Acne occurs due to blockage of the pilosebaceous unit (oil ducts). Some people are particularly sensitive to naturally circulating hormones called androgens. These hormones cause an increase in oil production, which encourages bacteria to grow. When this combines with a blockage in the duct – a pimple forms.

We ensure that all aspects of this process are treated. This includes treatment of oil production, hormones (in women), bacteria and preventing blockage resulting in the best clearance of acne.

There are a number of lifestyle factors that can affect acne including stress, diet and exercise. Women are particularly more likely to suffer from acne with a hormonal trigger in their 30s and 40s.

https://www.acne.org.au/does-stress-cause-acne

https://www.acne.org.au/diet-and-exercise

https://www.acne.org.au/managing-your-type-of-acne#acnepregnancy

Whilst acne may be just a small annoyance for some people, acne that persists and causes scarring can be upsetting. Severe acne can have a significant impact on self-esteem and confidence.

It is particularly important to treat acne at an early stage, before it leads to scarring. Although there are significant advances in the treatment of acne scarring it is much easier (and cheaper) to treat the problem before it causes permanent damage.

Recent study regarding quality of life and acne treatments here. https://www.acne.org.au/oral-isotretinoin-and-quality-of-life

The best treatment for you will depend on the causes or triggers for your acne. Our Doctors are experts in all of the options available. We can advise on appropriate skin care to combine with other treatments with options including:

• Skin care advice,
• Oral antibiotics,
• Treatments to regular hormones in women,
• Chemical peels, microdermabrasion and extractions for very mild acne,
• Oral Isotretinoin
• Radiofrequency, laser and light based therapies particularly for acne scarring

There are a lot of products on the market that claim to fix acne, which can make it confusing to know what’s best for your skin. While using the right skin care products can improve your acne, it’s important to understand marketing hype surrounds some of them. As acne is a medical skin condition, we suggest that you get credible, professional advice from your GP or Dermatologist about which skin care products would suit your skin.

Here are some tips on what to look for in skincare products for acne.

What to look for in a facial cleanser

• Facial cleansers for acne should not irritate your skin as they clean off makeup, dirt and oil. It is especially important to avoid skin irritation if you’re using prescription treatments like Isotretinoin, benzoyl peroxide or retinoids.
• Only cleanse your skin twice a day. Over cleansing your skin can be detrimental to your acne.
• Choose a facial cleanser that is a ‘soap free’ liquid cleanser. It should be pH balanced and free from alcohol and abrasives.
• Choose a facial cleanser that has ‘high rinsability’ if you have oily skin. This ensures your skin won’t be left with surface film.
• Avoid facial cleansers that have high levels of fragrance, they may irritate your skin.
• Avoid gritty “ exfoliating” scrubs on your skin. When used correctly, glycolic or salicylic acid exfoliants can be less irritating and more effective ingredients to treat acne.
• Our specialist Dermatologists often recommend treating acne with products containing Niacinamide (Vitamin B3). When used in combination with some prescription treatments, Niacinamide reduces inflammation and regulates oil production.
• To remove dead skin from the surface, AHAs and BHAs (Alpha and Beta hydroxyl acids) are effective as they reduce micro blockages that can result in acne formation. It’s important to consult with a Dermatologist before you use AHA and BHA products on your skin. If the concentration is too high, your skin will be irritated. If the concentration is too low, the product won’t work.

Retinoids

Retinoids reduce the size and activity of your sebaceous glands so the amount of oil they produce declines. A common side effect of using retinoids is dry, scaly skin and irritated skin. Washing with a gentle soap free cleanser and using an oil free non-comedogenic moisturiser with sunscreen with minimum SPF30 can help. While many types of Vitamin A have helped reduce acne there are many strengths available. Our Dermatologists can advise you on which product is best for your skin.

Using prescription acne gels, lotions or creams

It’s important to only apply acne gels, lotions or creams to your skin after it is completely dry after cleansing. Treatments applied to your moist skin may cause irritation.

• Avoid applying these treatments to sensitive skin areas including your lips, eyes and nostrils.
• To prevent new pimples forming, apply the acne gel, lotion or cream to the areas of skin you normally get pimples developing.
• It’s important to note that prescription creams can be slow to work. To improve your skin, you may need to change your skin care routine every 6 weeks or so.

Tips for moisturising your skin

• Before you spend any time in direct sunlight, apply a sunscreen with a minimum of SPF30 to all exposed areas. This includes the back of your hands, neck and skin on your head.
• At night after you’ve cleansed and dried your skin, apply an oil-free, non-comedogenic moisturiser to red, flaky, itchy or dry areas that have been affected by acne. We suggest you also moisturise areas that haven’t been affected by acne.
• You may want to apply a moisturiser to sensitive skin areas not affected by acne such as around the eyes, sides of face, and the skin next to lips and nostrils, along with the neck.
• If you have mildly irritated skin you can apply this moisturiser over acne treatment gels, lotions or creams.

Mild cases of acne may require a short course of medication combined with prescription skin care to reduce breakouts. However, for severe or scarring acne a medication called Isotretinoin (Roaccutane) is the only prescribed drug, which can permanently improve acne breakouts. Only Dermatologists can prescribe Isotretinoin.

If you have severe acne, indentations and textural changes can occur to your skin leaving acne scars. A red and brown mark on your skin after acne is not considered to be acne scarring. They will usually improve without needing treatment.

Acne scarring is a result of acne cysts destroying your skin tissue. During the healing process an indentation (or scar) is left on your face. Acne scars on your back and chest are usually lumpy and raised with some keloid scars staying red for years.

