Acne has a huge impact on how we look and feel. The primary causes of acne are bacteria, hormones and inflammation and it can be exacerbated by things like diet. This Cheat Sheet has simple, clear advice on how you can manage your acne, the best skincare regime and some of the causes of acne.
How to manage it
There are different ways you can treat or manage your acne. You can use skincare bought over-the-counter (OTC) or treatments prescribed by a doctor, depending on the severity of your acne. We've set out a list of common treatments worth exploring:
- The basics - moisturise and cleanse: do this every morning and evening with a pH-balanced, fragrance-free, non-comedogenic products.
- Acids: Acids are an effective and gentle means of exfoliating the skin and clearing dead skin cells from clogged pores. Salicylic acid is a BHA (beta hydroxy acid) and is the most common acid used by people with acne prone skin. It helps with the exfoliation process and to manage sebum. Glycolic acid is another acid used to exfoliate the skin. It is an AHA (alpha hydroxy acid) and more gentle than it’s beta counterpart. If you have acne on your chest or back, an acid-based cleanser is a good way to manage it.
- Topical prescription creams: Topical creams such as prescription-grade retinoids can be very effective. Prescription retinoids have the greatest scientific research to back them up. They work by increasing the skin cell turnover in the skin, helping to remove dead skin cells and keratin that clogs pores. They are also an anti-inflammatory and antibacterial, so they reduce redness and swelling and fight the bacteria that cause acne.
Tretinoin, adapalene, and tazarotene are all retinoids. Topical creams can be used on any form of acne - whiteheads, blackheads, or inflamed acne such as pustules.
- Antibiotics: Red and swollen pimples can be treated with an antibiotic and a topical prescription cream. Antibiotics can be oral or topical. Oral antibiotics such as doxycycline fight bacteria internally. In contrast, topical antibiotics such as clindamycin fights bacteria on site. Both oral and topical antibiotics are commonly used as anti-inflammatory treatments as a ‘course’ of treatment. Chat to your doctor about which is best for you. If you take an oral antibiotic be sure to look into probiotics to help balance any side gut-related effects.
- Roaccutane / Isotretinoin: For people who suffer with severe acne - painful cysts that sit under the skin, red, inflamed spots - you should see a dermatologist. It is best to treat this kind of acne as quickly as possible to minimise scarring. Many dermatologists recommend roaccutane.
- Diet: Some people who suffer with acne report that changes to their diet can help. Try to avoid foods that contribute to inflammation such as dairy and foods with a high glycemic index (GI) such as sugar. Everyone’s body is different, so people will respond differently to different dietary changes.
Do’s and Don’ts
- Keep your skin hydrated. People often try to strip all the oil and moisture out of their skin to help reduce oil production in pimples. Your skin should instead be kept hydrated because it helps the skin to heal, reducing acne scarring and post inflammatory hyperpigmentation (PIH).
- Use an acid wash as an exfoliator. Acids are an effective and gentle means of exfoliating the skin and clearing dead skin cells from clogged pores. Salicylic acid is a BHA (beta hydroxy acid) and is effective for people with acne prone skin. It helps with the exfoliation process and to manage sebum production. Glycolic acid is another acid used to exfoliate the skin. It is an AHA (alpha hydroxy acid) and more gentle than it’s beta counterpart.
- Take Vitamin B3 supplements (Nicotinamide). Clinical studies have shown that this helps with skin cell production.
Do not ...
- Put toothpaste on your spots. Toothpaste will dry the skin around the spot causing it to tighten and increase the risk of scarring.
- Use products that are high in alcohol content. These dry out the skin and increase risk of scarring. Some formulations require small amounts of alcohol to stabilise the formula, this is OK.
- Use soap on your face. Like alcohol, this dehydrates the skin and strips it of good oils.
- Pick at, or squeeze, your spots. This causes trauma to the skin resulting in scarring.
- Eat foods that trigger acne. You can try eliminating or reducing your intake of dairy and high GI foods. But note that everyone is different - some skin is more sensitive to certain food groups than others so we recommend that you trial eliminating or reducing your intake, one food group at a time.
Through Software you can chat to a doctor who has experience in skin. They can offer you prescription-grade treatments to help with your acne. The Software team knows that skincare can be complicated so if you have any questions along the way just get in touch firstname.lastname@example.org.
Your skincare regime doesn't need to be complicated. In fact, if you are using an acne treatment you should keep it simple, to minimise irritation.
Step 1. Cleanse
Wash your face morning and evening with a gentle cleanser that is cream, foam, or gel-based. It should be non-comedogenic and fragrance free, meaning that it doesn’t contain ingredients that will further clog your pores or contribute to inflammation.
Step 2. Exfoliate
Every 3-5 days, exfoliate using a salicylic acid wash. This will help remove dead skin cells. Be careful not to over exfoliate - this can dry out your skin, stripping your skin of its protective layer that is required to help pimples heal.
Step 3. Moisturise
Keep your skin hydrated - hydration is key to help with the healing process and allows you to use your prescription creams regularly. Find a light, water-based, non-comedogenic moisturiser that has no additional fragrance. Apply this morning and night.
Step 4. SPF
Apply SPF every day. Many people find that SPF causes them to break out but the key is to find the right one for you. There are SPFs available in the pharmacy that are designed for sensitive skin. They are usually water-based (as opposed to oil based) and non-comedogenic.
It's important to know that all acne is caused by hormones. It is then exacerbated by factors such as bacteria and sensitivities.
How hormones cause acne
Hormones such as androgens (otherwise known as male sex hormones) cause a surge in our body’s production of sebum; these hormones work on oil glands to make them bigger and work harder. The combination of oil-gland enlargement and sebum over-production results in acne. Even if androgen levels are ‘normal’, people who get acne have a genetic sensitivity to them. This trigger explains why acne is common in teenagers, during a woman’s period, during menopause, or when taking steroids.
How bacteria causes acne
Our follicles have an incredible self-cleaning function called the sebaceous gland, which produces an oily substance called sebum. Sebum expels dead cells through our pores. This cleaning process of excretion continually happens in every pore, but sometimes the follicle gets clogged.
Pimples form when skin oils, skin cells, and bacteria get caught inside our hair follicles.
When this happens, the sebaceous gland will still continue to produce sebum, which builds up inside the follicle and creates a breeding ground for a bacteria called c. acnes.
As this bacteria multiplies, the body’s immune system is triggered and the skin around the area becomes inflamed. The body releases white blood cells to the site to help fight the bacteria, and this is often then released as pus.
Inflammation and Sensitivities
There are a number of factors that exacerbate acne, including inflammation and sensitivities. Red, swollen, pimples can be painful and cause acne scarring and post inflammatory hyperpigmentation.
Acne is a chronic inflammatory disease, so people should avoid triggers that exacerbate inflammation in the body. Particular foods, make-up, and certain skincare ingredients are all potential triggers. Take a look at our Guide to Acne for more information.