Acne: “Not All Breakouts Are Created Equally”

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There is no single disease which causes more psychological trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychological suffering than does acne vulgaris.” – Sulzberger & Zaldems


For some people acne is just an annoying condition while for others it is a significant problem that has a very significant impact on their lifestyle and quality of life.

Acne can show up as pimples, blackheads, whiteheads, congested pores, pustules or cysts (deep seated pimples). It is one of the most common skin conditions affecting most people at some point in their lives. All forms of acne start out as a clogged, congested pore. Skin normally sheds its dead cells and pores get blocked because sometimes this process is not complete. Leftover dead cells mix with excess surface oil and block the pores and as a result, the cells, sebum and bacteria get trapped leading to inflammation which shows up as tender, red bumps. These blemishes are seen in areas where there are many oil producing glands (sebaceous glands) mainly on the face, back and chest. A lot can be done to control acne with over the counter preparations. More difficult cases need to consult a physician.

Acne shows up in puberty as the oil glands come to life when stimulated by male hormones produced in the adrenal glands of both boys and girls but why it affects some and not others in not well understood. These oil glands, located just beneath the skin, constantly produce and secrete oil through the skin pores to lubricate and protect the skin. When the pores are blocked by dead cells and debris, the oil produced builds up and naturally occurring bacteria feast on the oil and multiply leading to the inflammation of the surrounding tissue. If the inflammation is near the surface, you get a pustule; if it’s deeper you get a papule which is a pimple; deeper than this forms a cyst. When the oil breaks through the surface, you get a whitehead and if this oil oxidises turning from white to black, you get a blackhead.


Faulty skin cell turnover and stress may also play roles in the development of acne. Stress boosts the hormones that stimulate oil production so acne tends to worsen in periods of stress. There are mild, moderate and severe degrees of acne. Regardless of the degree of acne that may be present, the oil-bacteria-inflammation cycle has to be broken to get clear skin.

Acne is not just a teenage problem as cases of Adult Acne are on the increase. Adult acne eruptions usually occur along the jaw line and chin and are typically stubborn, under the skin cysts. Fortunately, therapy for preventing and treating acne are more effective than ever before. The major contributing factors to acne breakouts are hormonal imbalance, stress, diet and genetics.

The Acne/Diet Relationship

For years Dermatologists have stated that foods do not affect your skin but recent studies have shown a relationship between acne and the food we eat. Foods with a high glycaemic index such as processed carbohydrates and refined sugar are the culprits. The glycaemic index measures how a food affects blood sugar levels and hence insulin release. The faster a food breaks down during the digestive process, the higher the glycaemic index. It is believed that the rapid breakdown stimulates a rapid rate of insulin release which in turn stimulates increased oil production and skin cell turnover in the pores providing a feasting ground for bacteria. Foods with a high glycaemic index include Donuts, cake, sweets, white bread, corn flakes and potatoes to mention a few. Reducing your intake of such food may go a long way to help reduce breakouts.

Foods that contain preservative chemicals, artificial flavouring and colouring may also lead to breakouts.

The Acne/Hormonal Imbalance Relationship

Hormones are chemical messengers that regulate body function which circulate in the bloodstream. Hormonal imbalance may occur at any time in one’s lifetime and usually starts at puberty and for women, occurs during the menstrual cycle, pregnancy and menopause. Increased levels of circulating Androgen hormones increase oil production which contributes to the acne cycle. Monthly breakouts in women around the menstrual period is related to increased progesterone levels. Nearly 50% of all women experience monthly premenstrual acne flare ups. Progesterone causes fluid retention and puffiness. This rise in tissue swelling affects the skin compressing the pores shut leading to sebum build-up and blemish formation.

Hormones responsible for acne include Testosterone (an Androgen), Gonadotrophins, Anabolic Steroids, Coriticosteroids and Adrenocorticotrophic Hormone (ACTH). Stress leads to an increase in corticosteroids. Women with Polycystic Ovarian Syndrome (PCOS) produce too much Testosterone and are likely to have problematic acne and increased growth of facial and body hair (hirsuitism). Androgenic acne may be as a result of producing too much testosterone, producing too little oestrogen or a natural sensitivity to androgens which is the most common cause.

Oral contraceptive pills help in the treatment of acne by reducing the level of circulating androgens and blocking androgen receptors. The pill increases the level of Sex Hormone Binding Globin (SHBG) which binds to circulating androgens preventing them from reaching their targets. Depo-Provera (Medroxyprogesterone acetate) a long lasting injectable depot progesterone contraceptive occasionally has acne breakouts as a side effect.

