Acne is one of the most common skin conditions in the world, affecting 85% of Australians aged 15-24. In this article, we dive into the causes of acne and the best ingredients and treatments to treat each type of acne.

Acne Causing Pathways

Acne is a chronic inflammatory disease and can be range from clogged pores called ‘comedones’, which can be open (blackheads) or closed (whiteheads), papules (small red bumps on the skin) and pustules (like papules but filled with pus), to very large, painful, inflamed, and swollen nodules and cysts (‘blind pimples’).

Redness and pain, as well as post-inflammatory hyperpigmentation (PIH) and scarring, are also commonly reported symptoms. It doesn’t only occur on the face – it can appear on the chest and back (and sometimes upper arms) as a result of these areas containing a multitude of sebaceous glands.

Those of us who have ever had acne produce excess oil (sebum) and the skin cells lining their pores don’t shed properly, instead of collecting in the pore. The sticky skin cells and oil mix together along the length of the pore, creating a microscopic blockage called a microcomedone.

Acne bacteria (Cutibacterium acnes, which used to be called Propionibacterium acnes) feed on sebum, gathering and multiplying in large numbers around the oily plug, which signals to the body that it should start producing chemicals that result in inflammation.

The inflamed plug gradually enlarges to form visible comedones. In some instances, the comedone can burst, resulting in the bacteria and pus leaking out onto the surrounding tissue, creating even more inflammation, and causing other acne lesions like papules, pustules, nodules, and cysts.

Acne Treatments

There are many over-the-counter (OTC) cleansers and treatments aimed at unclogging pores (salicylic acid, glycolic acid) and killing bacteria (benzoyl peroxide, which also has a pore unclogging effect). These don’t fully target all the factors that cause acne – oil, sticky skin cells, bacteria, and inflammation.

This is where telehealth providers, like Qr8 MediSkin, come in, and their doctors can customise the best acne treatment in Australia for your skin – one that targets all the acne-causing pathways to help you manage acne (and post-inflammatory hyperpigmentation at the same time). Why is it truly the best? Because their clinically compounded acne treatments are blended for your skin’s needs and uniqueness! After an online video consultation with a doctor, your treatment is delivered to your door – their Skincare Support Team is on-hand to guide you through your treatment.

They use a number of acne-fighting active ingredients that can be formulated into a bespoke treatment cream base or serum:

AZELAIC ACID

A naturally-occurring acid derived from rye, wheat, and barley, azelaic acid acts as an antioxidant, anti-inflammatory, anti-bacterial, and depigmenting agent. The anti-inflammatory action of azelaic acid, combined with its antibacterial and pore unblocking functions, makes it a great treatment for mild to moderate acne, especially when combined with a prescription retinoid.

NIACINAMIDE

Niacinamide (also called Vitamin B3) has anti-inflammatory, skin barrier lipid regulating, sebum-regulating, depigmenting, antimicrobial, and photo-protective effects.

TAZAROTENE

A third-generation topical vitamin A analog, tazarotene produces similar effects to tretinoin, but it only binds to specific nuclear retinoic acid receptors (RARs). This means that tazarotene decreases acne papules and open comedones (blackheads) at a more rapid rate than tretinoin.

TRETINOIN

The most bioactive form of topical vitamin A, tretinoin is known to encourage and normalize skin cell turnover. A quicker cell turnover opens your pores, releasing trapped bacteria or irritants that are causing your acne. It also helps your skin regulate its natural oil (sebum) production, which can prevent future breakouts. They also have anti-inflammatory properties, which clear up active acne pustules.

RETINOIDS

Retinoids are derivatives of vitamin A. They can be applied topically on the skin or taken orally. Retinoid creams and gels are very effective at unblocking pores and preventing new blockages from developing.

Blackheads and whiteheads

To unclog your pores, we recommend using a topical retinoid. Over-the-counter retinoids and adapalene are available without a prescription. Use a benzoyl peroxide wash to help get rid of the excess Cutibacterium acne on your skin. Salicylic acid is another secret weapon in your acne-fighting arsenal: it is a beta-hydroxy acid that removes excess oil and exfoliates dead cells from the skin’s surface to keep pores clear.

For hard to clear up blackheads and whiteheads, you may need to wait from six to eight weeks to see an improvement. If there is no improvement, we suggest you visit a dermatologist to be prescribed a clinical-strength treatment.

Papules and pustules

Your best bet is a combination of benzoyl peroxide and salicylic acid that kills acne-causing bacteria and reduces inflammation. However, don’t forget to moisturize, as benzoyl peroxide can seriously dry out your skin.

As these types are more closely related to bacteria than your hormones or a lack of exfoliation. Inflammatory acne types really respond to antibiotics, either topical or oral.

Hormonal acne

This type of acne is generally found along your chin and jaw rather than on your T-zone, making an appearance around the same time each month. It can present a mix of cystic pimples and pustules. If your monthly breakouts leave behind PIH or consist of more than one or two pimples, it’s time to see a doctor or dermatologist.

Cystic acne

Due to the severity of cystic acne, over-the-counter (OTC) acne treatments aren’t strong enough. You’ll need to see a dermatologist or doctor for the following prescription medications:

Isotretinoin (Accutane): A powerful prescription medication that sees around 85% of people who take it experience improvements within four to six months. It is taken in pill form daily.

Oral antibiotics: These should only be used if the cystic acne covers a large area of your skin. However, they should only be used in the short term, due to concerns over bacterial resistance.

Topical retinoids: A clinical-strength retinoid is one of the best cystic acne treatments available. When used daily it unplugs hair follicles to remove and prevent severe acne.