Acne Treatments

What is Acne?

Acne, also known as acne vulgaris, is a skin condition where hair follicles become blocked by oil and dead skin cells. The spaces in which your hair follicles come out are known as sebaceous glands or skin pores. These produce the oily substance that stops the hair and skin from drying out, keeping it healthy. Overproduction of this oil however can result in mixing with dead skin cells and or bacteria that blocks the pores. 

Acne is extremely common with up to 85% of Australians experiencing it in their life. Of these people, 5% will experience a more severe form. While the condition is more common during the teenage years, half of all men and women will continue to get acne into their thirties. It can be embarrassing and distressing, particularly in its severe form, and can affect self-confidence and mental wellbeing.

The symptoms you may experience from this condition are:

• Whiteheads - closed blocked pores
• Blackheads - open blocked pores
• Pustules - white and red bumps from bacterial infected blocked pores
• Nodules - hard closed pores

These usually appear on the face, chest, or upper back. They can vary in severity from mild to more severe cystic acne, which can result in long-lasting scarring acne marks on the skin.

What Causes Acne?

Fundamentally it’s the blocking of skin pores that causes acne, however, there are various types of acne triggers.

Hormonal Acne

Hormone levels can greatly affect acne as they can drastically change how much oil the skin produces. Hormonal breakouts are tightly linked to changes in androgen levels in puberty, with teenagers commonly experiencing acne in the T-zone of the forehead, face, and jaw at this time.
The menstrual cycle also plays a large role in acne in women as fluctuations in estrogen and progesterone levels around one week before menstruation, often results in hormonal breakouts.

Cystic Acne

This is the most serious form of acne. This occurs when the normal bacteria that live on the skin mixes in with the excess oil and dead skin cells and becomes trapped in a pore. This results in painful, red, and inflamed cysts on the skin which can result in scarring if severe enough.

Medication Induced Acne

Some medicines can cause acne as a side effect. Particularly those that modify hormone levels in the body. Examples of drugs that can cause acne are corticosteroids, testosterone, and lithium.

Cosmetics

Oil-based cosmetics can result in worsening acne, especially if not removed regularly. For this reason, most cosmetics are now oil-free and recommended to be removed before sleeping.

Acne Treatments

There are various acne products available both over-the-counter and via prescription. Which acne treatment is right for you depends on the cause and severity of your acne. For this reason, it is best to speak to a health professional before treating your acne to gain insight into which treatment will be most appropriate. It is important to note that for almost every acne treatment, it will take about 4-8 weeks until noticeable improvement to symptoms occurs.

Please note that Australian law prevents us from naming specific prescription treatments. After completing an assessment, you will be presented with the treatment options our doctors can prescribe. Our doctors will then assess whether the treatment is suitable for you. You can also seek advice from your local GP or pharmacist.

Over the Counter Acne Gel

This gel works by killing bacteria on the skin, unblocking pores, and absorbing excess oil. The gel is used once or twice daily and comes in three strengths.

Common side effects for this treatment include redness and irritation at the application site.

Prescription Topical Gels and Creams

The major prescription gels and creams are topical retinoids or combination topical retinoids. These medicines work by actively unblocking pores and preventing new blockages. The treatments are applied to the skin daily, usually at night, and are left on without being washed off. 

Begin Assessment

It is important that you speak with your doctors and inform them of any existing skin conditions before starting this treatment. Side effects of these gels and creams include redness, dry skin, skin burning sensation, irritation, itching, and skin sensitivity to sunlight.

Oral Retinoid Tablets

These treatments are reserved for severe cases of acne that has not responded to other treatments. It should only be prescribed by a board-certified dermatologist or skin specialist. This medicine works by actively unblocking pores and preventing new blockages. 

This medicine is known to cause birth defects and as such, contraceptive methods must be used one month before starting, during and one month after the drug is ceased. 

Doctors are required to closely evaluate the risk vs. benefits of this treatment and its suitability for each patient. Monitoring of side effects should be undertaken by the treating GP or dermatologist. 

Side effects may commonly include dryness of the lips, mouth, nose, eyes, and skin, fragile skin, changes to the colour of the skin, increased susceptibility to sunburn, and hair growth.

Combined Oral Contraceptive Tablets

Birth control tablets for women can be used to treat hormonal acne as they can stabilise the amount of estrogen and progesterone in women. The stabilisation of these hormones, particularly around the time before menstruation, can greatly improve acne symptoms. This treatment may not be suitable for all women depending on medical conditions and their response to treatment. 

Side effects for the combined oral contraceptive pills can be changes to mood, libido, weight gain, and increased risk of blood clots. Refer to your GP to discuss the risks and benefits of this therapy.

Antibiotic Tablets

These treatments belong to a group of antibiotics known as tetracyclines. They work by killing bacteria in the body, including those that can worsen acne on the skin if in an acne-affected skin pore. These are particularly effective against cystic acne as it lowers the number of bacteria able to infect skin pores. 

These treatments are generally used after topical treatments but before oral retinoids. These treatments are not suitable for pregnant women or those with stomach problems. Each persons’ suitability should be discussed with a GP or specialist. Side effects of these treatments are increased skin sensitivity to sunlight, stomach upset, oral or vaginal thrush and oesophagus irritation.

Lifestyle and Home Remedies

Mild acne may be able to be treated by small changes to basic skincare routines such as:

• Avoiding oil-based cosmetics and creams - the excess oil from these products can worsen the skin.
• Avoid bursting pimples - bursting pimples releases the oils, dead skin and bacteria within, further exposing them to other pores.
• Wash the affected areas - washing the affected areas with gentle cleansers can remove dead skin and excess oils, lowing the potential for more blocked pores.
• Avoid heavy cleansers - heavy cleansers or scrubs can have the opposite effect as they can irritate the skin further.
• Shower regularly - this is to remove any excess oil or dead skin, particularly after sweating.

Written by Clinical Pharmacist Tyson Wilkman