ACNE TREATMENT

Dr Bryan is a local Consultant Dermatologist based in Belfast at Cathedral Dermatology Clinic where he sees patients with ‘all things skin’ including lumps and bumps, skin cancers, pigmentation, skin ageing and rashes such as acne, rosacea, psoriasis and eczema. He is passionate about raising awareness of dermatology and skin health. In his spare time, he enjoys travelling and spending time with friends, family and his partner and their two cavapoochon dogs.

Acne affects us all at some point in life. For most, it lingers through our puberty years, but some adults amongst us still suffer ‘breakouts’ well into their 20s, 30s and even later. Watching others living with clear skin can be frustrating for acne sufferers, leading to reduced self-confidence, low mood and a search and yearn for a long-term solution.

Who gets acne?

I, myself, recall my teenage acne, trying to look my best for the teacher-supervised assembly hall discos, then out comes a spot to say hello… Sudocrem to the rescue?! For the vast majority of us, acne appears during puberty but settles over a couple of years as our hormones balance out. In around 1 in 20 adults over the age of 35, however, acne persists well beyond those teenage years. Furthermore, in my clinics I have had adults tell me that they never experienced spots during puberty, so their acne started later in life. In essence, acne can be unpredictable, but for most of us it burns out as we reach our twenties.

What is acne?

Acne is an inflammatory skin disorder caused by a chain reaction triggered by sex hormones; mainly ‘androgens’. Our skin responds in a seemingly excessive way to these hormones, even at normal levels in the blood, during puberty and its associated hormonal changes, but also as part of conditions like polycystic ovarian syndrome, those taking hormone supplements for gender transition or when using steroids (either as a medical treatment or for a body building supplement).

Androgens trigger the oil glands to enlarge and produce more sebum. Some notice this as their skin feeling greasier. The opening to the glands, or ‘pores’, can become clogged with excessive sebum and dead skin debris which then forms a medium for acne-bacteria to grow and trigger inflammation. As a result, we see blackheads, pimples, acne papules and sometimes cysts or painful nodules on our skin because of this process.

What can I do to prevent and treat acne?

First and foremost, do not panic. I completely empathise with my patients when they tell me how down, frustrated or desperate they are – I had it myself and worked through most of what I am about to suggest below. It did clear eventually, so I want to start by emphasising that there are both medical and skin care options out there that help.

Skin-care

Any patient that attends me will recall my chat about the acne ladder. Let’s start at the bottom with skin care. So do you really understand what you are putting onto your skin?

Skin is a protective barrier to keep toxins out and water in; it helps to regulate our temperature; and harbours a diverse array of ‘good’ bugs and microorganisms that exist in harmony to maintain a ‘healthy skin environment’. If you use the wrong products, you can throw this harmony off.

I encourage everyone to speak to a dermatologist, their GP or an qualified skin therapist before trying any ‘in vogue’, social-media promoted acne products or spot-busting regimes. Non-regulated and too harsh a product might damage your skin’s barrier properties, thus welcoming in toxins and bacteria from the outside to trigger acne or other rashes like rosacea. Furthermore, excessive water loss can lead to eczema. It is important to cleanse twice per day, and perhaps consider a double cleanse in the evening. I suggest a gentle and pH-balanced cleanser. Soaps and some non-balanced cleansers can be too alkaline for our skin, so might induce a high pH which can throw off the optimal environment for healthy skin to flourish. The next time you are shopping for a face wash, have a look at the pH on the products. Oily cleansers, however helpful they might be for removing thicker make up, can fill pores and trigger acne. I suggest that patients avoid oil cleansers if they are acne-prone and use a micellar water first, then their preferred acnefriendly cleanser in the evening. One cleanse should suffice each morning.

Exfoliation can also help to unclog pores. Some find that physical exfoliators work best, this means with a scrub cloth or a beaded exfoliator scrub. Too rough a product or cloth, however, might harm the skin’s barrier. Furthermore, microplastic beads in certain products will rinse down the drain, enter the water system and risk harm to marine life. Beta-hydroxy acids (BHAs) such as salicylic acid, are found in cleansers, moisturisers and even skin peels.

They offer an alternative way to remove dead skin and, most importantly for acne, to cleanse your pores. So have a think about how you might add some BHA into your skin routine.

Moisturisers help to soothe damaged skin and act as a protective barrier. They can, however, contain lots of thick occlusive oils, paraffin and waxes that will clog your pores and further provoke acne lesions. If your skin is not dry, then it’s doing its own thing to self-moisturise so you don’t have to. If you do need a moisturiser, consider a product containing hyaluronic acid or niacinamide - these are humectant and attract water to hydrate the skin, without coating it in thicker oils.

Then finally to make-up; call it a friend as camouflage, but a foe in its ability to clog pores and trigger spots. It gives so many of my patients a boost knowing they can ‘hide behind their make-up mask’, but perhaps have a chat with your brand specialist about anti-acne/anti-comedogenic products, limit the layers you apply and prioritise use of powder products over liquids.

What else?

Your next step on the acne ladder is topical and then oral treatments. At these levels, patients will have to attend a medical doctor as most treatments require a prescription. Many options carry side-effects that need explained to you before you start, and perhaps some will not be suited to subgroups of patients, for example, during a pregnancy many acne medications are contraindicated.

Topical treatments, this means creams applied to the skin, can contain retinoids, antibiotics, bleaching chemicals like benzoyl peroxide, or acids such as azelaic or salicylic acid. Retinoids and benzoyl peroxide can irritate the skin so need building up slowly. Others might be used in combination products or alongside oral antibiotics to boost their effect and to limit antibiotic resistance. Many of my patients have already tried a low concentration benzoyl peroxide or a retinol product before attending the clinic. These can help in some milder cases, but be weary of using them without consulting a Dermatologist or your GP if you are under 18 when your delicate skin barrier is still maturing. Some products might cause damage or provoke acne flares in naïve skin.

Oral therapies include antibiotics, contraception, isotretinoin and anti-androgen medication such as spironolactone. At a dermatology appointment, I would discuss and develop with you a treatment plan tailored to your unique health and situation. Isotretinoin, or Accutane as many refer to it, is the pinnacle of the ladder and can only be prescribed by a Dermatologist.

Skin peels are offered by some skin clinics and even at beauty salons. If the correct acids and concentrations are used, they can help some patients’ acne. Furthermore, once acne has cleared but scarring or pigmentation persists, peels can also be used. Not dissimilar to my point on using inappropriate active agents on younger skin, be weary of skin peels without proper specialist input so that you don’t excessively shed your skin barrier and paradoxically aggravate your skin.

Acne is a massive and fascinating area of dermatology. No one patient is the same when they sit down with me in clinic, but I love taking them on their own tailored journey up the acne treatment ladder. Seeing the ecstasy of clear skin on my patients’ faces when they complete their treatment or after helping them to finally find the correct products to maintain their skin, makes every minute spent with them worthwhile.

So I will leave you to ponder again, do you really know what you are putting onto your skin?

If you have a skin related question or concern, book an appointment at Cathedral Dermatology Clinic for a consultation and treatment plan. Further information on what treatments and services the clinic provides can be found at: https:// cathedraldermatology.com/ Appointments can be booked via the website or by contacting info@ cathedraldermatology.com or 028 9032 2020

Dr Bryan Murphy

Consultant Dermatologist

Cathedral Dermatology Clinic