ACNE AND SKINCARE – THE DO’S AND DON’TS

Dr Mathobela, a leading specialist dermatologist and OXY’s resident skincare expert

Acne is a chronic skin disorder that is caused by at least one of the following four factors – increased sebum production, follicular hyperkeratinization (leading to occlusion of the hair follicle), bacterial colonization and inflammation.

Another factor that has been found to play a major role in acne formation is an impaired barrier function of the skin. Frequently, in acne-affected skin, the barrier function is compromised. Consequently, it leads to changes in functional properties such as elevated sebum excretion, enlarged sebaceous glands and subclinical inflammation.

Further, external factors that contribute to acne include cosmetics, stress, tobacco, or exposure to ultraviolet. These factors are called acne exposome factors.

 

When managing acne, it is important to target the four main pathogenesis – follicular hyperkeratosis,
inflammation, sebum production and the skin microbiome, while maintaining an intact skin barrier.

Proper care for acne skins:

• plays a very important role in supporting the treatment, and
• in mild forms of acne, appropriate skincare may result in an improvement of lesions.

The basic skincare regime should focus mainly on cleansing, protecting, moisturising, and preventing:

• Skin cleansing in acne should remove excess sebum and minimise oiliness – an exfoliated epidermis therefore helping to open blocked hair follicles. Recommended cleansers for oily skins include micellar fluids, gel or foam preparations and soaps or bar cleansers with acidic pH (5.0–7.0).  Not everyone with acne has an oily skin and therefore individuals with dry and easily irritated skins should rather use cream or lotion-based cleansers. Basic soaps and alcohol containing toners which are irritant to skin should be avoided.  Cleansers containing sulphurs, benzoyl peroxide and glycolic acid should be considered based on tolerability.
• Moisturising creams and preparations for acne prone patients should be cosmetics that do not promote the development of comedones (non-comedogenic) and should be non-greasy. Cosmetics for acne prone skins should be based on gels and emulsions (containing silicone derivatives in their substrates) and not on oils.

Moisturisers should also support the skin’s barrier function and therefore ingredients such as ceramides, hyaluronic acid and niacinamides should be used. Moisturising is recommended even for patients with very oily skins as when the skin is not moisturised it will lead to an evenhigher production of oil. Studies have shown that adjuvant skincare (including moisturising)improved the skin’s barrier function and therefore improved adherence to topical retinoid treatment, significantly reducing acne severity.

 

• Acne prone skin should also be protected from the harmful effects of everyday pollution and harsh effects of ultraviolet exposure. Consider using products with antioxidants such as vitamin C, vitamin E and even niacinamide.

 

Sun protection every day, even on a cloudy day, is a must. Therefore, all acne affected individuals should use a broad-spectrum sunscreen daily, reapplying every 3 hours especially when outdoors. Sun exposure can aggravate acne and worsen the blemishes left behind by healed acne spots. It should be emphasised that a measure of approximately a teaspoon of sunscreen should be used with every application. Acne medications can also make the skin sun sensitive which makes the usage of sunscreen even more important.

 

• Prevention and treatment involve using products that contain active ingredients that can treat and prevent acne formation. This includes products containing benzoyl peroxide, salicylic acid, tea tree oil, niacinamide or retinols. Part of prevention also includes improving one’s diet and limiting foods that are known to aggravate acne and it is also advised to stop smoking and to limit stress as much as possible.

 

It is also important to remember that acne skin is easily prone to irritation:

• Over washing and scrubbing may worsen the inflammatory phase of acne.
• Products that dry one’s skin can promote an inflammatory condition, increase sebum secretion and hyperkeratosis of pilosebaceous unit.
• Creams, emulsions, and solutions with a-hydroxy acids (e.g., glycolic acid) or b-hydroxy acids (e.g., salicylic acid) display keratolytic (peeling) activity and help to control sebum secretion and, to a lower extent. also inhibit the secretion of sebum.