Acne Update

June is acne awareness month. It’s a good time to revisit how you are caring for your acne prone skin. Acne is a skin condition that has been experienced by countless people with also seemingly countless approaches as to how to treat it.

Acne was once thought of as something you just had to dry up, but harsh detergent based cleansers (often containing sodium lauryl sulfate) have been found to only exacerbate this condition. It’s time to consider a holistic approach to acne, which not only treats the acne but also improves overall skin health.

What is acne?

Acne is an inherited disorder of the pores in our skin. Acne-prone skin sheds five times more dead skin cells than normal skin. This results in cell retention in the pores which is called hyperkeratosis. These skin cells (keratinocytes) mix with the excess oil that is commonly produced by acne-prone skin. The interaction creates a sticky kind of consistency that is difficult for the skin to purge properly. The abnormal shedding and sticky sebum ultimately leads to the formation of microcomedones.

When the opening of the pore is blocked by sticky sebum it often oxidizes from contact with air. The oxidized sebum turns dark forming a blackhead. When the pore opening is blocked by keratinocytes (skin cells) oil and dead cells back up behind that layer of dead skin. The oil does not turn black because air hasn't touched the sebum to oxidize it and make it turn black. This kind of clogged pore forms a closed comedo, milia, or whitehead. Both open and closed comedones are considered non-inflammatory acne.

Acne becomes inflamed when bacteria inside the pore feeds off the oil and dead cells. Inflammation occurs when the immune system perceives this as an attack and goes on the defensive, bringing in white blood cells to the area to fight the bacteria. Tiny capillaries called arterioles expand to allow the larger white blood cells to pass into the area. This is when you see redness and feel pain. These lesions are called a papules. When the dead cells and dead bacteria rise to the surface it creates a pustule. When all this happens in deeper layers of the skin a cyst can form. Papules, pustules and cysts are considered inflamed acne. Papules should not be extracted as the infection can spread to surrounding areas.

To exfoliate and clear the pores try ingredients that have a proven track record like salicylic acid which is both oil soluble and antibacterial. Make use of other anti inflammatory ingredients like licorice root which is a calming antioxidant. This can be great as a spot treatment. Salicylic based masques combined with licorice root are perfect for particularly vulnerable areas, especially when used prophylactically. I choose salicylic acid over other acne treatment ingredients (like benzoyl peroxide) because salicylic acid is gentler and less irritating for the skin types. When dead cells and bacteria form a pustule, now is the time to have your esthetician do some extractions. At home you can help this process along with a mild drying lotion that is used as a spot treatment for pustules.

Some skin types have weaker capillary walls which leak bacteria and inflammatory cytokines to surrounding tissues, thus increasing the likelihood of more inflamed blemishes. This can also be true for fragile cell walls that line the sebaceous gland, where a break in the wall results in a leakage of oil and bacteria. Some skins are hypersensitive which causes excessive inflammation. These skins may have androgens in their sebum which are even more pro-inflammatory, specifically a type of testosterone called Dihydrotestosterone (DHT). This reminds us that the causes of inflammatory acne are more than just what is going on on the surface of your skin. We must take a holistic approach when trying to treat the problem of acne.

Avoid a one size fits all acne approach. Most acne skincare routines focus on drying up the oil. It doesn’t consider skin sensitivity or the likelihood to become inflamed. Using a scrub on sensitive problem skin may lead to more breakouts, although particles that are specifically designed to be perfectly smooth, small and gentle can sometimes be an exception. If there is sensitivity and inflammation you need to deal with the inflammation first! Inflamed acne appears just how it sounds: as red or pus filled lesions that are often painful. Deeper inflamed nodules may require a dermatologists help. Non-inflamed comedones need to be softened before they are extracted. Closed comedones need a pathway for the oil to escape before cleaning. Your esthetician can be very helpful in recommending treatments and homecare that will soften clogged pores instead of hardening the skin's surface, causing sebum and dead cells to back up in the pores. This is a time where professional help from an esthetician to do extractions can be especially effective. The point being that a good esthetician knows how and what should be extracted. Beneficial treatments include: Peels (which one depends on your skin type), Desincrustation (a solution to soften oil), Steam (which hel