Acne
Acne is a widespread skin condition, well known as a teenage issue, although it also affects adults. It can be tempting to cover it up (with makeup or otherwise), but this is, at best, a temporary solution and is more likely to make things worse.
Different types of acne require different treatments, and any solution you choose should be tailored to your skin type. Boys experience acne differently from girls, and adolescents experience it differently from adults.
How acne forms
Sebaceous glands are found throughout the midlayer of the dermis. Some of the glands are attached to hair follicles and some are not. They produce sebum—a waxy, oily substance necessary for maintaining skin and hair health. Acne occurs when the pores of your skin become clogged with excess sebum and dead cells.
Trapped sebum facilitates the growth of bacteria normally present in the skin, particularly the bacteria Propionibacterium acnes, responsible for inflammatory lesions:
- Whiteheads contain trapped sebum that has not been exposed to air.
- Blackheads contain trapped sebum that has been exposed to air (the ‘head’ is oxidized sebum).
When blocked follicles dilate too much, they become retentional lesions:
- Pustules (commonly known as pimples) are filled with pus rather than excess sebum. They can be white or red.
- Cystic lesions are a more severe form of pustules with a sizable buildup of pus deeper under the skin in a liquid, semi-solid, or solid state.
- Papules contain trapped sebum, white blood cells and bacteria, the excess of which have caused a small follicle rupture. Papules appear as small, tender bumps with no visible fluid. They can be brown, purple, pink or red in color.
- Nodules, the more severe form of papules, have deeper follicle ruptures. Nodules appear as large, solid, painful lumps under the skin.
Acne typically affects the face, chest, upper back and shoulders.
What causes acne?
Trouble with acne is about 80% genetic. The experience of your parents is a good indication of what is in store for you. Other factors tend to be less consistent from person to person. This doesn’t mean they don’t play a role in acne formation, just that they are more dependent on the individual and the way their body reacts to different stimuli.
Hormones play a role in acne formation, especially for teenagers. Teens are more prone to acne because of the increase in androgens in the body during puberty, which in turn increase sebum production. The main culprit here is testosterone. Although it’s usually thought of as a male hormone, we all produce it to a certain extent.
These changes do not affect everyone equally. Some teens have generally clear skin, suffering no more than the occasional spot, while others struggle with severe and persistent acne.
Adult acne in women can be linked to the use of hormonal contraception, as well as hormonal changes that happen during the menstrual cycle and pregnancy.
There are many other factors that potentially contribute to acne formation and vary from person to person. Stress can influence acne—for some people, this is limited to stress in certain contexts. Eating foods with a high glycemic load—those that rapidly increase blood glucose levels—can also be detrimental to skin health. Eating greasy foods, however, has not been shown to contribute to acne outbreaks. The balance of bacteria that live on your skin, a.k.a. your cutaneous microbiota, has a direct effect on skin health and function.
Certain infections and medications can contribute to acne formation or make pre-existing acne worse. This is also true for anything that regularly touches your face—be it your own fingers or hair, as well as scarves, chin-straps, or face-masks. Obviously we cannot avoid these things altogether (especially when we have a civic duty to keep each other safe during a pandemic), but remembering to touch our faces as little as possible may help to some degree.
Skin care and cosmetics
Personal hygiene needs to be taken into account when dealing with acne. Although acne isn't a result of bad hygiene, skin care can have an impact.
Some things to consider:
- Don’t over-wash your face as this can reduce the presence of oils and bacteria necessary for healthy skin.
- Harsh scrubbing will irritate your skin and can make acne worse; wash your face gently with a mild cleanser.
- If your hair is long enough to fall in your face, wash it more often during acne outbreaks as the extra oils can be a contributing factor.
- Change your sheets and pillow cases regularly.
Acne may also be linked to using the wrong skin care product for your skin type. When establishing your skin care routine, consider the purpose of a product and what skin type it’s meant for. It will be easier to identify what products are best suited for you if you know what skin type you have. Be prepared for some trial and error as people react to chemicals differently.
