Understanding Your Skin

Types of acne and how to treat them.

Dr. Sonya Abdulla is a double-board certified dermatologist in Canada and the United States. Her practice is located in Toronto at Dermatology on Bloor. She specializes in the treatment of acne and rosacea and also provides clients with cosmetic injectables, laser therapy and energy-based treatments.

People that have acne tend to find products that can remove all excess oil. Is that the right thing to do? Can dryness cause breakouts?

Acne is complex and triggered by a number of processes including microcomedone formation, occlusion of the hair follicle, sebum production from hormones, and the presence of pro-inflammatory C acne bacteria. Targeting one mechanism will only get you partial improvement. Products that tend to be over drying can actually stimulate compensatory oil production. Your best strategy is to continue using hydrating ingredients like hyaluronic acid to protect your skin barrier function while using active ingredients that address acne.

Changing where you live, such as moving to another country, can lead to breakouts. Why?

We are a product of our environment! There are a number of factors that may trigger an acne flare. This may include changes in ambient humidity and secondary skin barrier dysfunction, pollution, dietary change and of course, stress and stress hormones. More simply, some of your skincare routines may have to adapt due to availability or lack of availability, of your favourite products.

What causes most breakouts?

In women, the cyclical flare of the menstrual cycle is typical. For most patients, the relative change in hormones before your period can trigger an acne flare, typically manifesting in tender cystic lesions on the lower face, jawline, extending into the neck. Additional factors may include increased heat, sweat humidity and occlusion from sports or repeated coverage of any area. This includes clothing such as a headband or undergarments or even hairstyles like bangs. Psychological and physiological stress can trigger increased stress hormone levels also leading to acne.

Dietary factors may play a role, but the exact relationship is unclear.  Food groups including dairy can trigger increased levels of insulin-like growth factor which through a complex series of hormonal interactions that trigger acne. Smoking has been consistently associated with acne, particularly deeper, resistant comedonal forms in adult patients. Lastly, skincare can contribute to acne flares.  Comedogenic ingredients such as coconut oil or sebum inducers such as vitamin E or squalene may contribute to breakouts.

In the summer what are main skin problems you see?

Acne and folliculitis can both flare in the summer months. Folliculitis is a form of inflammation of the hair follicle that tends to come on the chest, back and buttocks.  It lacks the presence of comedones (blackheads, whiteheads). Heat, humidity, sweat, and friction create the perfect environment for follicular occlusion and microorganism overgrowth, creating these acne-like lesions. Keep the areas in question cool, clean and dry. Opt for natural fibre clothing to let the area breathe. Limit friction and rubbing.  Look for cleansers with AHA, BHA to address follicular occlusion and microorganism overgrowth.

As for acne, occlusion from heat, humidity and sweat may trigger a flare. Look for non-comedogenic products for acne-prone skin, including sunscreen. Keep the canvas fresh and cleanse the skin after any intense activity to remove the occlusive layer of sweat, sebum and pollution.

Please describe the most common types of acne and how to treat them.

Acne morphology is complicated; most patients anticipate having one type of lesion when in reality many forms can exist concurrently.

The two most common types of non-inflammatory acne lesions are comedones. Comedones include both open and closed types, also known as black heads and white heads. Blackheads occur when the hair follicle is occluded by sebum and keratin debris, creating a plug and occluding the area. These comedones are open to the air, their contents become oxidized with air exposure giving a black color. Whiteheads are similar but covered by a thin layer of skin, avoiding air exposure and oxidation, maintaining a white yellow colour. These are typically treated with exfoliating ingredients such as AHA, BHA or comedolytic ingredients, such as retinoids or benzoyl peroxide.

Inflammatory acne lesions include papules, pustules, nodules and cysts. These deeper inflammatory lesions can respond to topical ingredients including AHA, BHA, retinoids and benzoyl peroxide but often require treatment working from the inside. Additional treatments may include oral contraceptive pills, anti-androgens such as spironolactone or isotretinoin. Antibiotics are being used less commonly and reserved for specific cases due to concerns with bacterial resistance. These medications by mouth require consultation with your dermatologist for next level, prescription therapies.

Is there any difference between men’s acne and women’s?

Female adult acne patients tend to have a predominance of acne on the face, favouring the lower aspect, extending along the jawline and into the neck. This is often referred to as hormonal acne. In some patients, a true hormonal level abnormality may exist but the majority of patients simply have a sensitivity to acne in these areas which may be related to hormone receptor expression, not abnormal hormone levels.

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