Acne

Acne most often affects areas of the skin densely populated with sebaceous follicles; including the face, upper part of the chest and back. Severe acne is inflammatory, however acne can also manifest in non-inflammatory forms.

All forms of acne are caused by changes in pilosebaceous units – skin structures consisting of a hair follicle and its associated sebaceous gland.

Acne generally occurs during adolescence, often continuing into young-adulthood. An increase in testosterone (which accrues in both genders during puberty) is the most common cause.

For many people, acne diminishes over time, tending to disappear completely (or at the very least decrease substantially) around our early 20s. However some will experience acne well into their 30’s and 40’s and can in fact develop acne well into adulthood.

Larger nodules are known as cysts whilst the term nodulocystic has been used to describe severe cases of inflammatory acne. Cysts generally appear on the buttocks, groin or armpit area but can occur anywhere that sweat collects in hair follicles and perspiration ducts. Cystic acne affects the deeper layer of skin tissue more profoundly than common acne.

Aside from scarring, the main effects of cysts or nodulocystic acne tend to be psychological and can result in reduced self-esteem and depression. Acne usually appears during adolescence, when teens already tend to be at their most socially insecure. Early and intensive treatment is therefore advocated to lessen the emotional and physical impacts of acne. Topical skin care is only one part of the treatment process.

Effective treatments for acne are very different depending on whether the acne is a dry acne (acne tarda), or a wet/oily acne. All too often people think all acne is produced from oily skin, however, many cases of acne are actually caused by the skin being ‘dried out’. Sadly, this is generally caused by the inappropriate use of cosmetics for the true skin type. When the natural lipidic balance of the skin is out of shape, the skin produces an over-abundance of sebum. Simple mistakes such as this can send the sebaceous glands into overdrive, which can result in acne.

Grade I acne is commonly seen in early adolescence, especially on the nose and/or forehead. Many adults also experience grade I acne, as blackheads on the nose and forehead. Milia are commonly found around the eye area and chin.

Grade I acne may progress to Grade II if left untreated.

Suggested treatment: tailored facial treatments supported by customised skin care designed for your skin type. 

In teens, acne may progress from the nose and forehead to other areas of the face. Acne may start to affect the chest and shoulders, with occasional breakouts on the back, especially in males. Adult women may find greater breakout activity on the cheeks, chin and jaw line area, especially just before and during the menstrual cycle.

Grade II acne may progress to Grade III, especially if pimples are habitually picked at or squeezed, as these habits cause the acne to spread.

Suggested treatment: More serious skin treatments with a specialised acne focus will be necessary. Pay careful attention to the ingredients/ types of facials as products and treatments range from potentially harmful Benzoyl Peroxide and other ingredients that can unnecessarily peel the skin, through to the pure and active products found in the  in the dermaviduals range. Many ‘over-the-counter’ products contain the ingredient Benzoyl Peroxide. Please carefully consider using these products as research indicates increased sensitivity to sunlight and allergies reactions to it. Whilst these ingredients can lead to short term fixes in the skin, often longer term problems can be created.

Grade III usually involves other body areas, such as the neck, chest, shoulders, and/or upper back and face. The chance of scarring becomes higher as the infection spreads and becomes deeper.

Suggested treatment: Only a qualified dermatologist or specialist skin treatment therapist should treat acne at this stage. Grade III acne is usually treated with both topical and systemic therapies available only by prescription. Left untreated, Grade III acne may progress to Grade IV.

Acne of this severity usually extends beyond the face, and may affect the entire back, chest, shoulders, and upper arms. The infection is deep and widespread. Nearly all cystic acne sufferers develop scarring.

Suggested treatment: Grade IV acne should be treated by a dermatologist in conjunction with your skin care therapist. It tends to be hard to control, and almost always requires powerful systemic medications in addition to topical treatments. 

