Acne is one of the most annoying things that can happen to your skin, quite often it is very confusing to understand why you are getting acne, what products will help you alleviate your acne problem and also what you can do to decrease the occurrence of acne on your skin. In this article, we will explore different types of acne and pimples, why you might get acne and the skincare products and ingredients that can come to your rescue.

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Why do we get acne?

About 80% of adult acne is a continuation of acne that a person first started suffering as a teenager and for the rest 20% of the people, they had never experienced acne as a serious problem before and suddenly when they are in their 20’s, 30’s or 40’s they see it as a regular occurrence.

To understand the reason why you get acne, you need to first check for yourself, which part of your face do you get your acne. If it is the lower part of the face, i.e., area from the nose towards to your jawline and if the pimples are cystic and painful and if you get these around the same time, every month, then you are probably struggling with hormonal acne. Apart from hormonal reasons you can get acne due to your diet, stress, makeup, fragrance and use of chemical exfoliants too.  Let’s look closely at each of the reasons that cause acne.

Hormonal Imbalance

Hormonal imbalance is one of the major contributors to adult acne, especially in women. The imbalance caused by the fluctuation of hormones could be due to the fluctuation in hormones around her periods or when she is pregnant or during the delivery or breastfeeding the baby, during or after the menopause or can also be caused by the hormonal fluctuations caused by the use of birth control pills. This hormonal imbalance leads to the increased production of oil in the sebaceous glands of the skin, ultimately causing breakouts and painful and ugly looking acne.

Stress

Regular exposure to stress not only affects your body health but also your skin health. Stress releases a hormone called cortisol, which is our body’s built-in alarm system. Cortisol, which causes a fight or flight response in our body, signals the body to focus on just the basic functionality of our body and stop other functions of the body like immunity, thus regular exposure to cortisol weakens the immunity of our body and thus damages the skin barrier. A damaged skin barrier results in a dry skin and inflammation which ultimately causes breakouts and acne.

Additionally, The increased levels of cortisol caused by stress, also influence hormonal balance resulting in increased production of oil in the sebaceous glands and thus aggravating acne caused by damaged skin barrier.

The 3 P’s ( Polens, Pollutants and Personal care products)

Pollen is a very fine powder secreted from the flowers, grasses, plants and weeds is generally used to fertilize the same species is one of the most common causes of allergies. Though benign in nature for the human body, the presence of pollen is recognized as a harmful intruder by the human body and the immune system is triggered resulting in inflammation. The inflammation in turn causes redness and irritation resulting in and breakouts.

Skincare products and makeup also constitute one of the major factors for acne and breakouts. When not cleaned at the end of the day, skincare products, sunscreen, makeup not only are left sitting on your skin, they tend to rub off to pillows and bedsheets which then rot and then come in contact with your skin the next day causing skin infections and also breakouts and acne.

Some of the ingredients in skin care products can also cause acne, the common culprits being coconut oil, dyes used in skincare products, fragrances among others. Fragrances not only cause irritation, they can be sensitizing and also can act as vasodilators, dilating the blood vessels in your skin which lead to further redness on the skin triggering the immune system, further aggravating the acne.

Bad Diet

A bad diet can play an important role in the development of acne in our skin, fried foods, dairy products, refined sugar, whey protein and chocolate are found to trigger acne.

Too much exfoliation

These days we see people doing too much exfoliation, especially when you use AHA’s and BHA’s and use them too frequently or just use harsh cleansers or cleanse too many times, you tend to not only dry off the skin, resulting in excess secretion of sebaceous oil resulting in breakouts, it can also damage the skin barrier and hence aggravating the problem.

Different types of acne

What acne comes down to internally is the combination of inflammation and skin cell turnover. The 50% of the dust we see and don’t see is made up of dead skin cells and when this mixes with the sebaceous oil secreted in the sebaceous glands, it tends to block the pores, which is also accompanied by bacteria known as P. acnes. Our body sensing this will trigger the immune system, where it sends white blood cells to fight the bacteria, which finally results in a pimple.

Acne can generally be categorised into two groups

  • Inflammatory acne
  • Non-inflammatory acne

Non-inflammatory acne is generally referred to whiteheads and blackheads, while inflammatory acne is referred to papules, pustules, cysts and nodules. Unlike non-inflammatory acne, inflammatory acne can cause more permanent scarring or pitting on the skin.

Different types of Acne, Blackheads, Whiteheads, Papule, Pustule, Cyst and Nodules

Whiteheads 

Whitehead and blackheads both are formed by the concoction of dead skin cells, oil and bacteria. But whiteheads appear wheatish or flesh coloured spots and bumps, which are circular and can be easily punctured without causing much pain. The whiteheads are closed comedones, meaning they are not exposed to air.

