Out, Damned Spot!


Andrew Kuo and Farouq Manji investigate the development, causation and treatment of the common ailment of acne.

Acne (or pimples) affects more than 100 million people worldwide. Women over 25 comprise over half of those affected, and 90% of all teenagers develop acne at some point. Acne can develop on the face, shoulders, back and even on the scalp, and can lead to scarring, redness and irritation.

Acne is more than just a medical problem however, affecting one’s self-esteem and confidence. Acne usually subsides after a few years, however for some it may carry on for life.

The world market for acne treatments has been estimated in excess of €72 billion. Millions of people everywhere, every day attack their blemishes with cleansers, creams, spot treatments, masks and wipes. They pop, twist, rub, scratch and brood over their acne. And many of us don’t really understand what it really is.

Acne develops at the level of your hair follicle, around sebaceous glands that produce the oil on your skin. This oil is important in keeping your skin pliable and healthy.

Stressful episodes like final exams can cause an upsurge in hormones, which can lead to breakouts

Your skin undergoes a natural shedding and renewal process, losing and replacing skin cells all the time. When your pores become plugged by dead cells however, both oil and bacteria become trapped in the follicle. This is a nice environment for bacteria to grow in and simultaneously the glands continue to produce oil, causing swelling of the skin.

Eventually your immune system cells attack the bacteria, which causes inflammation and further swelling. Over time, the dead bacteria, skin and defence cells all die and break down into little bits, forming pus. Inflammation is also responsible for the observable redness, scarring and hyperpigmentation.

If the plugged pore is open and pushes above the surface of the skin, a blackhead is formed (the colour from which comes from the dead cells, not dirt). A closed plug below the surface of the skin results in a whitehead instead.

Despite what a lot of people believe, many of the causes of acne are in fact out of our control. The major factors involved are skin oil, shedding skin cells and bacteria.

Oil production is driven by hormones, over which we are almost powerless. Stressful episodes (like final exams) can cause an upsurge in hormones, which can lead to breakouts. In the same vein, teenagers tend to develop acne when they hit puberty because their hormones spike. Adherence to a good skin treatment routine can overcome these problems.

Irregular shedding of the skin and irritation can lead to clogged pores, and this we have some control over. Harsh cleansers are not necessary, and can actually make blemishes worse. Gentle exfoliating cleansers and creams can help get rid of dead skin cells and other debris. It is important to note that dirt doesn’t cause acne, but it can contribute to clogging! So a daily, regular and gentle cleaning regimen is advisable.

Until recently it was commonly believed that diet has nothing to do with acne, however an emerging body of evidence suggests that diet may play an indirect role in the development of blemishes. Eating foods with high sugar and fat, as well as the over-consumption of dairy products, can cause acne. Studies have shown that a diet consisting of lean protein, vegetables and complex carbohydrates can significantly reduce acne in adolescents.

Treatments of acne are vast and varied, and natural and chemical methods are often Dilloninvoked. Sun exposure such as tanning will initially improve acne, however consistent exposure will increase the plugging of pores. This, and the premature aging of skin coupled with the higher risk of skin cancer make regular tanning a bad idea.

In the vast array of products available, most acne treatments contain benzoyl peroxide, salicylic acid and glycolic acid. They work either by killing bacteria and/or unclogging pores. Generally, they are available in over-the-counter medications as well as in prescription form. Relatively safe, the most common side effect is skin dryness.

Products containing tretinoin and adapalene are topical products derived from vitamin A and are available through prescription. They work by increasing skin cell turnover and preventing hair follicles from plugging. There are many other antibiotic treatments available through prescription that kill excess bacteria as well.
Newer, non-drug strategies involve the use of light and laser technology. Laser therapy penetrates the deeper layers of skin and suppresses the production of oil. Light therapy targets and destroys the bacteria responsible for the inflammatory response seen in acne. Though these are generally effective methods, they are not widely available due to cost and demand.

In most cases acne resolution takes time and effort. Treatment results vary between people, so you have to find the one that works for you. These guidelines should put you on-track for healthier skin, but you should consult your doctor or dermatologist for advice before taking any medication or starting a serious programme.

Looking good!


Tips to Avoid Acne

  • Avoid excess sun exposure
  • Irritating your skin increases oil production, so avoid:
    * Over-washing your face or using harsh soaps/scrubs
    * Touching, or scratching your skin
    * Tight clothing or hats that irritate the skin and trap sweat and bacteria
  • Don’t pick at your pimples. Squeezing can force bacteria deeper into the skin and cause scarring
  • Follow a daily, strict cleansing regime
  • Reduce stressful episodes to get your hormones in check
  • Be conscious of your diet. Avoid greasy, sugary foods.