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Acne Treatment

Acne is a common skin condition that affects most of us at some point. Acne is characterised by blackheads and spots, often leading to social embarrassment, low confidence and scarring, which is why early treatment is essential. Learn more about this important skin disease and what treatments are available at Rejuvenate Face

What is acne?

 

Acne vulgaris is a common long-term disease of the hair follicle and sebum (or oil) producing glands (the pilosebaceous unit). Acne was previously viewed as only affecting young people, with over 85% of teenagers developing acne between 12 and 25. It is now recognised that adults also suffer from acne, with over 25% of women and 10% of men experiencing acne in their 40s.

What Is Acne
Adult Onset Acne

Adult Onset Acne

Adult onset acne is even more challenging to treat, as the skin is more sensitive. Acne that appears specifically in women aged >25 years is now called adult female acne. The reasons for the rise in adult acne are unknown.

Click on the images to see Our Acne Treatment Range

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Our Acne Treatment Range
Biretix - Cantabria Labs
SkinMed Acne Protocol

Aims of acne treatment

Acne is common and troublesome. Treatment aims to clear spots as much as possible and prevent scarring.

Aims of Acne Treatment

What areas does acne affect?

Acne most commonly develops on the:

 

Face

 

This affects almost everyone with acne.

 

Back

 

This affects more than half of people with acne.

 

Chest

 

This affects about 15% of people with acne.

What Areas Does Acne Affect

Causes of acne

Acne results from several processes: 

 

  1. Increased keratin blocking the hair follicle.

  2. A bacterium called Cutibacterium acnes.

  3. Changes in the acidity or pH of the skin. 

  4. Increased levels of androgen.

  5. Inflammation

Causes of Acne

Keratin and acne

Increased skin keratin, a protein typically found in the skin, blocks the pores. This is called a keratin plug.

This plug, combined with increased sebum production, causes white and blackheads that characterise one of the main types of acne.

Androgens, sebum and acne

Androgens control sebum production through receptors (similar to a key) on sebaceous glands and keratinocytes.

 

When androgens bind to these receptors, more sebum is produced.

Bacteria and acne

The bacteria associated with acne is called Cutibacterium acnes.

 

This bacterium, which thrives in sebum, is thought to alter the skin's protective barrier and causes inflammation.

Skin acidity and acne

People with acne have been found to have less acidic skin than those without.

 

This bacteria-friendly environment allows acne-forming bacteria to increase.

The combination of increased sebum, bacteria, and keratin generates the spots and bumps associated with acne.
 
Oral and topical medications try to reduce the levels of sebum, kill bacteria and decrease keratin production.

Effects of acne

Acne may lead to -

 

  • Embarrassment.

  • Social isolation.

  • Depression.

  • Anxiety.

 

Without early treatment, permanent skin scarring can occur.

Effects Of Acne

Click to find out more about topical treatments for acne but first, let’s look at the different types of spots you can get with acne.

The stigma with acne

Acne, unfortunately, can adversely affect the quality of life. Many acne sufferers have negative feelings about their condition. Individuals with visible physical skin conditions, especially on the face, are well known to impair psychological well-being, such as depression and anxiety. This also leads to trouble sleeping, digestive problems and headaches.

Acne isn't only a problem for teenagers. The skin condition affects almost 13 per cent of adults aged 59 and older and more than 1 in 10 children between ages 5 and 13.

Types of Spots

There are six main types of spots caused by acne:

Blackheads

These are small black bumps on the skin. They are black due to the melanin pigment produced by the hair follicle. This is not dirt.

Whiteheads
 
Whiteheads are firmer and do not empty when squeezed.

Papules

There are small red bumps that may feel tender or sore.

Pustules
 
These are similar to papules but have a white tip in the centre, caused by a build-up of pus.

Nodules
 
These large hard lumps build up beneath the skin's surface and can be painful.

Cysts
 
Acne cysts are the most severe type of spot caused by acne with large pus-filled lumps. Cysts carry the greatest risk of causing permanent scarring.

Types of Spots

Types of acne

There are many types of acne:

 

  1. Inflammatory

  2. Non-inflammatory

  3. Nodulocystic

  4. Fungal

  5. Maskne

Types of Acne

Inflammatory Acne

These are red, swollen, tender lumps and bumps.

 

This can be divided into papular or pustular acne and is usually caused by Cutibacterium acnes.

Non-Inflammatory Acne

Non-inflammatory acne is characterised by blackheads (called open comedo) and small whiteheads (called closed comedo).

