The Skin Centre offers the most effective treatment of acne and acne scarring. To ensure you receive the earliest possible appointment time, we now run a dedicated acne clinic, serviced by Dr Robert Stable in conjunction with leading  Dermatologist,  Dr Michael Freeman.

Acne is a spectrum condition, where cases can be anywhere from mild to severe.  There are many different treatments for these issues as everybody has different needs. This is why we conduct individual assessments to provide you with the best possible treatment.

Acne (acne vulgaris) is a condition caused by blockages within the follicular (hair) canal of the skin. Bacteria can grow in the trapped oil in the glands and break down into substances called free fatty acids that irritate your skin. This gives you whiteheads, blackheads, red bumps, yellow pus-filled spots or deep cysts.

While it’s very tempting, remember, never squeeze or pick acne as this can induce scarring.

Acne is very common (and normal) in teenagers and more so in some families. In general, diet is not a cause of acne, however a low GI diet will be beneficial in treating acne.

Acne is commonly separated into inflammatory and non-inflammatory types. There are a number of different sub types:

 
Noninflammatory
  • Closed comedone

  • Open comedone

 
Inflammatory
  • Papular

  • Pustular

  • Cystic/Nodular

 

Cases are categorised as mild, moderate or severe based on lesion count, scarring, ongoing purulent discharge or sinus tract formation.

Cause

Normally in your skin you have a gland called the sebaceous gland that produces sebum, which is excreted into the hair follicle shaft within your skin. In adolescence (puberty) increasing androgen production (hormones) causes an increase in the size of these ducts, sebum production and an increase in keratin production (hard skin layer produced by skin cells).

The sebum, when contaminated with the bacteria P.acnes, alters the shedding keratin within the follicle and causes a plug and therefore a blockage, this plug is known as a comedone.

Initially this is a micro comedone, however as the plug enlarges without enlarging the follicle or pore opening to the skin, a white papule (lump less than 5mm in size) can be seen on the skin. This is known as a closed comedone. If this closed comedone continues to enlarge it can rupture through the follicle releasing all the material into the skin causing an inflammatory reaction resulting in the pustules commonly associated with acne. The plug may reform and rupture repeatedly leading to severe scarring cystic acne. 

On the other hand, if the plug enlarges but also dilates the follicle/pore opening to the skin then an open comedone is formed, also know as a blackhead.

 

Treatment

The aim of treating acne is to break the chain of events that leads to the inflammation stage. Depending on the severity of your condition, the treatment of acne has different starting points.

Generally speaking they aim to target one or a combination of the triggers mentioned before: 

  • Control Androgen production (Androgen is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors).

  • Eliminate P.acnes bacteria from the skin (P. acnes bacteria live deep within follicles and pores, away from the surface of the skin).

  • Control the keratin production (Keratin is a family of fibrous structural proteins and is the key structural material making up the outer layer of human skin).

  • Minimise blockages to the pore/follicle opening. 

Once the level of inflammation has settled, treatments are often tapered until a minimal dose is required. Treatment of any scarring as the result of acne can be considered after all the inflammation has settled. 

A common approach to acne starts with regular cleansing, plus either/or a combination of benzoyl peroxide (found in Proactive and Epiduo) and antibiotics (usually Erythromycin ethylsuccinate). Other topical treatments can also be added at this stage to gain extra improvement and improve the effect. Non-greasy lubricants and water-based cosmetics are ideal for those patients who wish to use makeup. If you have acne, you should avoid cream-based cleansing agents. 

If you have trialled an over-the-counter treatment for acne, and are not seeing results, then a prescription of a topical retinoid often combined with benzyl peroxide would be the next step. The addition of topical or oral antibiotics will also lead to additional improvements.

For female patients, the oral contraceptive pill can be used to regulate the hormonal imbalance and control the mechanisms triggering acne within the pore. For female patients who progress to oral retinoids (roaccutane) an oral contraceptive pill and a second line of contraception must be implemented prior to commencing treatment. 

Side Effects

For severe acne, isotretinoin is usually the next step, which is an oral retinoid drug. Being one of the strongest medications for acne means that it has a higher likelihood of side effects and there are some important factors to be aware of. These are listed below. 

Side effects almost everybody gets:
  • Dry skin, particularly lips

  • Sensitive skin to sun (burn easier) 

Less common side effects:
  • Liver abnormalities (elevated plasma triglyceride levels) 

Rare and serious side effects:
  • Birth defects (only if pregnant while on the medication) 

  • Mood changes, including depression psychosis (seeing and hearing things) and rarely, suicidal ideation.

  • In rare cases it can trigger inflammatory bowel disease. 

*The above side effect list is a guide only, for more information please refer to the full product information leaflet included with your medication, or consult your healthcare professional.

Treatments Offered

Below is a list of common treatments of acne that we offer at The Skin Centre:
  • Cleansers

  • Topical or oral antibiotics

  • Topical or oral retinoids

  • Red light therapy

  • Pulse dye laser

  • PDT

  • Microdermabrasion

  • Roaccutane (accutane)

  • Dermaroller (at-home hand tools sold here)

Acne Scarring 

At the Skin Centre, we also offer treatments for the removal of acne scarring. This can be done through a diverse range of techniques from laser through to diamond abrasion. Below is a list of the treatments we offer for acne scarring:

  • Fractionated CO2 or Erbium laser

  • Regrowing the skin for depressed scarring

  • Pulsed dye laser for the redness

  • Focal Chemical Peels

  • Diamond abrasion.

Fact Sheets