Do you suffer from acne? Here at Harley Street Emporium one of the most common questions we are asked is, “What is the best acne treatment?”
To help resolve this issue, we evaluated some of the top acne treatments with the help of GP, Dr Bhavjit Kaur, from Health & Aesthetic Clinic in Greenwich, London, alongside the advice of dermatologist and acne experts, Dr Anjali Mahto and Dr Nick Lowe.
Acne can result from plugged hair follicles. Excess oil, dirt, and dead skin cells on the surface of your skin clog your pores and create spots as well as small, localised infections. Treatments clear away the bacteria and dry up the excess oils that lead to acne.
There are many facets to treating acne ranging from lifestyle changes, topical medications, oral medications, and cosmetic medical procedures.
killing Propionibacterium acnes (P.acnes) – the bacteria responsible for causing acne which can colonise the skin and hair follicles
normalising skin cell shedding and sebum production in the pore to prevent blockage.
P. acnes bacteria itself does not directly cause significant damage to the skin. Instead, most of the damage caused by acne is due to the inflammation caused by the immune response to the presence of the P. acnes bacteria.
Diet and lifestyle changes are also important – so read on.
Dr Bhavjit gives her top tips for Acne management:
While genetics contribute to acne, it appears that how we live each day matters too. Foods that fight inflammation such as fruits and vegetables, nuts, fish or fish oil supplements are great examples of foods that help clear the skin. Not consuming enough antioxidants, vitamins and minerals can have a major impact on acne. Low levels of vitamin C and E, zinc, selenium, and carotenoids help fight free radicals that break down skin elastin, produce collagen, and repair skin damage.
A high intake of sugar is one area that has been linked to acne but more recently low fat dairy products have also been implicated. A study published in the Journal of the American Academy of Dermatology in 2015 found that teenagers with acne consumed more low fat or skimmed milk than those who didn’t.
milk-low-fat-acne-link-journal-harley-street-emporiumAccording to Harley Street dermatologist and acne expert, Dr Nick Lowe, the reason the low fat milk products may be a contributory factor is because they have a higher glycemic index – or GI. And that brings us to our next point – sugar.
Most dermatologists and nutritionists now agree that there is evidence to suggest that simple sugars (or simple carbohydrates) may also be part of the problem.
Although it’s not conclusive, some people with acne have reported improvement in their skin when they follow a low-glycemic index (GI) diet, which can be achieved by:
increasing the consumption of whole grains, fresh fruits and vegetables, fish, olive oil, garlic
decreasing the consumption of high-glycemic index foods such as white bread, biscuits, cakes, ice creams and bottled drinks.
Consultant dermatologist, Dr Anjali Mahto, explains how it works: “If someone eats refined sugar or a simple carbohydrate such as white bread or a piece of cake, their blood glucose level will go up. As a response their body will release the hormone insulin to try to combat this.
“Once insulin is released, the body will also release other hormones called IGFs (Insulin-like Growth Factors) and these sometimes increase the activity of oil glands which in turn affect hormones such as testosterone which can drive acne.”
Dr Mahto adds: “Guidelines in the US and UK do still clearly state that people should not try to control acne with diet alone as we just don’t have enough evidence, but there does seem to be an emerging link between acne and sugar.”
Many people with mild acne or spots can manage their condition with some basic lifestyle changes around managing oily skin.
Keeping your face clean and your hair away from it is vital. Oils from your hair and face also build up on your bedding. Changing your pillowcases daily or at least weekly can help prevent this build-up. Regular towel washing is also a good idea.
Using a gentle cleanser that is specifically designed for acne and excess oil production can help with clearing up acne. Dr Bhavjit emphasises the importance of cleansing, and that once you have thoroughly cleansed it is vital to follow with an exfoliant that contains a gentle Alpha hydroxy acid (AHA) or Beta hydroxy acid (BHA) to destroy acne-causing bacteria. Salicylic Acid is a BHA and is often recommended. Dr Nick Lowe. The acclenz™ Purify & Renew Foaming Cleanser is a salicylic acid based cleanser specifically designed to treat acne.
Dr Bhavjit suggests not using skin care products that can be irritating, such as scented lotions or oil-based makeup, as well as choosing moisturisers and sunscreens that are labelled “noncomedogenic.” This means that the product won’t clog your pores.
“When I use makeup products I look for items that are good for acne prone skin so that they won’t clog my pores these are labelled ‘non comedogenic,’” says Dr Bhavjit. “Those that suffer from get acne shouldn’t be going for rich, thick creams. Instead opting for lightweight gels and lotions, they will ensure your pores don’t get clogged”
Dr Nick Lowe acclenz™ Oil Control Day Cream is a great choice as it’s light weight and helps control sebum production.
Cleansing regularly with luke warm water and your chosen cleanser is important too.
“I always ensure I cleanse morning and evening, I will always take my makeup off and stick to a regimented skin care regime,’ Dr Bhavjit says. “Not removing our makeup is one of the biggest crimes we commit against our skin.”