 

They are non-inflammatory as they do not have the redness described above.

Nodulocystic acne

Non-inflammatory acne is characterised by blackheads (called open comedo) and small whiteheads (called closed comedo).

They are non-inflammatory as they do not have the redness described above.

Fungal acne

Pityrosporum folliculitis or fungal acne is caused by infection of hair follicles with the fungus species Malassezia.

 

Fungal acne may appear similar to acne but is treated with antifungal agents. If your acne worsens with traditional treatments, you may have fungal rather than bacterial acne!

Maskne

This new type of acne emerged during the 2019 coronavirus pandemic due to the widespread use of reusable masks.

Risk factors for acne

There are several contributing factors linked to the rising number of acne sufferers.

  • Changes in our diet.

  • Foods with a high glycaemic index.

  • Environmental pollution.

  • Smoking.

  • Stress.

  • Increasing use of comedogenic (spot-forming) cosmetic products.

  • Altered immunity or resistance to disease.

  • Changes in skin acidity.

  • Spot-inducing make-up (comedogenic)

  • Conditions associated with increased androgen levels (pre-diabetes, polycystic ovarian syndrome).

  • Altered hormone levels such as progesterone, steroids, or insulin.

Risk Factors For Acne

Let's now focus on the treatments available for acne.

Treatments for Acne Vulgaris

A variety of topical and oral treatments are available for acne.

Most treatments are -

  • Not effective.

  • Poorly tolerated, as they cause skin irritation and dryness.

  • Costly over time.

Antibiotics, either placed onto the skin (called a topical treatment) or given as a tablet, are becoming less popular due to emerging bacterial resistance (meaning they become less effective).

First-line agents to treat acne are the topical treatments such as

  • Retinoids.

  • Azelaic acid.

  • Benzoyl peroxide.

  • Antibiotics.

For more severe acne, oral treatments are required.

  • Antibiotics.

  • Isotretinoin.

  • Hormonal treatments.

New treatments for acne include

Treatments For Acne Vulgaris

Topical treatments for acne

Topical treatments are those applied to the skin. There are many different ingredients and combinations that help dampen down spots, preventing further inflammation or even removing the underlying causes of acne, such as bacteria.

Oral treatments for acne

This section will cover some of the oral or systemic medicines used for acne, such as

 

Oral antibiotics for acne

Antibiotics are indicated (with caution) for moderate-to-severe or inflammatory acne resistant to topical treatments.

Examples used include

  • Penicillins (amoxicillin).

  • Macrolides (azithromycin and erythromycin).

  • Tetracyclines (doxycycline, minocycline, and sarecycline).

Antibiotics improve acne by decreasing the concentration of C. acnes.

 

Oral antibiotics are best used combined with topical retinoids and benzoyl peroxide. Once improvement is achieved, topical treatments should be continued.

 

There is an ongoing debate about whether topical and oral antibiotics should be used for acne due to concerns about growing antibiotic resistance.

 

As a rule, antibiotics (topical and oral) should not be used for more than three months.

oral antibiotics for acne

Oral isotretinoin has the best treatment response of all the treatments listed so far. Albeit with many downsides and potential risks. It is also useful for people with acne scarring.

 

Isotretinoin is the only treatment that targets all four mechanisms that cause acne:

 

  • Increased sebum production.

  • C. acnes.

  • Inflammation.

  • Increased keratin production.


Side effects may include dryness, aches and pains (myalgia), altered liver enzyme levels, and increased blood lipids. Most of these reverse when the drug is stopped.

 

The use of isotretinoin is also linked with mood changes, depression and suicide.

 

As isotretinoin is a known cause of abnormalities in babies, two specific forms of contraception are advised with monthly pregnancy tests.

oral retinoid for acne

There are many hormones implicated in the development of acne, such as

 

  • Androgens.

  • Oestrogens.

  • Insulin.

  • Insulin-like-growth factor.

 

Androgens remain the most important culprit.

 

Anti-Androgens

As explained, androgens increase sebum production and can cause nodulocystic, sudden-onset acne that may resist conventional treatments.

 

Combined oral contraceptives (COCs)

 

The COC contains oestrogen and progestins, leading to decreased levels of androgens. Improvement may take up to 6 months. COCs are first-line in females suffering from polycystic ovarian syndrome (PCOS).

 

See our free guide on the pill and acne.

