By Bonnie Staring
You’re an adult. You shouldn’t be getting acne, right? But the reality is that acne can occur at any time in life. Here’s what you need to know to understand and conquer this common but frustrating skin problem.
WHERE ACNE HAPPENS
Pilosebaceous follicles (pores) contain a hair root, a hair shaft and a sebaceous gland that produces sebum, an oily substance. The sebum flows into the hair shaft, travels up to the skin’s surface and works to protect the skin from infection and prevent water loss.
HOW ACNE HAPPENS
Acne is a visible result of disruptions of the biological process in the follicle. This disruption can be caused by many variables, (see “The Causes”), but there are four contributing factors that can produce acne, whether on their own or in combination.
1. LACK OF HAIR. “Like the wick of a candle, the hair wicks sebum out,” explains Holly Sherrard, education director of the International Dermal Institute in Toronto. “When there’s a lack of hair there, the sebum tends to stay in the follicle.”
2. DEAD SKIN CELL BUILDUP. This buildup can block pores and trap the sebum inside. “People with a predisposition to acne can have four to five times as many dead skin cells building up on their skin,” says Sherrard.
3. THE SEBUM FACTOR. Either sebum is stickier and thicker than normal, or more sebum is being produced than the pore can excrete.
4. BACTERIA. Propionibacterium acnes require no oxygen to thrive. “So when you have a plug on the surface of the skin, the bacteria have a party and break down the sebum,” explains Sherrard. “The bacteria eat a certain portion of the sebum and leave behind fatty acids. The fatty acids cause inflammation.”
This type of acne appears on the skin as blackheads or whiteheads (also referred to as comedones) and occurs when sebum and dead skin cells block the follicle. Blackheads are open comedones in which the trapped sebum and cells reach the skin’s surface. In whiteheads, the trapped sebum and cells are below the surface.
This is often triggered by the acne bacteria Propionibacterium acnes. Inflammatory acne appears as red lesions and/or pimples (papules and pustules). In more severe cases inflammatory acne appears as nodules and cysts (also known as cystic acne), which lie underneath the skin.
Milia are small round pockets formed by dead skin cells trapped just under the skin. They can be light in appearance.
YOU ARE NOT ALONE
25 per cent of men and 50 per cent of women experience an occasional facial acne breakout, and one-third of these adults experience acne on the body, usually on the back or chest.
“It’s because of the many ways that acne can occur,” explains Dr. Adam J. Mamelak, MD, FRCPC, DABD, of the Meridia Medical Group in Toronto. “We expect acne to happen to a teenager, but when you’re an adult and you’re breaking out, it’s a different phenomenon.”
Adult acne tends to appear not as blackheads and whiteheads, but as tiny papules and pustules, “the red marks that don’t really result in anything,” adds Sherrard. Due to the loss of resilience in adult skin, it takes longer for the acne to heal.
“What people have to remember is that acne is a way for the body to tell you that something isn’t balanced,” explains Eva Lahman, president of Exel Professional Line Canada. “Everything from hormonal issues to eating habits may trigger acne. There is no single food that causes acne, but a poor diet is a cause.”
“Adult acne is thought to be multi-factorial, but one of the biggest causes is using anti-aging products that are too rich,” adds Toronto-based Dr. Lisa Kellett, MD, FRCPC, DABD. If you can still feel or see moisturizer on the surface of your skin long after you’ve finished applying it, you could be using too much or the wrong type. But she also cites dehydrated skin as another common acne cause, so never skip moisturizer altogether and always stay hydrated by drinking plenty of water and cutting back on alcohol and salty, processed foods.
Stress is also an acne cause, whether due to an important upcoming event or a hectic lifestyle. “With the influence of stress, women and men produce a more aggressive form of testosterone, which can cause a stickier, thicker sebum,” says Sherrard.
All experts agree that self-diagnosing and coming up with your own acne treatment may make your condition worse. Leave it to the professionals to determine what’s causing your acne and the best method(s) of treatment.
Accutane. This medication contains a vitamin A derivative called isotretinoin, which is a retinoid that reduces sebum production. Side effects include dryness of the skin, eyes and mouth, stomach upset and light headaches. “Accutane is not as successful in treating hormonal acne as other methods,” says Dr. Mamelak. Accutane should not be used if you are pregnant or planning to get pregnant. Speak with your doctor about alternatives.
TOPICAL RETINOIDS. These include Tretinoin, Adapaline and Tazarotene, which all work to unclog pores and clear the skin. All three products list skin irritation as a side-effect, which can be offset by using hydrating products recommended by your doctor. Tazarotene, like Accutane, should not be taken by women who are pregnant or trying to get pregnant.
ORAL ANTIBIOTICS. These antibiotics, such as Tetracycline, reduce the amount of acne bacteria in the skin, which reduces inflammation. Before taking any medication, always discuss any other prescriptions you may be taking, or any other conditions you have, with your doctor. AS SE EN IN
OBAGI CLENZIDERM™ This prescribed skin-care system includes products that contain a solubilized form of 5% benzoyl peroxide, which allows the medication to get down into the follicle to clear out acne bacteria.