You are more likely to develop acne scars if there is a high level of skin inflammation. Deep acne breakouts take longer to heal and can lead to acne scarring.

There are 7 different types of acne scars including:

• • Hypertrophic: These acne scars are raised and may be pigmented.
  • Boxcar scars: Boxcar scars can be oval or round shaped. They have a cross section of vertical sharp edges that look like they have been superficially punched out.
  • Deep divot scars: These very deep scars occur from a loss of volume of the subcutaneous tissue volume resulting in a large divot.
  • Keloid: This red to purple scar can be significantly raised and is larger than the size of the initial acne trauma.
  • Ice pick scars: These scars are shallow or deep narrow holes in the skin that look like they have been left by an ice pick.
  • Rolling scars: These acne scars undulate and are often caused by tethering of the skin to underlying structures.
  • Macular scarring: Many patients consider these to be scars even though there are no raised scars or indentations in the skin. It is characterised by flat areas of increased and/or decreased pigmentation.

Your skin type can determine the type of acne scarring you will have. When your skin heals, atrophic scarring occurs when tissue is lost. When excessive collagen is produced as your skin heals, hypertrophic scarring will occur.

The 4 grades of acne scars include:

• Grade 1: Macular scarring (or flat scarring) is characterised by flat areas of increased or decreased pigmentation. This grade of acne scarring is visible from over 50 centimeters away.
• Grade 2: This can include mild rolling scars and can be visible at distances of less than 50 centimeters away. Defined as mild disease, grade 2 acne scars can be covered by make-up.
• Grade 3: This acne scar can be hard to cover up with makeup or a short beard. It is visible at 50 centimeters or greater and is defined as moderate disease.
• Grade 4: Defined as severe disease, this grade of acne scar includes severe boxcar scars, deep divots, ice pick scars, and keloid/hypertrophic scarring.

Many patients at Melbourne City Dermatology seek treatment for acne and acne scarring. Our specialist Dermatologists and highly skilled nurses can help you achieve long lasting improvements in your acne scarring. Before discussing treatments for your acne scarring we appropriately manage any active acne you may have. Once you are ready to treat any acne scars our specialist Dermatologists can advise on our wide range of treatments available.

Some beauty and cosmetic clinics offer laser treatment for acne. It’s important to note that these treatments are often minimally effective. To treat acne scarring requires experience, time and the right equipment. Dermatologists have the right expertise to get your skin clear and then manage any residual scarring.

The Dermatologists and highly skilled nurses at Melbourne City Dermatology can advise you on the likely outcome and costs involved with a range of treatments. It is important to think about how you feel about your acne scarring and what you would like to achieve. The best method to treat your scarring will depend on your skin type, the severity and the type of scarring present. It is also important to recognise that treating acne scarring is usually not an instant fix. Several treatments are usually required and a slow and steady approach often gives the best outcomes with least potential for complications.

Our state of the art treatment options including laser and fractionated radio frequency devices to address pitted acne scars, deep scars, skin pigment changes and ice pick scars. In choosing a specialist Dermatologist at Melbourne City Dermatology for treatment of your acne scarring you can be sure you receive the most appropriate treatments and expertise in a safe medical environment.

The treatments available at Melbourne City Dermatology clinic include:

• Chemical peels

• TCA CROSS

• Laser and Intense pulsed light for erythema

• Subcision for deeper scarring

• Surgical removal of scars

• Injections to soften keloid scars

• Laser treatments for texture changes, including fractionated laser

• Radiofrequency treatments

• Q-switched laser for skin pigment changes

Severe cystic acne responds very well to Isotretinoin, a retinoid that prevents further blockage of your skin pores as it unblocks them. Isotretinoin is effective at soothing redness and inflammation while reducing oil and serum production.

Isotretinoin is a prescription only medication that is only available from a Dermatologist in Australia. Your Dermatologist will explain in the possible risks associated with taking this medication. Female patients need to be vigilant with using contraception while they are taking Isotretinoin and MUST NOT become pregnant during this time. Over the course of taking Isotretinoin your specialist Dermatologist carefully assesses and monitors your progress.

A healthy balanced diet high in fruit and vegetables is sensible but there is no dietary cure for acne. The only medical research with any evidence that diet affects acne suggested that people should avoid extremely high intakes of dairy and sugar products.

If you have acne, research is now showing that a low glycaemic index (GI) diet can control your blood sugar levels. A low GI diet can improve the way your metabolic hormones interact with your sex hormones, which can help improve your acne. Low GI foods include:

• Fruits and vegetables
• Protein rich foods including nuts, legumes, fish, beef and lamb
• Wholegrain breads and cereals.

Patients who have severe acne have a medical disorder of the oil glands, which usually requires medical treatment. For these patients, diet will have little to no impact on their acne. Focusing too much on dietary changes can be dangerous, as it can delay treatment and lead to further scarring.

You will need to book an appointment with the Dermatologist to discuss your acne treatment options. You can see our fees here. https://www.melbournecitydermatology.com.au/faqs/

If you require a prescription for Isotretinoin, it is not an expensive medication, and costs no more than a standard medical prescription. When you get medically supervised treatment from a Dermatologist is usually much cheaper than the financial and emotional cost of delayed treatment, over the counter creams or beauty salon visits.

At Melbourne City Dermatology, we work hard to keep our waiting list short. If you have severe acne, it is likely that you will be seen within 1-2 weeks. For particularly urgent cases, your General Practitioner can download an urgent referral form and request an early appointment if needed. To call and check what appointments are available, please ring our friendly receptionists on 9939 8115.