Acne & Blemish Conditions

Acne forms from trapped sebum (oil) in a pore. Once the pore is clogged by overlying skin cells, the acne cycle begins, which is a complicated process involving oil secretion, bacteria entrapment, and inflammation. Once sebum becomes trapped, bacteria beings to digest the oil, increasing the amount of inflammation and causing a pimple to become more irritated. If acne pimples get too large, or too deep in the skin, they can develop cysts and nodules, which may result in scarring.

Millions of people in Canada have acne. Acne is most common in people 13-30 years old, however, acne can appear at almost any age. Even people in their 40s and 50s can develop acne. It is estimated that 80% of people will have acne at some point in their life. People of every race and skin colour get acne. Fortunately, acne tends to improve as people age. Acne is the most common skin disease, and effective acne treatments are available in Ottawa for people with acne, pimples, and acne scars.

Acne is most common in areas where there are a high number of oil glands. Not surprisingly the face is the most common area where acne occurs. However, many people get acne on their back and chest as well. Rarely, acne can appear on other areas of the body.

There are different types of pimples and blemishes.

The most common are types of acne spots are:

• Whiteheads – These are pimples that are under the skin’s surface, and appear as a small, round white bump. Whiteheads are also called closed comedones.
• Blackheads – These are darker coloured pimples that stay under the surface of the skin. Blackheads are also called open comedones.
• Papules – These acne pimples are small, round and pink. Papules can be tender to the touch.
• Pustules – These types of pimples are inflamed, tender, and have pus. They tend to be larger than papules.
• Nodules – Nodules are large, tender, solid pimples that are deeper than papules or pustules. They are often tender.
• Cysts – Cysts are tender, deep acne pimples that can cause scarring if left untreated.

Acne is a complex process that is triggered by many factors. There is not a single reason that acne occurs. Some of the factors that can cause or worsen acne include;

Hormones – Male hormones (testosterone) can worsen acne. Testosterone and other male hormones increase sebum (oil) production, which can worsen inflammation. Many women also notice that acne may worsen with at certain times of their menstrual cycle or during pregnancy when hormones fluctuate.

Genetics – Unfortunately acne runs in families, and having parents or siblings with acne increases your chances of having acne. It is estimated that about 50% of people with acne have a family member who has had acne as well.

Cosmetic Products & Mechanical Factors – Certain makeups and cosmetic products can clog up oil glands, leading to an increase in pimples. Make sure to use non-comedogenic (non-pimple forming) make-up, sunscreen, and other cosmetic products. Similarly, obstruction of skin follicles and pores with helmets, headbands, or chin-straps can also clog pores, and worsen acne.

Bacteria – A specific bacteria found on our skin called P. acnes is a known contributor to acne. P. acnes is found normally on our skin, however, the exact role of this bacteria in acne is unclear. Many treatments are directed to decreasing the amount of P. acnes on the skin, which can help with inflammation and pimple formation.

Stress – There appears to be a link between stress and acne. Further studies are needed to confirm this link, however, it appears that lowering your stress may improve your acne.

Medications – Certain prescription medications can worsen acne. Speak to your physician to see if medications you are taking may be impacting your acne.

Diet – The link between diet and acne has been debated for decades. Most recently, studies have demonstrated a link between high-glycemic foods (i.e. white bread, high sugar foods) and acne formation. Eating a healthy and balanced diet may improve acne.

There are a few things you can do to prevent acne. Using make-up, sunscreen, and cosmetic products that are non-pimple forming is the first step. Cleaning your face with a gentle cleaner, and not scrubbing or irritating your skin is also important. Avoiding high-glycemic foods may also improve acne. However, many factors of acne are not controllable, and this is where treatments are most valuable. When small pimples do form, avoid scrubbing or popping them, which may make inflammation worse.

Many acne treatments are available in Ottawa for people with very mild to severe acne and acne scarring. Initial treatment begins with optimal skin care. Using the proper cleanser, moisturizer and sunscreen is the first step to controlling acne. When a pimple does occur, avoiding scrubbing, irritating, or picking the pimple can help it resolve faster.

Non-Prescription Treatments – Many patients initially use to ‘over the counter’ or nonprescription acne treatments. Common non-prescription creams containing benzoyl peroxide and salicylic acid help to decrease inflammation and can help prevent some acne pimples from forming. However, over the counter treatments are not effective in treating more moderate or severe acne.

Prescription Creams & Gels – Prescription topical treatments such as those containing vitamin A derivatives or retinoids are considered as a first step in treating more moderate cases of acne. Retinoids such as Retin-A® (tretinoin), Differin® (adapalene), and Tazorac® (tazarotene) work by making way for new skin cells underneath older skin cells. This helps to prevent pores from plugging and pimples from forming. Retinoids also have anti-aging properties, helping to minimize fine lines and certain dark spots. Retinoids are often combined with topical antibiotics such as clindamycin and anti-inflammatory creams such as benzoyl peroxide for added benefit. Topical treatments are applied either once or twice per day depending on the medications used and are often continued for months. Side effects can occur, and it is important to discuss these with your prescribing physician prior to starting treatment.

BLU-U® Light & Photodynamic Therapy – BLU-U® Light and photodynamic therapy can be used to decrease bacteria (P. acnes) on the skin’s surface as well as to help shrink the sebaceous glands, decreasing the amount of sebum (oil) produced. Most people require 2-10 treatments to obtain results. Treatments are usually performed 1-2 times per week, and take anywhere from 15-60 minutes. BLU-U® can be used without medications making it an excellent option for patients of any age with mild acne who would like to avoid medications or topical treatments.

Oral Antibiotics – Oral antibiotics such as tetracycline and doxycycline can be used for more severe cases of acne. These oral antibiotics work by decreasing the amount of inflammation in the skin, therefore helping to decrease the number and severity of pimples. Oral antibiotics are often combined with topical treatments to increase effectiveness, as well as to help decrease the risk of bacterial resistance. Oral antibiotics are often taken once or twice per day depending on the medications used. Side effects can occur, and it is important to discuss these with your prescribing physician prior to starting treatment.

Isotretinoin (Accutane®)– Accutane® and other similar medications such as Epuris® and Clarus® are considered the most effective treatment of severe acne or in individuals who have significant acne with scarring. Isotretinoin is effective in patients with deep cystic or nodular acne, where topical treatments are usually ineffective. Serious side effects can occur with isotretinoin and it is important to discuss these with your prescribing physician.

Acne scarring occurs from prolonged inflammation, usually in deeper pimples such as nodules or cysts. Acne scarring is also more common in severe cases of acne. The acne scar is due to abnormal collagen formation in and around the pore. Acne scarring can often be permanent, however, there are treatments available in Ottawa to improve acne scarring.

The first step is to prevent new pimples from forming and treating current acne. Once acne is under control, the focus can be directed to treating acne scarring. There are many treatment options for acne scarring. Laser and energy-based devices, such as non-ablative, fractional lasers can be beneficial in helping to remodel abnormal collagen and can improve the appearance of acne scarring with minimal downtime.

Platelet-rich plasma (PRP) can be used along with micro-needling to further help the appearance of acne scarring. For more severe, depressed scars, occasionally minor surgery is needed to remove the scar.