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What
causes acne?
There are a number of contributors to the formation of acne. Excess
oil and sebum production exacerbated by hormonal influences on sebaceous
glands, as well as dead skin physically blocking pores can cause acne.
A bacterium named Propionobacterium acnes has also been implicated
as a cause of acne. All treatments for acne will address one or more
of these issues.
There have been
no studies showing that acne is caused or exacerbated by your diet,
contrary to the usual belief that certain foods can worsen acne.
What
treatments are available?
Acne can be treated in a number of ways. The first step in treating
acne is appropriate skin care.
Skin
care
A good cleanser is the first step in the treatment of acne. A cleanser
containing alpha-hydroxy acids or beta-hydroxy acids, such as those
found in ASAP
and Cosmedix skin care products, can help remove the oil and dead
skin cells from the surface of the skin to prevent the physical blockage
of pores and acne. Exfoliants with these ingredients can also be used.
Beta-hydroxy acids (including salicylic acid) have the advantage of
having anti-inflammatory properties also.
Benzyl peroxide
is a good product for reducing active acne lesions and also has anti-inflammatory
properties. It is found in well-known products such as ‘Pro-activ’
but is also available more inexpensively over-the-counter at your
local pharmacist. It is available in concentrations up to 10%. The
higher the concentration, the more flaking and irritation to the skin.
Therefore, commencement should be with the lower concentrations.
Retinols, derivatives
of Vitamin A, are also used in the treatment of acne. Retinols work
by increasing the natural turnover rate of the skin. Therefore there
are less dead skin cells at the surface of the skin and less blockages
as a result. This property of retinols also means that skin texture
and fine wrinkles also improve. The downside of retinols is the initial
response of the skin, or the ‘retinoic response’. Skin
can usually appear red, flaky, lumpy, and irritated for up to one
month after commencement of retinols. Starting slowly is important
to reduce these side effects. Sunscreen is also imperative with the
use of retinols as they can initially exacerbate sun sensitivity.
Retinols should not be used in pregnant mothers, those planning to
be pregnant, or those who are breast-feeding.
Examples
of Vitamin A derivatives include prescription-only variants such as
Stieve-A, and Retin-A. Cosmedix
also has a range of retinols of varying strength. Although more expensive
than their prescription-only variants, they have the added property
of being ‘chirally correct’. Each molecule has a left
and a right-sided version, like a pair of hands. In the case of retinols,
the left sided version is more active and less irritating to the skin.
Cosmedix has more of the left sided version of the molecule and is
therefore ‘chirally correct’.
Microdermabrasion
Microdermabrasion is another method of helping to physically remove
dead skin cells from the surface of the skin and reduce pore blockage
and acne. It is especially effective for comedones (blackheads). It
also helps with the penetration of skin care products. Microdermabrasion
also improves lymphatic drainage of the face.
Make-up/foundation
Make-up is also implicated in the cause of acne. Foundations, even
those claiming to be ‘oil-free’ can physically block pores
and cause acne. This often leads to a vicious cycle of applying make-up
to cover acne lesions, and in turn this causes more acne, leading
to the use of more make-up. Acne due to make-up use is termed ‘acne
cosmetica’. Mineral make-up does not block pores, and instead
sits on top of the skin. At The Victorian Cosmetic Institute, we recommend
Glo-minerals foundations as they have anti-oxidants and anti-inflammatory
properties as well as being a mineral make-up. Importantly, they also
have a SPF factor to help prevent aging and post-inflammatory hyperpigmentation
from acne lesions (see below).