HORMONAL THERAPY. Birth control pills can be used to moderate a woman’s androgen levels, which is good news for acne sufferers, because androgens can trigger excessive sebum production. Hormonal therapy is usually prescribed when acne flare-ups consistently appear during menstruation or when other acne treatments haven’t had the desired effect. Hormone therapy is not recommended for women who smoke, are over the age of 35 or suffer from certain medical conditions such as high blood pressure or heart disease.
“Look for products that specifically treat adult acne, not infomercial-based products for all ages. Adults with acne have specific skin care requirements,” advises Dr. Kellett.
DERMALOGICA’S MEDIBAC CLEANING™ ADULT ACNE KIT:
Salicylic acid exfoliates and reduces acne formation.
CLINIQUE ACNE SOLUTIONS CLEAR SKIN SYSTEM:
Contains salicylic acid, plus gentle moisturizers that soothe skin.
YOUR SKIN-CARE REGIMEN
“When you treat the face as one area, that’s where mistakes start to happen,” says Sherrard. She strongly suggests adults use acne-fighting products on only the parts of the face and body that actually have the acne to avoid excess dehydration. You can also fight acne by encouraging healthy skin. “I recommend a regimen that keeps the skin hydrated and protected,” explains Dr. Mamelak. “I call it the Three Rs: reflect, restore, rebuild. Reflect means wear sunscreen. Restore means use an antioxidant and moisturizer. Rebuild means use products and treatments to rebuild the skin’s collagen.”
OTHER ACNE TREATMENTS
PEELS. A chemical peel uses a chemical solution to remove the outer layers of the skin to help control acne, rejuvenate the skin and reduce the appearance of scarring. Always seek the advice of a professional to determine the type and strength of chemical peel that’s right for your skin. Choices range from mild peels (with alphahydroxy acids (AHAs) such as glycolic acid, lactic acid or fruit-based acids) and moderate peels (with trichloroacetic acid (TCA)), to strong peels (with Phenol).
“Your esthetician or dermatologist should be asking you questions about your skin’s sensitivity, the type of products you use, even if you plan on travelling or have just come back from a holiday in a dry, sunny or humid destination,” says Lahman. Moderate and strong peels are always performed by dermatologists. Depending on the patient and the type/strength of the peel, a spot test may be done to ensure its effectiveness.
MICRODERMABRASION. This noninvasive exfoliation process promotes collagen production and, by shedding dead skin cells, allows topical acne products to get deep into the skin. Dr. Kellett recommends diamond peel microdermabrasion, which is a gentle, crystal-free process that allows patients to return to their normal activities after an appointment.
LASER TREATMENTS. Unlike peels and microdermabrasion, laser treatments allow skin-care professionals to zero-in on problem areas. These treatments are used for both diminishing acne breakouts and reducing the appearance of acne scars.
PHOTODYNAMIC THERAPY WITH LEVULAN. This non-invasive treatment uses a topical photosensitizing solution and light therapy to target specific areas affected by acne. “It is very effective and helps control acne and sebum production,” says Dr. Kellett.
FACIALS. Regular facials will encourage healthier skin and also help relax you, which can keep stress-induced acne at bay. Wondering why you’ve broken out after a facial? It could be that it’s been too long—or not long enough—since the last one. A change in a skin-care routine, even a healthier one, may reflect on the skin for a short amount of time.
EXTRACTIONS. Lahman urges readers not to perform their own extractions. “There are certain techniques to open and close the pores properly. Once a pore is open, it’s susceptible to bacteria,” she explains. So don’t pick, poke, pop, squeeze or scratch. Seriously. Don’t.
REMOVING ACNE SCARS Acne scars develop as a result of inflammatory acne, leaving behind either an increase or decrease in tissue. Hypertrophic or keloid scars are created by a buildup of collagen in the skin.
Decreased-tissue scars are more common and include several types. Icepick and box car scars are named after their shapes and can vary in depth. Rolling scars give the skin an undulating appearance due to the upper layer of skin tethering to subcutaneous tissue.
A number of acne treatment methods such as topical retinoids, peels, microdermabrasion and laser treatments can also be used to reduce the appearance of these scars. Again, have your skin care professional determine the best method for the type of scar you have and the length of time it’s been present. “The higher the level of scarring, the more aggressive the treatment needs to be. The more aggressive the treatment, the greater the amount of downtime,” explains Dr. Mamelak. “Think of it as steps up the ladder; each step higher has the capacity to increase the level of improvement.”
LEVEL 1: Topical products containing vitamin A derivatives or glycolic acid.
LEVEL 2: Chemical peels.
LEVEL 3: Microdermabrasion.
LEVEL 4: Laser treatments/resurfacing. “An excellent treatment is the ProFractional laser,” says Dr. Kellett. The system is well known for its ability to be used on all areas of the face and for most skin types.
LEVEL 5: Soft-tissue augmentation, which uses injectables such as collagen or subcutaneous fat to fill in areas of tissue loss, or steroid injections.
LEVEL 6: Subcision, a surgical procedure that breaks up the tissue comprising a deep-set scar to “raise” the surface of the skin.
LEVEL 7: Surgical excision involves removing the scar tissue and, if necessary, skin grafting.
“Acne is something that people struggle with their entire life,” says Dr. Mamelak. “The ideal scenario is to stop the acne to prevent more scars from occurring.” So while those spots or bumps may not disappear overnight, you can be assured that—with the help of professionals, products and treatments—your skin can enjoy a clear future.