Blackheads

Blackheads are similar to whiteheads, but what makes blackheads different from whiteheads is that these are open comedones, meaning they have an opening at the top, where the sebaceous oil is exposed to the air making it oxidised turning it black.

Papules

Papules are similar to whiteheads, except they are tender bumps with redness and swelling around the centre caused by inflammation

Pustules

Pustules are similar to papules, it is just they are bigger and have raised centres with pus.

Nodules

Nodules can look like flesh coloured lumps that are hard and painful often accompanied by red inflammation. Here the root and inflammation are extended deeper into the skin layers, which makes it all the more difficult to treat.

Cysts

Cysts are the type of acne, that is in a different league of their own, Cysts have roots and inflammation so deep into the skin layers, they have a membrane that covers the inner surface like a womb. Cysts can stay on your skin for years and in order to remove them, a dermatologist has to cut into them to remove the lining and extract it from its roots.

How to get rid of acne and get clear skin

While Nodules and Cysts can only be extracted surgically by a dermatologist. Apart from Nodules and Cysts, you can treat the other types of acne with various available treatments. But when it comes to acne, no one ingredient or treatment will work for everyone and will often involve trying out different ingredients to see what works and then sticking to it.  Let’s explore some of the more important skincare ingredients that are effective in treating acne.

Salicylic Acid

Salicylic acid is a Beta Hydroxy Acid (BHA)  and is oil soluble, because of its lipophilic nature, Salicylic acid can reach into the fatty parts of our skin, such as our hair follicles and pores, thus making them an excellent solution for unclogging pores, clearing acne and controlling sebum production on your skin. Not only it is great for unclogging pores, but salicylic acid is also great for soothing inflammation and exfoliating dead cells from the skin, which makes it a great candidate for treating acne.

When you are seeking out spot treatments that focus just on the area affected with acne or cleansers which have very less contact time with the skin, look for products with 2% Salicylic acid and when you are looking for products like serums and toners which will be applied to your whole face, look for products with less concentrations, i.e., up to 0.5%.

Retinols & Retinoids

Much before they became so popular as anti-ageing ingredients, Retinols and Retinoids were first researched and marketed for the treatment of acne and hyperpigmentation, because they help regulate the sebum production in the pores and also at the same time resurface the skin to speed up the skin cell turnover rate. It is generally a thing of concern that Retinols and Retinoids cause thinning of the top layer of the skin, the epidermis, on the contrary, it is great that it helps shed off the dead skin layer in the stratum corneum and also simultaneously thickens the dermis layer, making it an effective ingredient for the treatment of acne.

While you can find retinol in personal skincare products and over the counter products, you will have to get a prescription from a doctor to be able to access retinoids which are the high concentration, original forms of retinoic acid. Luckily these days you can find adapalene gel(Differin gel) and tretinoin cream, in lower concentrations available as the OTC, without a prescription.

Benzoyl Peroxide

Benzoyl Peroxide is another common ingredient that you will find in acne treatment products and is an effective one too. Benzoyl peroxide works by killing the acne-causing bacteria inside the skin pores. You will find generally Benzoyl peroxide in concentrations of 2.5%, 5% and 10%.

Benzoyl peroxide should be used only in moderate to severe cases of acne as it is strong and can have side effects too. The side effects of using benzoyl peroxide include peeling, flaking, redness, irritation and burning. Because of this reason, it is always advisable to consult a dermatologist before using Benzoyl peroxide for your acne.

Willow Bark

Willow bark is the bark extracted from the willow tree. Because it contains Salicilin and has amazing antibacterial and anti-inflammatory properties, it is often touted as a natural alternative to Salicylic acid. If you have sensitive skin and want a gentler alternative to Salicylic acid for treating acne, then willow bark is for you. Willow bark is also great for calming redness, reducing sebum and also alleviating signs of ageing.

Tea tree oil

Tea tree oil also referred to as Melaleuca alternifolia leaf oil, is an essential oil derived from the leaves of tea tree. It is a natural anti-bacterial and anti-inflammatory ingredient that is used in a lot of natural acne treatment products.

As with any essential oil, it is not advised to directly apply tea tree oil to your skin as it can sensitize your skin. It is best to dilute the tree oil with water or Jojoba oil.

Witch Hazel

Witch hazel is frequently used in a lot of acne care products. It is a great astringent and has amazing anti-inflammatory properties and is a very effective ingredient for treating acne. It is widely used in products targeted for oily skin, because of drying, toning and tightening action on the skin.

Centella Asiatica

Centella Asiatica, commonly known as Gotu Kola or Cica is another ingredient that is effective in treating acne.

This article is medically reviewed by our expert dermatologist, Dr Nagakeerthana Sunder, M.D. DVL

References

  • https://pubmed.ncbi.nlm.nih.gov/32310680/
  • https://pubmed.ncbi.nlm.nih.gov/30972839/
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