All about Spots, Pimples and Acne

Last Monday I was able to appear on Koffietijd in order to talk about acne. Once again, from the enormous number of reactions, I realised how many people struggle with spots and acne and how great the need is for information. Obviously there was not enough time to cover everything during the programme. A good deal of the information below can also be found in my Skin Book.

You’re not alone
At least 90% of people are affected at some time in their lives by acne. And those are not only teenagers, but also adult men (25%) and women (50%). Acne is more common than all other skin conditions put together. Even so, we know from studies that only a very small number of people seek professional help. This is a pity, as there is very much that can be done about acne. The sooner you take action, the less chance there is of scarring and pigmentation spots.

What causes acne?
Acne is caused by an abnormal cornification of the upper skin cells, an increase in sebum production and inflammation of the skin due to the presence of bacteria. Treatment will only be successful if all of the above causes are dealt with together. And this, unfortunately, is also the very reason why most acne treatments do not work.

‘External’ causes. Cosmetics, diet, stress and smoking.
Although acne is caused by a combination of genetic conditions and hormonal disruptions, there are also factors which can aggravate acne. A very common cause is the use of cosmetic products. Over oily products, dehydrating products and products with irritating ingredients can cause acne. Most people with acne could see a vast improvement by adjusting their skincare routine.
Diet can also have an impact on acne. It is clear at the moment that milk products are linked with acne. This seems to be due to hormone type chemicals which are present in these products. As well as milk products, foods with a high sugar content can also affect acne. The “sugar peak” in the blood stimulates the production of insulin. Insulin, in turn, stimulates the production of androgens and these, in turn, increase sebum production. People suffering from acne don’t have to avoid eating and drinking milk and sugar products, but should take care not to have too much.
It is not only diet which has a negative influence on acne, but also stress (and sleep deficiency). It has long been known that stress can aggravate skin conditions such as eczema and psoriasis. But stress also makes the skin vulnerable to bacteria, causing acne to worsen. In 2007, Peter Elias, Professor of Dermatology at the University Hospital in San Fransisco, showed that stress in mice led to an increase in the production of the stress hormone (glucocorticoid). He showed that this hormone not only disrupted the skin’s barrier function, but it also reduced a number of chemicals in the skin which protect against bacterial attack.
A study which was recently published in the Journal of American Academy of Dermatology revealed that there is a very strong link between smoking and acne. As well as this, it showed that the amount of cigarettes smoked correlated with the severity of the acne. It is connected to the acne with primarily lots of bumps and blackheads but relatively little inflammation. This is also the type of acne which is mostly predominant in adults; around 85% of women with acne have this type. So smoking also has a negative impact on acne.

How to treat acne
Before you can treat acne successfully it is essential to determine which type of acne it is. Is it mild acne with mainly bumps and blackheads, or are lots of real pimples, pustules or even abscesses also present?
Sometimes it looks as though someone has acne, but it is in fact something quite different. It is very important that this is recognised. Because treating a condition as though it is acne, while it isn’t, can increase the risk of aggravating the problem. The presence of facial redness, small visible blood vessels, an over-sensitive skin and spots which don’t contain sebum, but mainly moisture, is most probably not acne. The symptoms, or a combination of these, indicate Rosacea. A troublesome condition where the real challenge is receiving the correct treatment. I mention this deliberately because many people with Rosacea (and their practitioners!) do not know the cause of the skin problem. They tackle the problem with medicine meant for acne, but which only irritates the Rosacea. A condition which looks similar to Rosacea is Perioral Dermatitis. This is usually found in young women. The bumps are located mainly around the mouth. Although there isn’t normally any sebum present, they can become inflamed. These bumps should not be treated as acne either.
Red bumps can also indicate an over sensitive reaction to skincare products or make-up. These don’t contain sebum either. The bumps are also often itchy.

Using skincare products
There is one very important rule which needs to be observed when treating acne. The skin which has acne is by definition an over sensitive and irritated skin , and should be treated as such. Be careful and don’t do anything which will cause further irritation. Avoid perfumed products and products containing denatured alcohol. Only use cosmetic products with an actual function and use no more than stated. The more often the skin is handled the greater the risk of problems. Regular scrubbing or steaming aggravates acne. Don’t wash the skin more than necessary and for acne skin use products containing ingredients with proven effectiveness. One of the most effective cosmetic ingredients for treating acne is Salicylic Acid. Salicylic Acid is an Exfoliant and works by reducing cornification and unblocking the sebaceous glands. A concentration of between 1 and 2% is usually sufficient to treat mild acne (blackheads). An extra advantage of Salicylic Acid is that it reduces inflammation. Benzoyl Peroxide is also a very suitable ingredient in treating acne. You can buy Benzoyl Peroxide over the counter at the Chemist, preferably in a concentration of 5%. It kills the bacteria P. acnes and has been successfully used to treat acne for the last 40 years. With proper use (a thin layer once a day) most people have success with this. As little as 1 to 3% of the users develop an allergy. The skin doesn’t get used to it either, so it remains effective over a long period of time.

Apply Benzoyl Peroxide onto, not only the spots, but the whole area affected. Pimples take around two weeks to appear. In other words, if you only treat the visible spots with a cosmetic product, your acne will not get better over two weeks. As Benzoyl Peroxide kills bacteria, it won’t be as effective for just blackheads and bumps. Other cosmetic ingredients which can help improve skin with acne are ingredients which are anti-inflammatory or barrier repairing, such as for example, Niacinamide, allantoin, green tea, Glycyrrhiza Glabra or Quercetin. Topical use of Vitamin C is also known to reduce acne. With the above information, most forms of acne can be cleared up. If you want to find out which products are suitable for your skin you can check out Product Advice on my blog…

Stubborn cases of spots
But with extra stubborn cases more is definitely required. Peelings with a high concentration of Glycolic Acid, or better still Salicylic Acid, can improve the acne significantly. Besides this they can lighten already established pigmentation caused by acne. Laser or light treatment tackles the bacteria P. acnes and halts sebum production. Examples of this are treatments with the KTP laser or the 1064 YAG laser. Another advantage to this is that pigmentation spots and scars which are already present will become less visible. Less expensive techniques are treatments with blue or red light, but these only have a temporary effect. Photo Dynamic Therapy is available for severe acne and disables the over-active sebaceous glands. This is a new treatment which has good results. Unfortunately it is also very pricey.

Help! I still have acne!
People with acne still have a problem with going to see a Doctor. If you really do want good results, then you often won’t go wrong by combining a good skincare routine and/or treatment together with medication prescribed by a Doctor. Therefore a good relationship between Beauty Therapist and Doctor is also key. By and large, combining a good skincare routine with an antibiotic cream in the daytime and a cream with Vitamin A Acid at night will provide the solution. If the acne is severe then perhaps more medicine will be required in the fight. In this case I am thinking of oral antibiotics, the contraceptive pill which counteracts the effects of male hormones in your body and Accutane, a Vitamin A preparation. These should only be used if nothing else helps. It has uncomfortable side effects and makes the skin very dry because it practically shuts down sebum production.

In the majority of cases the treatment of acne is very successful. But it is a gradual process. There is no simple cause for spots and acne, and no simple solution either.

Regards Jetske

(Research Physician Cosmetic Dermatology)

You can also read:
‘The (Cosmetic) Treatment for Acne‘,
‘Spots. Should I Go to the Doctor or Not?’,
‘The Effects of Stress on Skin‘,
‘Skin Ageing Due to the Sun‘,
‘Is There a Relationship between Diet and Acne?‘ and
‘Help with Choosing an Exfoliant‘.