Acne is said to effect over 80% of all people at some time in their lives but it is still one of the least researched conditions in medicine. There is very little fundamental clinical research being done into acne anywhere in the world, even to this day.

As a doctor with a special interest in acne for over twenty years, I have seen patients whose lives are totally run not by their family or their career but by how their skin looks. When their skin is relatively clear, they can exist but when their skin is breaking out, they are anti-social, depressed and often very angry with everyone and anything.

I see teenage boys especially, who cannot look me in the eye as I try to help them understand their condition. The anger in their voice and mannerisms is a window to the internal torment caused by their acne skin.

So what causes this common but sometimes devastating skin problem? The true fundamental cause is not yet known but the one thing in common to all acne patients is blockage of the opening of a hair follicle, commonly referred to as the pore. It is not uncommon for people to believe that a pore is a ventilation hole in the skin or the opening of a sweat gland but in truth, it is the opening of a hair follicle where no hair is actually growing.

Each hair follicle has an oil or sebaceous gland attached to the side of the follicle. Think of follicles as being like narrow necked flowerpots and the actual hair as being the flower. Most flowerpots are empty but all have an oil gland. For the oil to get to the surface of the skin it must first go into the hair follicle and then work its way to the surface. Anything which blocks the outflow of sebum from the hair follicle will result in a build up of sebum.

This is the confusing part. This build up of sebum results in the creation of a comedo (whitehead or blackhead) but in many people that is all that happens. In others, the whiteheads become infected, red and swollen and may go on to form pustules, commonly called zits. The mechanism which converts a whitehead to a red, tender lump is still unclear.

However, we do know that the main ingredients of the blockage are dead skin cells and oils plus makeup and we do have techniques which can deal with these problems. The dead skin cells come from both the inside of the hair follicle and from the surface. That is the reason why it is best to wear hair off the face, as dead cells falling off the hair tend to enter the pore and add to the blockage. The main techniques to deal with the dead skin cells are the use of products which help remove the dead skin cells.

At Australian Skin Clinics, we developed a product that is a very special exfoliating scrub. The scrub contains fruit acids which soften the glue that holds the dead skin cells together but also very fine nylon beads which are so gentle the product can be used every day. By combining both a gentle mechanical exfoliator with a chemical exfoliator we have been able to achieve much more efficient removal of dead skin cells with no skin irritation.

Once the gentle exfoliation is performed we are able to get other products to penetrate more easily into the hair follicle and further reduce the pore blockage. We use both prescription strength products but also a clear skin gel which we developed to help with both acne clients but also as an anti-aging product.

The other ingredient in the problem is oil. Most of the oil comes from the oil (sebaceous) gland. The only force driving the oil gland is hormones – specifically male hormones which explains why men tend to get more severe acne than women. Women with acne do not have more male hormones than normal but their oil glands seem to be more sensitive.

Hormone levels are controlled by the pituitary gland in the brain, which in turn is controlled by the hypothalamus. The hypothalamus is the centre of emotion in the brain, which explains why acne seems to get worse when we are stressed. I still have clients tell me that they were told to put oil on their skin so that their oil glands would be less active. This is absolute unscientific nonsense. For this type of treatment to be effective, it would mean that the body had some method of measuring the degree of oiliness in the skin. There are no known sensors of skin oiliness so this technique not only does not work but it also makes the acne worse.

Reducing oil production in males is difficult other than by using the controversial medication Roaccutane. In females it is possible to reduce the effect of male hormones with two products both of which require a prescription. Cyproterone acetate, a common ingredient in some birth control pills and spirinolactone, a special type of fluid tablet, have both been found to be beneficial in female acne patients.

Makeup is a major ingredient in causing acne. For many years I tried to get my clients to stop wearing makeup but five years ago I found the secret – use pigment based makeup not dye based. The colour in most makeup is dye based. Dyes are derived from petrolatum – the same thing that vaseloine is made from. It is extremely pore clogging even if in a water base. Pigment based makeup such as Jane Iredale and Glo Minerals use products such as iron oxide for colour. These do not penetrate into the hair follicle but rather sit on the surface of the skin. They have very good anti red concealing properties, don’t tend to run with perspiration and have sun protecting properties but most importantly, they do not aggravate acne.

We have been using Microdermabrasion as part of our acne program since 1996. With over 8000 treatments performed, we have no doubt this excellent technology is of great benefit to acne patients provided it is performed correctly. The operator needs to be shown the technique for treating acne patients and be willing to very patiently perform extractions in severely infected clients.

Use of blue light to treat acne is still very new. Some reports give very promising results whilst others suggest there is no benefit at all. Blue light is only effective in acne clients who have infection with a specific bacterium called P. Acne. This form of acne is probably only present in around 70% of patients.

Using a combination of fruit acid based skin care, topical and oral antibiotics, anti-clogging products and weekly Microdermabrasions we were able to get her skin completely settled down and she looked so beautiful on her wedding day. It gives me such joy to help lovely people like Julie. I have seen so many people whose lives have been nearly destroyed by this condition.

Acne is a disease of the skin which can be greatly improved or even completely cleared with appropriate treatment. It severely impacts on the lives of people who suffer from it. The program and products developed by Australian Skin Clinics are now widely used by Cosmetic Physicians throughout Australia and New Zealand.

Dr. D.J. Grose
Australian Skin Products
PO Box 525
Unit 3/8 Centre View Drive
BIGGERA WATERS 4216
Ph: 07 5537 8378
Fax: 07 5537 8278
email to: dr.grose@ozskin.com