Spironolactone (Aldactone), a diuretic used for the treatment of hypertension binds to androgen receptors blocking androgens and thus inhibiting their effects. It is often used in addition to oestrogen supplements for the treatment of PCOS. Yasmin, a new generation OCP containing the progestin Drospirenone, has a structure similar to spironolactone and its associated properties of androgen receptor blockade and diuretic properties making it a good choice for women who want to avoid the possible water retention associated with the use of other OCP’s.

Treatment
The focus of both prescription and at home therapy is to unclog pores, kill bacteria and minimise oil production.

Mild Acne

This exists if you have a few whiteheads, blackheads and occasional pimples. Treatment and prevention begins with regular exfoliation to prevent the build up of dead cells. Active ingredients to look for are salicylic acid and alpha hydroxy acids. Affected skin should be washed twice a day with a gentle cleanser such as Dove soap, Cetaphil, Neutrogena Rapid Clear Oil Control Foaming Cleanser and Clinique soap.

After cleansing, a toner or clarifying lotion containing salicylic acid should be swiped over skin with a cotton pad like Clinique Clarifying lotion and Skin Success Exfoliating Toner. At night, Benzoyl Peroxide 5% or 10% such as OXY 5 or 10 should be applied to affected areas to kill bacteria. It is important to use a suitable moisturiser. Oil control moisturisers like Clearasil Total Control All Day Mattifying Moisturiser can be used to blot excess surface oil.

A variety of mild scrubs and treatment masques can be used. Scrubs such as Botanical Buffing Beads by Peter Thomas Roth contain gentle jojoba beads that won’t scratch or irritate the skin. Sulphur containing treatment masques such as Origins “Out of Trouble” should be used once a week to help deep cleanse the pores and mop up excess oil.

Moderate Acne

This exists if you have more frequent pimples in addition to blackheads and whiteheads. If the above treatment regimen fails to improve skin condition after two weeks, a dermatologist should be consulted. Prescription retinoids such as Retin-A, Differin, Tazarotene and Tazorac are tried and tested with excellent results. This is usually given in combination with topical or oral antibiotics.

Microdermabrasion, which is the “sanding off” of the top layer of skin, helps control acne by decongesting blocked pores and is usually prescribed as a series. This is also achievable by the use of chemical peels. Clearlight, a high intensity light source similar to a laser and safe for use on black skin may be used to kill bacteria. A series of eight treatments is given within a month and results typically last four to six months. Another option is the Nlite-V a fast-pulsed dye laser. Two sessions are required and results last about three months.

There is also hormonal treatment for acne using birth control pills and androgen receptor blockers. When women produce excess androgens (male hormones that naturally occur in women in small amounts), the sebaceous glands are stimulated to produce excess oil leading to more blemishes. Oral contraceptives help stabilise androgen levels and if this does not work alone, an androgen blocker such as flutamide or spironolactone may help. Women who get breakouts at the same point during their menstrual cycles are the best candidates. The occasional one pimple every month does not warrant the use of hormonal therapy.

Severe Acne

This exists when you have deep painful cysts in addition to whiteheads, blackheads and pimples. Cystic acne is deep set with no surface opening and is most likely to form acne pit scars due to the way it heals. Skin is pulled downwards leaving an indentation). A good skincare regimen is needed in addition to a Dermatologists care. Each cyst should be injected with Cortisone by your dermatologist. This is neither convenient nor cost effective for chronic sufferers because it doesn’t reduce outbreaks.

Prescription Accutane can be prescribed for a 15 week cycle which may clear acne for several months or sometimes for good. Accutane (Isotretinoin) is an oral Vitamin A derivative wonderful for the treatment of severe, resistant acne that works by shutting down oil production. The downside is that it is highly teratogenic and may have serious side effects and as a result should never be given to pregnant women. An alternative to Accutane is the Smoothbeam laser that heats oil glands slowing or stopping oil production. A series of four to six treatments are recommended. Skin clears within a week and results can last up to six months.

Thanks for reading my article. Get yourself glowing!


Comments to Acne: “Not All Breakouts Are Created Equally”

  • I’m having a terrible acne problem. My beautiful face is so full of blemishes. Pls I would like to consult with u nd seek help. I believe that God Almighty will use u to heal me!

    constance ajunwa June 13, 2015 4:07 pm Reply

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