Dermatologist on the one thing that might be making your acne worse

Dr. Shreya Andric is a dermatologist based in Sydney. She is passionate about skin health and her mission is to educate the public on how to care for their skin, and also clear up the vast amount of misinformation out there on this topic.

While Dr. Andric has independently chosen the products that appear in this article, she does not receive revenue from the links. Some of the links may return revenue to Yahoo Lifestyle Australia.

Acne is a very common skin condition that is identified by the presence of blackheads and whiteheads, as well as red and pus-filled spots (pustules).

It usually starts during puberty and can range in severity from a few spots on the face, neck, back and chest (which most teenagers will have at some time), to a more severe problem that can cause scarring and reduce self-confidence.

It tends to clear by the early to mid-twenties, but it can go on for longer. It can also develop for the first time in people in their late twenties and beyond.

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What causes acne?

The sebaceous (oil-producing) glands are affected by hormones. In people who have acne, these glands are particularly sensitive, even to normal blood levels of these hormones. This results in the glands producing too much oil.

At the same time, the lining of the pores becomes thickened and dead skin cells are not shed properly. A combination of the oil (sebum) and dead skin cells builds up and plugs the pores producing blackheads and whiteheads.

The acne bacteria live on everyone’s skin and usually cause no problems. In those with acne, the build-up of oil creates the perfect environment for the bacteria to multiply. This is accompanied by inflammation which results in the formation of red, swollen, or pus-filled spots.

Acne can occasionally be caused by medications given for other health conditions or by certain contraceptive injections, intrauterine devices or pills. Steroid tablets taken by body-builders contain hormones that can trigger acne too.

Tips and tricks

- Avoid picking or squeezing your spots as this causes further inflammation and may result in scarring and infection.

- Let your GP or dermatologist know if your acne is making you feel anxious or depressed.

- Expect to use your treatments for at least two months before you see improvement. Make sure you understand how to use them correctly so that you get the maximum benefit.

- Choose oil-free and non-comedogenic skincare products and makeup; mineral makeup is a great option as it sits on top of the skin.

- Avoid scrubs as these can irritate the skin and make your acne worse.

- Speak with your doctor before permanently cutting any foods out of your diet as this can lead to nutritional deficiencies. Diet can play a role in causing acne, however, keeping your skin clear usually requires more than a diet change.

Acne and diet

When it comes to diet and acne, the evidence shows that high glycaemic index (GI) diets (eg, sugar and sugary foods, white bread, potatoes, white rice, etc) may cause or aggravate acne. Switching to a low GI diet may help. There is also evidence that consuming skim milk is associated with acne.

Most acne patients have normal hormone levels if tested; however, acne can sometimes be caused by a problem with the hormones. The most common hormonal problem associated with acne is polycystic ovarian syndrome in females. This is associated with irregular periods, unusual hair growth or hair loss, and these symptoms are worthwhile mentioning to your doctor if you have them.

Acne treatment

Treatment of acne depends on severity. Acne treatments can be broken down into the following categories:

- Topical treatments (eg, cleansers, gels, lotions, creams) – these can be prescription or over the counter

- Oral antibiotics – used for their anti-inflammatory effects, rather than their antibacterial effects

- Oral contraceptive pills

- Isotretinoin capsules

- Other treatments

Topical treatments

These are usually the first line treatment for those with mild to moderate acne. There are numerous options including benzoyl peroxide, antibiotics (eg, clindamycin), retinoids (eg, adapalene, tretinoin), azelaic acid and nicotinamide.

Most should be applied to the whole face, rather than as spot treatment and consistency is key – no treatment will work in one day, or one week even; most will need a minimum of 8 weeks to have an effect.

Many of these treatments can be irritating when first used so it is ideal to gradually increase the use of the treatment, eg, starting 2-3 times per week and then building up to every night as tolerated.

You can also use an oil-free, non-comedogenic moisturiser on top to offset any irritation. Benzoyl peroxide can be found over the counter in the Benzac products. Keep in mind this can bleach towels and pillowcases! Azelaic acid (Azclear and Finacea), niacinamide (Propaira Acne Prone Skin), and products containing salicylic acid (La Roche Posay Effaclar range and Ego’s Elucent products) can also be found over the counter. These are good choices to start with for people with mild acne.

Oral antibiotics

Your doctor may advise a course of antibiotic treatments, which are often used in combination with a suitable topical treatment. Antibiotics need to be taken for at least 6-8 weeks to see a response, but a course is often three to six months.

Oral contraceptive pills

Some forms of the oral contraceptive pill can be helpful in females with acne. The most effective contain a hormone blocker (eg, cyproterone acetate), which reduces the amount of oil the skin produces. It usually takes at least three months for the benefits to show.

Isotretinoin

A highly effective treatment for severe or persistent acne. The improvements can be long-lasting in those who complete a course of treatment – in 80% of patients, their acne is cured; the remaining 20% might need a second or a third course later in life. This should only be prescribed by a dermatologist after discussing the potential side effects.

Other treatments

Blue light treatment has been found to be effective in the treatment of mild to moderate acne. It uses light in the blue wavelength range to kill the acne bacteria on the skin. Multiple treatments are required and acne usually does not completely clear with light treatment alone.

Laser treatments and chemical peels performed by experienced dermatologists and plastic surgeons are effective at improving the appearance of acne scarring, however, it is important to treat the acne first and to be aware that multiple treatment sessions, and often different modalities are required to obtain the best results.

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