Acne plagues around 9.4% of the world’s entire population, making it the eight most prevalent disease. In Australia, 85% of people aged 15-25 years old are affected by this common skin condition.
Contrary to popular belief, it isn’t caused by poor hygiene – which means no amount of cleansing, scrubbing, or exfoliating will clear up your breakouts. You might be surprised to learn that overly enthusiastic cleansing and exfoliating can irritate your skin and make your acne worse!
We talk about the causes of acne, the mechanics behind getting pimples, and what active ingredients you should look for when searching high and low for the best acne treatment product in Australia that actually does what it says on the tin.
Acne: The Science
Acne is a chronic inflammatory skin disease that should always be treated as a medical condition. Its propensity to worsen and spread over time when left untreated is well known in the skin care community. Chronic acne is bound to leave those who have it with pocked skin, dark marks, and overly sensitive skin.
Acne comes in many forms and range from mild to severe: clogged pores called ‘comedones’, which can be open (blackheads) or closed (whiteheads), papules (small red bumps on the skin), and pustules (like papules but filled with pus), to large, painful and swollen nodules and cysts (‘blind pimples’).
How does acne start?
It begins with a simple clogged pore. A large number of acne sufferers produce sebum (oil) from their sebaceous glands and their skin cells are sticky and prone to getting lodged in pores and hair follicles. These sticky skin cells and sebum create a blockage so small you would have to use a microscope to see it, a microcomedone.
Acne bacteria are drawn to this mix of dead skin cells and sebum, gathering, feeding, and multiplying around the microcomedone. This bacterial invasion signals to your body that it needs to start producing chemicals that result in inflammation.
The inflamed plug eventually becomes large enough for you to be able to see it, now it graduates to being a comedone. Sometimes, if you’re unlucky, the comedone can burst! Spreading bacteria and pus onto the surrounding skin. This can set off a chain reaction that further spreads inflammation, and can even cause other types of acne to get in on the action like papules, pustules, nodules, and cysts. Redness and pain, as well as resulting hyperpigmentation and scarring, are part of the commonly reported side effects of acne.
Are our hormones to blame?
Excessive sebum production (known as ‘seborrhoea’) is triggered by hormone levels. The hormones involved in the acne process are called androgens, which includes dihydrotestosterone (DHT) and testosterone. Adrenal glands, testes and ovaries produce androgens in males and females, or they are made by converting precursor chemicals found in the skin, hair, sweat glands, and sebaceous glands.
The rampant acne you get in your teens is a direct result of the natural increase in androgens during puberty. Conversely, adult acne is also quite prevalent, but usually far less severe – acne in your adulthood is likely to rear its head during menstruation, pregnancy, while taking medication that affects your hormones, when you are stressed or your diet is particularly bad, or it happens as our skin ages and begins to dry.
Because of this hormonal basis, acne treatments can sometimes include anti-androgen drugs such as oral contraceptives, spironolactone, and cyproterone acetate. Vitamin A is used to reduce sebaceous gland activity.
Acne treatments: OTC to prescription
With a wash of over-the-counter (OTC) remedies to prescription-only treatments, there are a myriad of ways to treat and prevent acne from returning. When browsing the shelves of skin care you will find acne cleansers and treatments for unclogging pores (look for salicylic and glycolic acid in the ingredients list) and killing bacteria (benzoyl peroxide). These rarely clear breakouts because they don’t target the factors that cause acne – oil, excess skin cells, and bacteria.
Clinically formulated treatments can be found through Australian telehealth providers whose doctors can create the best acne treatment product for you. This can only be done effectively once a doctor has identified and targeted any and all acne-causing pathways. Qr8 MediSkin, based in Brisbane, does just that! All patients benefit from a one-on-one video consultation with a doctor and the direct delivery of your acne treatment anywhere in Australia. Their service completely eliminates the need to visit a dermatologist or pharmacy!
One thing note about acne treatment: Purging is one of the possible side effects of prescription retinoid use, especially if you had a lot of comedones. What you can’t see are the microcomedones. Retinoids speed up the shedding of skin cells to begin to regulate the skin cells that block your pores, causing pimples. Unfortunately for some, in the initial stages of treatment, you are simultaneously clearing out and temporarily blocking pores with extra skin cells, pushing all existing comedones to the surface, and causing microcomedones to turn into full blown comedones and what appears to be a sudden acne breakout. Don’t worry, this is all part of the process of ridding your skin of acne.
The best acne treatment ingredients
Creating a treatment cream or serum that targets how your acne begins involves a number of different active ingredients that bring unique properties to the acne battleground.
This is a naturally-occurring acid derived from rye, wheat and barley (when made in a lab scientists use vegetable oils to produce it). Azelaic acid has antioxidant, anti-inflammatory, anti-bacterial and depigmenting properties. The anti-inflammatory effect, coupled with its anti-bacterial and pore clearing abilities, make it a frontline soldier in the treatment of mild to moderate acne when combined with a prescription retinoid.
Known commonly as niacinamide, vitamin B3 has anti-inflammatory, skin barrier lipid regulating, sebum regulating, depigmenting, antimicrobial and photo-protective effects when used topically. This active ingredient is gentle on the skin and as such is found in many cosmetic and OTC products.
Tazarotene is similar to tretinoin (the purest form of vitamin A), however it only binds to specific nuclear retinoic acid receptors (RARs). What this means in plain English is that it is particularly effective at reducing papules and open comedones at a faster rate than tretinoin.