These slight adjustments can go a long way in helping you resolve mild acne.
Topical medications are lotions, gels and creams that you apply to your skin; a thin coat is applied in the morning and before bedtime. Some are available over the counter, and others require a prescription. Over the counter (OTC) acne products usually contain the active ingredient salicylic acid or benzoyl peroxide; these substances reduce the amount of oil your body produces as well as fighting inflammation. These medications can help treat existing blemishes and prevent new ones from forming.
Benzoyl peroxide is usually the first-line treatment prescribed by doctors for mild and moderate acne. Benzoyl peroxide kills P.acnes by oxidising its proteins. Benzoyl peroxide is mildly effective at breaking down pimples (comedones) and inhibiting inflammation. It is commonly paired with a topical antibiotic or retinoid to improve its effectiveness, especially in people of colour who have a higher risk of scarring. However using these treatments may increase skin dryness, photosensitivity, redness and occasional peeling. Sunscreen use is often advised during treatment, to prevent sunburn.
Essential Oils have been shown to contain antibacterial molecules that are toxic to P. acnes bacteria. Some essential oils, such as Tea Tree Essential Oil and Thyme Essential Oil are commonly used as topical acne treatments.
Oral medications for acne are also called systemic treatments; they are only available with a prescription from your doctor. These drugs are commonly used to treat moderate to severe acne that doesn’t respond to topical agents.
Dr Bhavjit explains that doctors may prescribe a daily antibiotic pill, such as tetracycline. It can help fight bacteria and infection from the inside out. Antibiotics are commonly used with topical medication when gels and creams alone don’t improve your condition. Antibiotics are suitable for short-term use; they work by destroying acne-causing bacteria.
The most common oral antibiotics are: erythromycin and tetracycline family drugs:
“Depending on your severity of your acne, antibiotics of this nature can be a wonderful thing,” Dr Bhavjit says, because they go where the topical medications can’t.
Several OTC medications, like benzoyl peroxide are also directly toxic to P. acnes bacteria. However, these topically applied medications have difficulty penetrating to the base of the hair follicle, which is where the P. acnes bacteria are causing problems.
Prescription topical medications can help when OTC products aren’t strong enough. These acne gels or creams may contain Tretinoin (a retinoid drug that comes from vitamin A). P. acnes bacteria use the fatty acids and triglycerides found in sebum as its primary food source. Limiting the amount of sebum production can suppress the growth of P. acnes bacteria by reducing its food supply. Treatments with retinoids can decrease the production of sebum in the skin Isotretinoin Isotretinoin is very effective it reduces the size of oil glands so that they make less oil as well as regulating skin cell turnover so that the cells don’t block the release of bacteria and excess oil from your pores. However Isotretinoin is used for those suffering with severe cystic acne. Your doctor may prescribe it when other acne drugs haven’t worked. However, the side effects can be severe, so it isn’t for everyone. As well as these hormonal treatments such as androgen inhibitors (eg. Spironolactone, Cyproterone) and birth control pills may also decrease sebum production. Regulating hormone levels can help improve acne for some women.
Although not prescribed as commonly as medication, a few medical procedures may be used to treat severe acne. These procedures can all typically be performed in your doctor’s office or by a dermatologist.
Drainage and Extraction
Drainage and Extraction involves draining of large cysts that form under your skin. In the procedure fluids, dirt, pus, and dead skin are removed from inside the cyst to reduce infection and pain.
Light and Laser Treatments.
Laser therapy helps improve acne infection and reduce the amount of bacteria on your skin that causes acne.
Dr Bhavjit explains that certain light and laser therapies can also decrease the production of sebum in the skin. Diode lasers can be used to treat overactive sebaceous glands, thereby reducing the amount of sebum. Blue light phototherapy can be used to directly kill P. acnes bacteria growing in the skin. These therapies work by using high intensity light to excite a bacterial molecule called a porphyrin. Porphyrin is produced in large quantities by P. acnes bacteria. Excitation of porphyrins with blue light causes them to release free radicals into the bacteria and killing them.
Chemical peels and microdermabrasion remove the top layer of your skin. In the process, whiteheads and blackheads are also removed. Beta hydroxyl acids peels (BHA), otherwise known, as Salicylic acid peels are advantageous for those suffering from acne.  A deep BHA peel can be beneficial for those suffering from acne because the irritation and inflammation are kept to a minimum due to its antiseptic properties. As salicylic acid is lipid of fat-soluble it’s a good peeling agent for blemish-prone skin and is miraculous for those pesky acne scars.
Microdermabrasion involves lightly sanding off the top layers of the skin which can be useful for people with acne as it removed the unwanted dead cell layer that can be responsible for clogging pores.
Although the battle with acne can seem never ending it is a treatable condition. If lifestyle changes don’t seem to do the trick, it is best to try the least invasive treatments, or OTC products. However if ou aren’t responding and it’s causing you distress, or if you are at high risk of scarring, you need to speak to your doctor or dermatologist. They will evaluate the severity of your acne and suggest next steps for treatment.