Ask ID: Acne

We asked Prof Niki Ralph:
Acne is a chronic inflammatory skin condition affecting 9.4% of the global population. Latest worldwide studies also show it is 1 of 3 skin conditions in the top 10 chronic conditions worldwide.

Acne, in its many forms, affects 85% of 12 - 24 yr olds. Unfortunately, it often continues into adulthood. In a recent study, 35% of women and 20% of men reported acne in their 30s and 26% of women and 12% of men in 40’s.

Teenagers often develop sudden onset acne over a period of weeks to months, whereas adults, especially females may have grumbling onset with intermittent breakouts, often linked to their menstrual cycle. This may be triggered for many reasons including stress, change of hormones - oral contraception, pregnancy or during the postpartum period.

Adults who suffer with acne may not always tolerate the same anti-acne therapies that teenagers use as they may be too drying on the skin, which leads to redness, irritation and often discontinuation of the products. It may even cause further breakouts. It is important to introduce products slowly rather than the addition of too many products all at once. Skin needs time to adapt to new products especially active ingredients such as retinoids. It takes approximately 21-28 days for a new top layer of skin (epidermis) to regenerate, therefore acne will not show signs of improvement immediately after starting a new skin care routine, in fact the skin may actually flare as it adapts.
The addition of too many AHA’s (alpha hydroxy acid such as lactic and glycolic acid) and BHA’s (beta hydroxy acids – such as salicyclic acid) as well as nightly retinoid will cause too much drying of the skin and lead to irritation and redness.

A regular skin care routine is vital and this may be used alongside prescription topical or oral therapies for the management of adult acne. Ensure make-up and SPF are oil-free, non-comedongenic (non-blackhead forming). Double cleansing at night ensures a deep cleanse of the skin to remove the build up of the oil, makeup, and debris which has gathered on the skin over the day. For adults I would start with a micellar water followed by a cream cleanser.

For very oily teenage skin a foaming or gel cleanser may be preferable. My go to products include @biologique_recherche_ireland Micellaire Biosensible followed by Lait U milky cream cleanser which removes oil but also hydrates the skin. Other suitable products for adults with acne, who find many products too drying include @larocheposay Toleriane Dermocleanser (for sensitive skin) or @cerave Hydrating cleanser.
Lotion P50 by Biologique Recherche has been a gamechanger for me with my acne prone skin. It is ideal for normal to oily skin. It works by gently exfoliating the skin, purifies pores, regulates oil production and re-balances the pH of the skin. This gentle blend of acids helps to shrink enlarged pores and remove and dissolve dead skin cells and impurities on daily basis. It is a daily chemical exfoliant rather than a physical exfoliant (microbeads) which can be quite harsh on the skin leading to excessive dryness and irritation.
The use of topical retinoids is ideal for those who have acne prone skin but also wish to address photoageing such as fine lines and wrinkles. They work by exfoliating the skin removing the dead skin cells therefore preventing formation of blackheads which can become inflamed and lead to formation of acne spots (papules and pustules). They should only be applied at night and a sunscreen must be worn in conjunction with the use of a retinoid. When introducing a retinoid one should start slowly with a pea-sized amount every 2-3nights, being careful to avoid the delicate skin around the eye and mouth. Ideally allow it to dry for 5-10 mins and then apply a moisturiser before bed, otherwise too much topical retinoid introduced too quickly will result in redness/irritation of the skin.
For adults suffering with deeper lesions such as inflammatory cystic lesions on the jawline/chin/neck they should seek medical advice from their GP or Dermatologist. That should also be the first port of call for anyone who feels their acne may be scarring the skin, as topical therapies will not be sufficient to treat scarring acne or deeper cystic/nodular lesions.