Understanding Acne: The Inside Story

So, What is Acne?
It’s important to understand that acne is a condition of the pilosabaceous unit.

The pilosebaceous unit is a fancy medical word for a structure in your skin involving your hair follicle and the sebum gland, which is attached to the hair follicle. In acne, the sebum gland produces too much oil and it can’t get out because the hair follicle gets blocked with dead skin cells, leading to commedones and cysts. Bacteria get super excited about the trapped oil leading to inflammation and nodules.

In simple terms, the cause of acne is three fold- too much oil, too much plugging and too much bacteria. Let’s take a look at each one in more detail and discover their respective clinically proven treatments so you can skinvest wisely without wasting your money, leaving you enough for your pilates subscription- now that’s girl math.

1. Too Much Oil

Your sebum gland is responsible for producing oil. In acne, this gland goes into overdrive when it comes into contact with a breakdown product of testosterone called DHT- that’s right, your oil gland is like the Mariah Carey of the skinworld- a little bit of a diva. A build up of oil leads to congestion and the associated commedones, cysts and nodules.

How to Treat It?

Enter spironolactone. This is an oral diuretic (medication that makes you pee a bit more) and is commonly used to treat heart failure and high blood pressure. It’s great in acne because it also reduces testosterone levels, which in turn reduces DHT and consequently, the amount of oil your sebum gland produces.

Does it have any side effects?

• It can cause changes in your menstrual cycle, like making it last a bit longer but doesn’t affect fertility.
• There is a risk of high potassium levels so be aware of symptoms such as chest pain or dizziness.

Is it right for me?

• It should be avoided in pregnancy.
• Your kidneys need to be in good shape before starting it.

How long does it take to work?

• You will start to notice your results within three months.

2. Blocked Hair Follicles

In acne sufferers, hair follicles get blocked with dead skin cells and a protein called keratin. This blockage traps oil inside allowing it to build up, causing those pesky pimples.

How to Treat It?

Use keratolytics, substances that cut through the keratin and unblock the follicles.

The most researched are retinoids, which are forms of vitamin A.

There are two main types

• Topical retinoids- are effective and should be introduced slowly to avoid purging. Tretinoin is the most potent form and retinol is the least. Start at the lowest concentration appropriate for your skin- this is something your doctor can advise on. You should start to see results after 6 weeks.
• Oral Isotretinoin- the common brand name is Roaccutane. It is potent and should only be prescribed by a dermatologist. It can dry out your skin and make it very sensitive, even in the genital area. A typical course lasts about six months. Sometimes this is enough to nip the acne in the bud but occasionally another course is required.

Other Keratinolytics and how to use them

• Alpha Hydoxy Acids (AHAs) and Beta-Hydroxy Acids (BHAs) are excellent at keeping the top layer of your skin resurfaced and cutting through that keratin. Use an at home daily cleanser containing salicylic acid or glycolic acid at night. Boost the effects by attending for in clinic acid peels with a bespoke combination of acids that are right for your skin, for a more profound effect.

3. Abnormal Microbiome

Normally, bacteria live peacefully on our skin. But when oil gets trapped, it creates a breeding ground for bacteria, leading to inflammation, redness, pain and sore nodules.

A bacterium known as Propionibacterium acnes lives naturally on the skin. It’s normally harmless, but when a sebaceous gland becomes blocked, it can start to reproduce and trigger an immune response, causing the pimple to become inflamed and grow large.

How to Treat It?

• A short course of oral antibiotics can help, but overuse can lead to antibiotic resistance meaning they become ineffective, so you don’t want to rely on this on a regular basis.
• Products that support your microbiome and contain antibacterials like azelaic acid, AHAs (like glycolic acid), and BHAs (like salicylic acid) are useful. But take care not to strip your skin of its natural oils – protect that skin barrier and use panthenol alongside if your skin is feeling sensitive.
• Laser treatments like ClearLift and plasma treatments like AgeJet can also help, by killing the bacteria, though you have to be the right candidate and results may vary- it’s useful to come in for a consultation for this.

Other Things to Know

• Skin cell turnover takes around six weeks. Be patient with new products.
• Acne treatment is a journey, but there are many proven methods to help you clear your skin with patience and consistency, you will get there.
• Certain dietary factors may contribute to acne, be mindful of overindulging in dairy products and high glycemic index foods (sugars and fats).

References:

1. American Academy of Dermatology: Guidelines on the use of oral spironolactone and isotretinoin for acne treatment.
2. Journal of Clinical and Aesthetic Dermatology: Studies on the efficacy and safety of retinoids in acne management.
3. Dermatologic Therapy: Research on the role of the microbiome in acne and the use of antibiotics.