Acne has been a big part of my life, both professionally and personally, for many years. As a consultant dermatologist with over 10 years’ experience of caring for patients with skin disease, I see hundreds of patients a year with acne, ranging from tweens and teenagers to men and women in their 50s and 60s who have battled with their skin for years.
Being a fellow acne sufferer since I was 14, I have a real personal insight into this condition, which helps the way I approach my consultations. Acne is often a lifelong battle, with ages and stages of our lives determining its activity. Acne can have a significant impact on self-esteem, confidence and personal relationships, and even dermatologists are not exempt from this.
Over the years I have had patients commenting to me about my acne, questioning why my own skin is so bad, asking me if I can really be trusted to treat theirs. This has been difficult to swallow.
As a hormonally driven process, we know that acne has peaks and troughs at different times of our lives. Puberty, pregnancy and the menopause are notorious culprits for flare-ups. My own acne has been particularly bad through my two pregnancies (both boys) resulting in scarring, and at times of stress when studying for pivotal physician exams.
Medical management for women is often dictated by their family planning intentions, pregnancy and breastfeeding, and so having a good approach to self-management is particularly helpful for many patients.
Does diet affect my acne?
This is probably the most commonly asked question from patients. One study in the US found an increased incidence of acne in teenagers who drank low-fat milk compared with those who drank full-fat milk. No other study has demonstrated a conclusive link with dairy consumption, and I do not routinely recommend elimination of dairy from diets.
There is, however, more evidence to suggest that following a low-GI diet can be beneficial. High carbohydrate foods results in blood sugar spikes and the production of insulin, and IGF-1 (insulin growth factor 1). These in turn can increase oil production and promote the production of male hormones (androgens), which exacerbate acne. Making good carbohydrate choices like wholemeal bread rather than white, incorporating pulses and vegetables into your diet, and minimising sugar intake can be helpful for some patients.
What skincare should I use?
Skincare is an important aspect of acne management and often overlooked. It can be overwhelming to know which products to use and I generally aim to keep things simple for patients with oil-prone skin.
Morning: Cleaning the skin in the morning is recommended for all patients. You may wish to consider using an antioxidant serum in the morning, if skin ageing is a concern. Next apply a light moisturiser and sunscreen, either combined or separately. Try to build sunscreen into your everyday skincare routine, to prevent sun damage and premature ageing. An ultra-light sunscreen is recommended, rather than heavy products that can cause further breakouts and congestion.
Evening: For those who wear make-up, double cleansing at night, firstly with micellar water and then a cream cleanser is recommended
Avoiding facial oils and heavy creams is important as these will block pores. Instead look for products labelled as non-comedogenic. For those with very oily skin, a toner containing glycolic acid can assist with improving congestion. Next up are serums; these are products that contain active ingredients and are an important tool in acne management. Good ingredients to look for are niacinamide, retinol and retinyl palmitate.
I recommend exfoliating twice a week, ideally with a product containing alpha hydroxy acids and beta hydroxy acids, which will refine pores and enhance overall skin texture. Patients with oily skin do not usually require a moisturiser at night.
When should I see a GP or dermatologist?
If you are struggling with acne, either with the physical or emotional impact or both, please do make an appointment with your GP or see a dermatologist. Many patients will need to move onto prescribed medications, for example strong topical retinoids, oral antibiotics, the combined oral contraceptive pill, spironolactone or isotretinoin.
Acne is a medical condition and should not be accepted as the norm – lots can be done about it and we take it seriously. Seek professional help if you are battling this condition and not winning, at any age.
Dr Victoria Scott-Lang is a dermatologist at KM Surgical and Dermatology Associates, Christchurch.