Antibiotics
Antibiotics have also been widely used in the treatment of acne. Antibiotics
work by reducing the acne-causing bacteria (including Propionobacterium
acnes) at the surface of the skin. Antibiotics are most suited to
inflamed acne lesions. They do unfortunately also affect the rest
of the body as well as the skin, and can result in side effects such
as oral and vaginal thrush, diarrhoea, liver function abnormalities,
and sun sensitivity. Minomycin has also been associated with hyperpigmentation
when used for prolonged periods. Antibiotics such as doxycycline,
minomycin, clindamycin, trimethoprim, trimethoprim plus suxamethoxazole
(Bactrim), are commonly prescribed for prolonged periods. The author
does not believe in the long-term use (greater than 2 months) of antibiotics
for acne as their efficacy is low and the potential side effects can
be significant. Penetration into the skin can also be minimal. With
widespread use of antibiotics for acne, there is increasing resistance
of the acne-causing bacteria to the commonly used antibiotics, resulting
decrease in their effectiveness.
Topical antibiotics
are another option for the treatment of acne. Common examples of topical
antibiotics include erythromycin (Eryacne gel) or clindamycin (Clindatech
lotion). As for oral antibiotics, they require a prescription from
a doctor. The advantage of topical antibiotics is they have no systemic
side effects, and can have some anti-inflammatory properties.
Hormonal
treatments
Particular hormones, in particular androgens, have also been known
to increase oil and sebum production and exacerbate acne.
For females, options
for controlling the hormones that cause acne include particular variants
of the oral contraceptive pill. The variants that are of particular
use are the ones containing Cyproterone acetate or Aldactone. The
trade names of the pill containing these ingredients include; Dianne-35
and Yasmin. Cyproterone acetate and Aldactone work by helping to switch
off the androgenic hormones, or the hormones that increase oil/sebum
production and cause acne. Aldactone can also be used without the
pill in those females who do not want to be on the pill. It is, however,
not compatible with pregnancy, so it is not suitable for those females
who are attempting to fall pregnant or who are pregnant.
Oral
Isotretinoin/Roaccutane
Roaccutane, or oral isotretinoin, also a derivative of Vitamin A,
is the gold standard in the treatment of acne. Prescribed only by
dermatologists, it is mostly used for severe forms of acne only, as
it has a number of significant side effects. Generally, a six-month
course is prescribed, and involves taking a tablet or two each day.
The side effects from Roaccutane are the main problem with treatment
and include; dry skin, dry eyes, dry lips, cracked lips, hair loss,
mood changes, and liver function abnormalities. Pregnancy must be
completely excluded during treatment with Roaccutane, as it is known
to cause serious birth defects.
Photodynamic
therapy
Recently, there have been advances in the treatment of acne that do
not involve drugs with significant side effects, and can be highly
effective. Photodynamic
therapy is such a treatment that targets sebaceous gland activity.
Being a localised treatment, it only has localised side effects, ie
on the treated skin. There has been some studies showing that it may
be as effective as Roaccutane in some cases. Photodynamic therapy
works by placing a substance called 5-aminolevulenic acid on the skin,
which is attracted specifically to the sebaceous glands, and then
activating the substance with a light source or laser. This specifically
disrupts the function of the sebaceous glands and reduces their activity
and the acne they cause. The results can last up to a year and some
people require no further treatments for acne after their initial
treatments.
Sunscreens
Sunscreens are important to help reduce pigmentation after an acne
lesion has passed. However, some sunscreens themselves can cause acne
by blocking pores. At The Victorian Cosmetic Institute, we recommend
Reflect sunscreen from Cosmedix. Reflect is a spray on, non-oily sunscreen
with Titanium Dioxide.
Overall, acne
is a problem that has many arms of treatment. The more of these that
can be implemented, the greater the chance of success. There are a
number of treatments now that are an alternative to Roaccutane and
its side effects, although it still remains the gold standard in acne
treatment. Acne is a problem not just only of teenagers, but also
of people in their twenties, thirties and forties. It is an important
issue to address in all cases, as not only does successful treatment
resurrect lost confidence, but prevents scarring that is often irreversible.
Dr. Gavin Chan
(MBBS)
The Victorian Cosmetic Institute
Level 6, 200 High St
Lower Templestowe 3107
(03)88500655
www.thevictoriancosmeticinstitute.com.au
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