Your dermatologist will walk through all of this with you.
Managing Your Acne at Home
You can do plenty at home to help control acne in conjunction with the above treatments.
Sticking to a cleansing routine is essential, as is using non-comedogenic makeup, 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 the harmful effects of UV rays, 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 increase 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 mainly 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 damage often disappears with time.
Dermatologists are experts in acne scar treatment. Three main options are available.
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.
As with microdermabrasion, chemical peels remove your upper skin layer. Solutions containing mild acids are applied to the skin, promoting resurfacing and rejuvenation.
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 affect your quality of life and make you want to hide 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, we can fast-track strategies involving managing outbreaks and possibly talking with mental health professionals.
In most cases, 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
Knowing when to seek medical help for acne treatment can be tricky. 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 James Redwood is a local GP at Doctors of South Melbourne.