Types of acne and acne treatment

The cause of acne

During our transition from child to adulthood, we go through puberty. During puberty, our body synthesises and releases the sex steroid hormones (oestrogen/progesterone and testosterone). This affects our skin’s appearance. During our teenage years, the skin contains plenty of the proteins, elastin and collagen which give our skin its plumpness and elasticity. It is when our body produces fewer proteins that cause our skin to become more fragile and lose its fullness. While still supple and elastic, teenage skin thickens and becomes tougher, making it more resilient than paediatric skin.

All of these hormones work to develop our body to adulthood in stages. Testosterone is an androgen also known as male hormones but is present in both males and females. Androgen places an important role in boys for the development of reproductive organs and growth and maintaining muscle and bone strength in girls. However, the increased levels of Androgen during puberty triggers the enlargement of oil glands to make more sebum. Too much sebum production causes a plug to form when mixed with dead skin cells which cause acne.

What are the types of acne? Is adult acne different from adolescent acne?

For some of us, acne stops after puberty. However, many do experience adult acne beyond puberty and up to 40 years old. The triggers for adult and adolescent acne are similar.

1. Excessive sebum production

2. Clogged pores (from a mixture of sebum with dead skin cells)

3. Bacteria caused by poor hygiene

4. Inflammation

Adult acne can be caused by the following factors as well.

Hormones

Menstruation or pregnancy can influence your skin’s oil production.

Beauty products

Haircare, skincare products and makeup which are comedogenic can cause acne.

Stress

Stress may not be the direct cause of acne but it can act as a prompt. When we are stress, our adrenal glands stimulate sebaceous glands to secrete more sebum (oil).

Diet

Though many experts dispute that diet can cause acne, we strongly believe you are what you eat. We recommend lowering your sugar and dairy intake.

Medication

Though medication triggered acne is very rare, it does happen. Acne can be caused by medication such as corticosteroids, lithium, anticonvulsants, barbiturates, androgenic steroids, DHEA, and drugs that contain bromides or iodides. Whilst with regular acne, we tend to get a combination of acne types. With acne caused by medication, they are usually almost identical small red papules.

What are the different types of acne?

Non-inflammatory acne types (Whiteheads and Blackheads)

Whiteheads are small white or flesh coloured spots and are usually circular with red circle around it. The skin around the whiteheads may appear tight when whiteheads are raised. Whiteheads are also called closed comedones.

Blackheads are essentially whiteheads but open and have been exposed to air. Oxidation takes places when the plug exposes to air turning it black. Blackheads are also called open comedones.

Minor to mild forms (Papules and Pustules)

Papules are small lumps under the skin's surface. They are hard; can feel tender, looks pink, and often raised. You can generally observe the skin around a papule to be slightly swollen and red. They do not have a visible center nor the pores look widened. Papules are an inflammation of whitehead and blackheads caused by irritation to them.

Pustules are bigger lumps with a clear round center. This center contains white and yellow pus (of immune and bacterial cells), and the bumps often look angry red/ pinkish.

Pustules generally look like whiteheads but much larger and more inflamed.

Moderate to severe forms (Nodules and Cysts)

Nodules are inflamed lumps located deeper within the skin and are often solid and painful. They tend not to have a visible center and look like larger and deeper papules.

This type of acne occurs when clogged pores damage deeper skin tissues and cells.

Nodules are serious form of acne and can cause dark spots or scarring.

Cysts are filled with pus and are generally big and soft to the touch (on the surface). They are red or white lumps deep in the skin and can be painful.

Cysts are the most serious type of acne. They are deeper within the skin than nodules. Being so deep in the skin, they can leave bad scars.

So what can you do to treat different types of acne prone skin?

1. Use a gentle cleanser no more than twice a day.

2. The key is to keep your skin clean and using product anti-bacterial products / ingredients. I have listed some of the ingredients below which help with acne.

3. Use an oil-free moisturiser. Most people suffering from acne are nervous about moisturising fearing it can exacerbate acne further. However, it is crucial to hydrate skin so it does not over dry from using acne products.

4. Avoid makeup if you can. If you have to wear makeup, choose an oil-free formulation and check that ingredients are non-comedogenic* and non-acnegenic**.

5. Avoid touching your face and popping the acne.

6. Do not scrub your face. This may aggravates acne and makes it worse.

7. Wash your pillowcase at least once a week.

Please see a dermatologist if you have moderate to severe forms of acne. There are prescribed medication and treatments available and your dermatologist is best to advise.

I have listed ingredients which can help treat acne. Before you start your shopping spree, there will be terms you would come across.

“Non-comedogenic” or “Non-acnegenic” – what do they mean?

*Non-comedogenic means the product does not contain any ingredients which may clog pores.

**Non-acnegenic means that a product that has been formulated with ingredients that are less likely to cause acne or make it worse.

Both non-acnegenic and non-comedogenic refer to the ingredients and not the actual product/ formulation. Choosing a non-acnegenic and non-comedogenic product does not guarantee that it will not cause acne or clog pores. However, you are minimising the risk by using ingredients which will not clog pores or aggravate your acne. It can still cause your skin to breakout so observe your skin.

Stop products if you see an adverse reaction and consult a dermatologist.

Actives ingredients for treating acne: for non-inflammatory and minor-to-mild forms of acne:

And finally, there are treatments available for all different types of acne. With all the airbrushing, make up, lighting and retouching, it is very challenging to see anyone suffering from acne in the media. You may feel alone but there are many people out there suffering from acne.

Remember, acne does not define you as a person. It is part of your skin at this stage. It is a condition you can definitely treat it with using the right products and patience.

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