 

Spironolactone

 

This is a potassium-sparing diuretic that blocks androgen receptors. Spironolactone decreases testosterone levels, and there is a reduction in the size of sebum-producing sebaceous glands.

 

Spironolactone is effective in all types of acne and may also be used in male patients. In females, spironolactone can be combined with the COC pill.

combined oral contraceptive pill
spironolactone
hormone teatments for acne

Other treatments for acne

Other treatment options: Several treatment options are available to treat and manage acne.

These include

LED light therapy.
Chemical peels.
Extraction.
Steroids.
Cannabinoids.
Probiotics.
Anti-microbial peptides (AMP)

LED light therapy

This is as effective as some other treatments for mild-to-moderate inflammatory acne.

LED therapy

Chemical peels

Superficial chemical peels using glycolic acid or salicylic acid are also effective in non-inflammatory acne, although multiple treatments may be necessary.

chemical peels for acne

Extraction

This is reserved for resistant comedones. There is a risk of scarring after extraction.

extraction for acne

Steroids

Intralesional steroids are a treatment for nodular or cystic acne. This treatment may cause thinning of the skin (called atrophy) if used too often.

steroids for acne

Cannabinoids

Cannabidiol (derived from the cannabis plant) inhibits lipid formation (lipogenesis) and inflammation and has shown some promise in treating acne.

cannabinoids for acne

Oral probiotics

Probiotics have been shown to decrease C. acnes on the skin and inflammation.

probiotics for acne

Anti-microbial peptides

AMPs bind to acne-forming bacteria and enhance the skin's immune response, killing antibiotic-resistant organisms.

 

AMPs are steadily becoming the most addition to acne treatments in addressing the increasing rate of antibiotic resistance.

anti-microbials for acne

Summary

The number of options is daunting. Fortunately, there are, at last, some sensible suggestions to tackle acne.

 

These recommendations are summarised below and will change over time. For now:

Mild acne

Topical combination therapy:

 

Benzoyl peroxide + antibiotic; or

Retinoid + benzoyl peroxide; or

Retinoid + benzoyl peroxide + antibiotic

 

No response -

 

Add topical retinoid or benzoyl peroxide.

Consider alternate retinoid

Consider topical dapsone

Moderate acne

Topical combination therapy:

 

Benzoyl peroxide + antibiotic; or

Retinoid + benzoyl peroxide; or

Retinoid + benzoyl peroxide + antibiotic

 

Oral antibiotic + topical retinoid + benzoyl peroxide

Oral antibiotic + topical retinoid + benzoyl peroxide + topical antibiotic

 

If female, add oral spironolactone or a combined oral contraceptive.

 

No response -

 

Consider alternate combination therapy.

Consider changing oral antibiotics.

Consider oral isotretinoin

Severe acne

Oral antibiotic + topical combination therapy:

Benzoyl peroxide + antibiotic; or
Retinoid + benzoyl peroxide; or
Retinoid + benzoyl peroxide + antibiotic

If there is no response -

Consider changing oral antibiotics.
If a female add oral spironolactone or combined oral contraceptive    
Consider oral isotretinoin
 

How Rejuvenate Face can help with acne

We provide one-to-one support and advice for people suffering from mild to moderate acne, such as:

  • Educational material - see our acne self-care webpage.

  • Advice on the Contraceptive Pill and Myth Buster on the role of diet.

We also offer a variety of treatments, such as:

 

We try to avoid antibiotics but can tailor these if needed.

We can also provide a referral service if your acne warrants secondary care specialist advice.

Click to download our free information leaflets

The Pill and Acne

Self-care recommendations for acne

Guide to Topical acne treatments

Free Information Leaflets

FIND OUT MORE ABOUT ACNE

There are several excellent resources and information about ace. These are independent, unbiased, and written by experts. Nice guidelines are referred to as Clinical Knowledge Summaries [CKS].

The Primary Care Dermatology Society (PCDS) - Acne: acne vulgaris

 

https://www.pcds.org.uk/clinical-guidance/acne-vulgaris

 

British Association of Dermatologists Patient Information Leaflet - Acne 

https://www.bad.org.uk/pils/acne/

 

Derm.net NZ - Acne

https://dermnetnz.org/topics/acne

NHS Conditions - Acne

https://www.nhs.uk/conditions/acne/

NICE Guidance - Acne Vulgaris

https://www.nice.org.uk/guidance/ng198

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Acne Dermatology Help Websites

Support for Acne

 

Acne Support

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