Once you have a diagnosis, a dermatologist or esthetician can recommend medications or treatments specific to your situation.
While makeup is a great way to hide pimples and boost your confidence, it does influence your skin. Some makeup products can dry your skin or clog your pores, and even cause acne outbreaks. Don’t believe everything you see advertised when it comes to makeup. For example, some toners—especially those that have an alcohol base—tend to dry your skin instead of hydrating it as claimed.
When choosing makeup and skin care products, it’s better to rely on a few good quality products. Research on the products you are considering. Make sure you know what's in the products you’re using and switch to products better suited to your skin if necessary. If you are serious about using only what’s best for your skin it might be worth consulting a dermatologist.
Don’t pop them!
We've all been there—standing in front of a mirror, fighting the urge to pop a pimple.
Dermatologists and estheticians alike advise against pimple popping. This is because squeezing an already inflamed area can make the inflammation worse and push pore debri deeper into the skin, likely forming another pimple. You may even cause the follicle to rupture resulting in the infection entering the lower layer of the skin, where it will take longer to heal. Even when it seems like you’ve gotten all of the pus out, it’s likely that you haven’t.
Popping pimples can also cause scarring. Every time you damage your skin, there's a chance that tissue will be lost as the skin heals. The more tissue lost, the more likely you are to develop an acne scar. These scars can heal with time, but it often takes a couple of years. In addition to scars, some people develop dark marks in their skin called post-inflammatory hyperpigmentation.
What can I do about acne?
Some acne requires more care than others, and while each person and skin type has different needs, there is some universal advice for maintaining healthy skin.
Be gentle with your skin
To prevent sebum buildup that can contribute to acne, wash your face once or twice every day with a mild cleanser and lukewarm water.
Do not rub your face with a washcloth (or anything else for that matter)—this won't help get rid of acne or pimples. On the contrary, it can make acne worse by irritating the skin.
Remove your makeup every day
When washing your face, be sure to take the time to remove all of your makeup so that it doesn't clog your pores.
Know your products
If you are using moisturisers, toners, concealers, hair oils, and even perfumes, make sure that the ingredients are healthy and don't cause conditions you are trying to avoid. Remember, ‘more expensive’ does not always equal ‘better’. Do some research or consult someone who has.
Tackle your blemishes
In addition to ordinary skin products, such as moisturisers and cleansers, there are a number of over-the-counter products specifically formulated to target acne or pimples. No one product will have the same effect on everyone, so you may have to try several to find what works for you. Make sure you use them as intended and, unless told otherwise by a health professional, don't use several products at once.
Eat well
Sugar, dairy products, and other foods can contribute to inflammation, making pimples and acne worse. You can try cutting certain food groups from your diet to see if it has an impact on your skin. But be sure you eat a well-rounded diet while doing so—depriving yourself of essential nutrients will negatively impact your health.
In the case of chronic acne
Some cases of acne can be frustratingly persistent in spite of your best efforts. A doctor or dermatologist can help you identify the most effective therapies and prescribe medications, if necessary. Often a combination of approaches is needed to effectively tackle acne and scarring.
Potential skin therapies include:
Light therapy
A variety of light-based therapies have been shown to be successful. Most will require multiple visits to your doctor's office.
Chemical peel
A chemical peel can be used to treat mild acne. It’s a process that uses repeated applications of a chemical solution to remove the outer layer of skin in order to allow a new and healthy layer of skin to grow. Your skin and acne type determine if a chemical peel is suitable for you, how many treatments you need, and what kind of aftercare is recommended.
Drainage and extraction
Often used as a last resort, an extraction is one of a variety of minor surgical interventions to excise blemishes. Such procedures can leave small scars, so consult your doctor to decide if this is the best option.
Steroid or cortisone injection
This treatment is typically used for tender, swollen acne nodules, or resilient cysts. Diluted corticosteroid is injected into a cyst to reduce redness, swelling, and pain. This is a short-term treatment that can be performed repeatedly, but it does have some potential side-effects, such as thinning of the skin and discoloration of the treated area.
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