Acne occurs due to increased production of oil from the glands (sebaceous glands) next to the hair follicles as well as a build up of old skin around the top of the glands that blocks them and causes the oil and secretions to accumulate. Bacteria (most commonly the species Propionibacterium acnes) collect in the build up of trapped secretions. The body’s immune cells (white blood cells) collect around the bacteria to try to eliminate them causing the inflammation, redness, swelling and pustules. The oil production by the glands is stimulated by hormones which is why acne tends to start around puberty. In some women hormone problems, such as polycystic ovary syndrome, may be contributing to the persistence of acne and appropriate investigation and treatment of the underlying hormone problem can help the acne.
There are several treatment options for acne which can be tailored to the individual patient’s acne and circumstances:
Skin Care Advice
Sometimes all that is needed is a change in the skin care products being used on the skin. Over-use of rich moisturisers can make acne worse as the oils in the moisturisers contribute to blocking the sebaceous glands. Washes or cleansers containing salicylic acid can be particularly helpful in removing the excess oil and reduce the tendency to acne. Glycolic acid products can also be helpful.
Prescription Creams and Tablets
Creams and lotions containing antibiotics or vitamin A products (retinoids) can be very helpful and may be enough to control the acne. For more severe acne, antibiotic tablets can be helpful and are usually well tolerated.
To see their maximum effects, treatment for at least a couple of months is usually needed. In some girls and women, subtle hormone problems can contribute to the acne and assessment of this and treatment, usually with an oral contraceptive pill and/or other medication and dietary changes may be helpful.
Microdermabrasion and Superficial Chemical Peels
Microdermabrasion and glycolic acid peels can help remove part of the top layer of the skin, particularly the old skin around the top of the glands, and so reduce the tendency to blocked pores and the build up of secretions that cause blackheads, whiteheads and acne. Microdermabrasion and superficial chemical peels can be added to enhance other treatments.
For more severe acne, unresponsive to prescription creams and antibiotics, Roaccutane®/Isotretinoin tablets can be a very effective treatment. The average duration of treatment is six months. Almost all patients experience dryness of the skin, lips and eyes and an increased tendency to burn in strong sun. Rarer side effects include liver problems and a change in blood fat levels, but regular blood tests can monitor for this. Because Roaccutane® can affect the development of unborn babies, women must take adequate contraceptive measures before, while and for at least one month after a course of Roaccutane®. There has been concern raised as to whether Roaccutane® may contribute to depression in a small number of individuals, but the majority of patients who receive Roaccutane® experience no significant psychological adverse effects and notice a significant and permanent improvement in their acne.
Blue and Red Light Treatment
Many patients with acne notice that their skin improves with sunlight. However excessive exposure to ultraviolet light in sunlight can damage skin, increasing the chance of skin cancer and wrinkles. However the blue part of sunlight can be beneficial in acne in that it kills the Propionibacterium acnes bacteria without the adverse effects of ultraviolet light. There is increasing evidence that light emitting diodes (LED) producing blue light can be beneficial in acne. Red light has also been reported to have an anti-inflammatory effect on the skin and to add to the benefit of blue light. Treatment under either the blue or the red light takes approximately 20 minutes and is usually done as a series of treatments of either blue or red light on separate visits done at least twice a week, or both blue and red on the same visit once a week. Some improvement usually starts to be seen after 4 weeks and published studies suggest this improvement continues for up to two months after treatment is stopped. Blue and red light is probably not as powerful in dealing with severe acne as Roaccutane®, but does not have the side effects of Roaccutane®, so is an option for some patients. It is painless and gentle with no known side effects.
Pulse dye lasers (585nm and 595 nm wavelength) are reported to be of some benefit in acne. The original brand of pulse dye laser used in some of the earliest published studies was the “N-lite” brand. The pulse dye laser was originally developed to treat red birth marks in babies and is useful in reducing the redness of inflammed acne and early acne scars. It may also have some effect in reducing the Propionibacterium acnes bacteria. The laser setting that we use for acne is very gentle and does not cause significant marks or bruising and helps the redness from the acne fade more quickly. We also several other lasers/energy based devices which can help acne including long pulse NdYag, intense pulsed light and Fractora. Our dermatologist can discuss the best laser option for you at your consultation.
Photodynamic Therapy for Acne
There has been increasing interest in using photodynamic therapy to treat acne, particularly in the United States. A cream, called porphyrin cream, which is absorbed by the overactive oil glands and temporarily makes the skin more sensitive to light, is applied to the skin for between 30 minutes and three hours before either LED light or pulse dye laser is used. It has been suggested that this may cause a more rapid improvement in the acne than LED light or lasers alone, but it is very important to avoid excess light exposure for 48 hours following the treatment, until the effects of the light sensitizing cream has worn off.
Individualised Treatment Plan
As described above, there are many different options for treating acne. Dr Farrell has many years experience in treating acne with all of these options and can discuss with you in detail at your consultation the best option for you, your circumstances and lifestyle.
Dr Farrell also has great experience in treating acne scars and has a wide range of effective treatment available for scars (subscision, pulse dye laser, lasergenesis/long pulse NdYag laser, microneedling, steroid or 5-fluorouracil injections, fillers, Fractora, Fotona SP Dynamis, Fraxel Restore and Fraxel Repair) which she can discuss at your consultation.
An individual treatment plan for dealing with your scars can be made taking into account the type of scars (e.g. rolled, boxed, ice-pick), the severity of and number of scars, your skin type and colour and your lifestyle.