Acne

Acne is the most common skin condition in the world. It is a medical condition, not a hygiene failure and not something people bring on themselves, and it is treatable.

Most people arriving at a clinic for acne have already tried several things that did not work. Usually the reason is that the treatment addressed one part of the problem while leaving the others running.

How acne actually forms

Four things happen together in an affected follicle:

Excess oil. The sebaceous gland produces more sebum, largely under hormonal influence.
Blocked follicle. Dead skin cells fail to shed normally and plug the opening of the follicle. The plug is what you see as a blackhead or whitehead.
Bacterial overgrowth. Cutibacterium acnes, normally present on skin, multiplies in the blocked, oil-rich follicle.
Inflammation. The follicle wall ruptures, releasing its contents into the surrounding dermis. The immune response to that is the redness, swelling and pus of an inflamed pimple.

A treatment that addresses only one of these four - an antibacterial wash, say, with nothing done about follicular blockage or oil production - commonly disappoints. Effective plans usually combine measures.

What drives it

Hormones - androgens increase oil production. This is why acne is common in adolescence, around the menstrual cycle, in pregnancy, in polycystic ovary syndrome and on some medications.
Genetics - a strong family pattern.
Medications - some make acne worse; tell your practitioner everything you take.
Occlusive products - heavy cosmetics, hair products and some sunscreens.
Friction and pressure - helmets, straps, masks, phone screens.
Stress, which reliably worsens existing acne.

Diet plays a role for some people, particularly high-glycaemic-load foods and, in some studies, dairy - but it is not the main driver for most, and blaming diet has probably caused more unnecessary guilt than improvement.

What acne is not

Not caused by being unclean. Over-washing and scrubbing make acne worse, not better.
Not only a teenage condition. Adult acne, particularly in women along the jawline and chin, is common.
Not something to be embarrassed about at a consultation - we see it constantly.

Assessment

Consultation establishes the type of acne (comedonal, inflammatory, nodular or cystic), its severity, its distribution, how long it has been present, what you have already tried, whether it is scarring, and whether there is a hormonal driver worth investigating.

Two things change the plan considerably: scarring, which makes earlier, more decisive treatment the right call, and nodulocystic acne, which usually needs prescription medical treatment rather than in-clinic skin treatments alone.

Treatments used at Me Clinic

Chemical peels - salicylic and other acids to clear follicular blockage
LED therapy - blue light targets acne bacteria; red light reduces inflammation
Photodynamic therapy and IPL and Laser Genesis - for inflammatory acne and associated redness
Microdermabrasion and epidermal levelling
Cortisone injections - to settle an individual inflamed cyst quickly
Cosmeceutical skincare, including retinoids and appropriate cleansers
Mineral make-up - non-comedogenic cover while treatment takes effect

Prescription treatment

Moderate and severe acne often needs prescription medication. Those are prescription-only medicines, so Australian law prevents us naming or promoting them in advertising to the public. They require a consultation with a doctor, who will assess whether they are appropriate, explain the risks and monitoring involved, and refer on where specialist management is needed. See prescription medication.

Timeframes

Acne treatment is slow. Most regimens take six to twelve weeks before a fair judgement can be made, and some cause an initial worsening before improvement. Stopping at four weeks because nothing has happened is the most common reason a workable plan gets abandoned.

Acne is also usually controlled rather than cured: maintenance treatment is normal, and stopping often means relapse.

Scarring

Inflammatory acne can leave permanent scars, and the deeper and longer-lasting the inflammation, the higher that risk. Two practical consequences: treat active acne properly rather than waiting it out, and do not squeeze or pick lesions. See acne scars.

The dark marks left after a pimple settles are usually post-inflammatory pigmentation rather than true scars, and those generally fade over months - faster with sun protection.

Risks

Dryness, peeling, redness and irritation from topical treatments
An initial flare before improvement
Increased sun sensitivity
Post-inflammatory pigmentation, more likely in darker skin types
Skin thinning, dimpling or pigment loss at a cortisone injection site
Blistering or burns from light-based treatment
Incomplete response, and relapse when treatment stops
Prescription medications carry their own risks, discussed at consultation

Tell your practitioner if you are pregnant, breastfeeding or planning a pregnancy - several acne treatments are unsafe in pregnancy. See risks and complications.

Cost

As at September 2024 and including GST, a skin assessment is $50 and a Cosmetic Doctor consultation is $150. Dermal skin treatments start from $130. A plan is quoted after assessment. Medical management of acne by a doctor may attract a Medicare rebate; in-clinic cosmetic treatments do not.

Booking

Me Clinic, 4 Burke Road, Malvern East VIC 3145. Phone 1300 852 050 or (03) 9569 3511, or use the online consultation form.

Individual results may vary. Any surgical or invasive procedure carries risks. Before proceeding you should seek a second opinion from an appropriately qualified health practitioner.