Enlargement of sebaceous glands and an increase in sebum production also occur with increased androgen (DHEA-S) production at puberty. The microcomedo may enlarge to form an open comedone (blackhead) or closed comedone (milia). Comedones are the direct result of sebaceous glands becoming clogged with sebum, a naturally occurring oil, and the accumulation of dead skin cells. In these conditions, naturally occurring Propionibacterium acnes (P. acnes) can cause inflammation, leading to lesions (papules, infected pustules, or nodules) in the dermis around the microcomedo or comedone, which results in redness and can result in scarring or hyperpigmentation.

Comedogenic substances

P. acnes are found naturally within our skin and produce a series of fatty acids with potentially comedogenic effects. {Definition: Believed to cause comedones, or pore blockages}. Additional substances that can contribute to acne are mineral oils (oil acne), tar (tar acne), chlorinated hydrocarbons (chloracne), drugs (acne medicamenta) and a multitude of cosmetic substances such as lanolin, cetyl alcohol, saturated fatty acids and their esters.

Those with sensitive skin should avoid ingredients such as ethoxilated alcohols and polyethylene glycols (PEG’s) as both are used as emulsifiers and solubilisers. With the influence of ultraviolet rays and atmospheric oxygen they develop peroxides which in turn generate aggressive radicals which can cause Majorca Acne.

Given these substances are widely used in many cosmetic products, the skin treatment therapist and educated consumer is advised to carefully study the ingredient list on products before prescribing products to treat acne. Even sun protection products can contain these harmful substances. Ethoxilated alcohols can be recognised on the ingredients listing either by their middle or final syllable (-eth), eg. Ceteareth-10.  Please note that no dermaviduals product contains these ingredients.

Hormones

Hormonal activity, such as menstrual cycles and puberty, may contribute to the formation of acne. During puberty, an increase in male sex hormones called androgens (occuring in both males and females) causes the follicular glands to grow larger and produce more sebum. Use of anabolic steroids may have a similar effect. Several hormones have been linked to the advent of acne in pregnant women and some can lead to disorders such as polycystic ovary syndrome or even the rare Cushing’s Syndrome.

Acne associated with menopause occurs as production of the natural anti-acne ovarian hormone Estradiol ceases to be produced at the onset of menopause. The lack of Estradiol can also cause thinning hair, hot flushes, thin skin, wrinkles, vaginal dryness, and can predispose women to osteopenia and osteoporosis, as well as triggering acne (known as Acne Climacterica in this situation).

Development of acne vulgaris in later years is uncommon, although this is the age group where Rosacea can occur. Indications of Rosacea are often confused with acne as they can present with similar symptoms.

Genetic

The tendency to develop acne can run in families. A family history of acne is associated with an earlier occurrence of acne and an increased number of retentional acne lesions.

Psychological

While the connection between acne and stress continues to be debated, scientific research indicates that “increased acne severity” is “significantly associated with increased stress levels”. The National Institute of Health (USA) lists stress as a factor that “can cause an acne flare.” A study of adolescents in Singapore “observed a statistically significant positive correlation between stress levels and severity of acne.” Adrenal stress stimulates the body to produce cortisol and adrenalin. These hormones trigger changes in the skin, such as increased oil & sebum production.

Infection

Bacteria in the pores, Propionibacterium acnes (P. acnes) is the anaerobic bacterium that causes acne. Resistance of P. acnes to commonly used antibiotics has been increasing.

Diet

A high glycemic diet and regular ingestion of cow’s milk have been associated with worsening acne.

There is no evidence to suggest that the consumption of chocolate and salt  contributes to acne.

Look out for these things that can lead to acne.

• UV exposure
• Incorrect skincare
• Poor quality and composition of makeup and primers
• Fruit acids or chemical peels in general over-peeling the skin
• Overuse of lipid substances or occlusive substances in topical skincare
• Alcohol substances of more than 10% concentration in cosmetic skincare
• Tight fitting clothes or hats
• Creams containing emulsifiers as they can lead to dissolving of natural lipids
• Some medications
• Hormonal fluctuations such as menopause
• Digestive disorders
• Constipation
• Vitamin A & vitamin C deficiency