Acne

Who gets acne?

Acne is a common medical condition and we understand how distressing it can be. It affects both male and females and it is not just teenagers who can suffer. In its mildest so-called “physiological” form it affects most of the adolescent population. More severe forms will affect up to 20% of this age group. Because of the hormonal drive, acne typically begins at puberty or in early adolescence, becoming most common and severe between the ages of 16 and 20 years. It is a chronic disease, persisting in many cases until the mid-20s, and in 7% of subjects with clinical acne it persists until 40 – 50 years of age.

Acne is a complex condition that requires a combination of treatments. A key component to treat acne is prescription medications; both oral and topical. These can only be prescribed by a doctor.

Treatments that we recommend

At Facial Artistry, Dr Bernard Leung and Elise Birchall (our dermal clinician) work syngeristically to offer a comprehensive list of treatment options. Each treatment plan is individually tailored to suit your needs.

A combination of treatments are usually best because they help treat current breakouts as well as prevent further acne from forming.

We recommend:

  1. Prescription only topical treatments
  2. Prescription only oral medications
  3. Chemical peels
  4. Microdermabrasion
  5. Physical and Light based therapy
  6. Skincare regime
  7. Acne scarring

It is important to bear in mind a number of principles with respect to treatment:

  • Acne is a chronic disease
  • A treatment strategy is needed and it is likely that long-term therapy will be required
  • Acne is a slow-responding disorder with little improvement in the first 3 – 6 weeks
  • There is a need for continued treatment
  • There is no evidence that fatty foods or chocolate adversely affect acne certain physiological events may influence acne, for example:
  • Stress may make acne worse
  • A premenstrual flare is common in 70% of females
  • Sunshine often helps acne but only temporarily

Each of the treatments listed above are described in more detail below.

Many acne sufferers find that even once they have cleared their acne and found the right solutions to help keep it under control, they can sometimes be left with acne scarring. There are a number of treatments Dr Bernard Leung can offer to help treat these unwanted scars. Read more about acne scarring.

Pathology of acne

Oil follicles (sebaceous follicles) produce oil (sebum) to protect our skin. Acne is a disease of the sebaceous follicles.

There are four main pathological changes found in acne

  1. Oil/sebum production is increased
  2. Blockage of opening of the sebaceous follicle resulting in the formation of whiteheads and blackheads (comedones).
  3. The opening (duct) of the sebaceous follicles become colonized with a bacteria normally present on the skin surface called Propionibacterium acnes (P. acnes).
  4. Inflammation – as a result of colonisation by P.acnes, the skin mounts an immune response resulting in inflammation, manifesting as pimples.

Topical treatment

Topical treatment is the main stay of acne treatment. Topical retinoids (Vitamin A like medications) are the first line of treatment for all grades of acne. This is usually used in combination with benzoyl peroxide, which has anticomdonal and antibacterial properties. They do need to be introduced gradually, as they can cause irritant dermatitis. Benzoyl peroxide is an over the counter topical treatment whereas topical retinoid are prescription only medications. Topical antibiotics are sometimes used. Topical treatments are available in combination forms on prescription.

Oral treatment

Oral antibiotics have been used extensively in the past. Whilst they are no doubt effective on inflammatory acne, their usefulness have declined in recent years due to the increasing problem of emergence of antibiotic resistant strains of P.acnes. There are also significant side effects associated with the long term use of certain antibiotics.

Female acne sufferers may also gain significant benefit from the use of oral contraceptive pills, provided that there are no contraindications. Modern low dose oral contraceptive pills with anti-androgenic (anti male hormone like effects) are particularly suitable. Oral isotretinoin is a highly effective treatment for acne. However, it has a high side effect profile and currently can only be prescribed by dermatologists in Australia.

Physical and light based treatment

It is important not to think of physical or laser treatments as the primary treatment for acne. They are useful though, when used in conjunction with medical treatments as discussed above. Microdermabrasion and chemical peels are helpful as they may decrease the clogging up of sebaceous follicles. Several treatment sessions may be necessary to help bring acne under control.

Photodynamic therapy is a new treatment that is helpful in controlling acne, by decreasing the colonisation of P.acnes.

Skin care program

It is important to avoid the use of comedogenic or heavy moisturisers, as these tend to increase the blockage of sebaceous follicles. Preparations containing AHA are particularly useful, and Facial Artistry stock a number of AHA containing products from the ASAP range. Some of the medications and treatments may make the skin more prone to the effect of sunlight. It is advisable to use a sunblock and a high SPF factor which is not comedogenic (eg ASAP Sunscreen Moisturiser).

Complications of acne

The main complications of acne are scarring and pigmentatory changes, which can either be hyperpigmentation (darkening) or hypopigmentation (lightening). For a detailed discussion of their treatments, please visit our acne scarring page. Laser Genesis and Fractional Laser Resurfacing are helpful with the treatment of acne scarring.

Now you know more about acne, what’s next?

We recommend that you make an appointment to see Dr Bernard Leung and his dermal clinician Elise Birchall. They will assess the severity of your acne and the impact that it has on your life. They will be able to advise you on a well thought out and effective program using the treatment methods mentioned above to bring your acne under control.

To request an appointment with Dr Bernard Leung please email us or call us on 02 6255 8988.