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08 Aug 2022 | CAPS Clinic

Acne: How it Forms and How to Treat it


Acne is an inflammatory condition of the skin that affects pilosebaceous units in the skin. It presents in the form of pustules, nodules, cysts, inflammatory papules, and blackheads. This common skin condition can be caused by several factors which include genetics, stress, diet, and environmental factors, affecting people of different ages. Considerable risk factors for acne development include family history, metabolic syndrome, and polycystic ovarian syndrome [1]. This skin condition is seen frequently in teenagers and adults alike, with 85% of individuals between 12-24 years of age suffering from this type of skin condition, with it affecting 9.4% worldwide. Acne can have a profound psychological effect on its patients. The cause of acne includes increased androgen hormones that stimulate an overproduction of skin cells, overactive sebum (oil) production, sebaceous gland growth and increased bacterial load [2,3,4].

During the covid pandemic mask’ ne was commonly seen in skin clinics worldwide. While masks such as the N95 are to be the most protective to Covid 19, they are also known to cause acne breakouts. Majority of research postulate that the inappropriate use of re-using masks is one of the main causes. Sweating and the spreading of skin microbes to the mask create great growth conditions for microbes to multiply, in turn causing the skin to breakout [5].


Today’s western diet features high GI foods, refined grains, red meat, milk and dairy products, egg protein, and saturated fats. Low glycaemic foods have also been shown to be beneficial in lowering the incidence of acne. High glycaemic index and glycaemic load induce hyperinsulinemia. This stimulates increased concentrations of Insulin Growth Factor-1 and androgens, which can also activate other pathways in our bodies, resulting in an increased incidence of acne [2].

SO… let’s debunk a myth about chocolate causing the skin to breakout. There is a common misconception about chocolate causing acne. In research the issues associated with acne flares and chocolate comes down to the other ingredients that are added to the commercial chocolate bars. Sugars, dairy, and overly processed foods can all have an effect not only on overall gut health, but they can also affect the skin in a way that can be stimulating for skin conditions such as acne. For instance, dairy is known for its mucous producing properties [2].

Whey protein in milk is known for acne producing properties. One interesting fact is that milk comes from 75-90% of pregnant cows, which confers high progesterone, androstenedione, dehydroepiandrosterone (DHEA), and dihydrotestosterone (DHT) content. These hormones increase the expression of androgen receptors stimulating androgen hormones in our bodies [2].

Alcohol has been reported to allow for bacterial proliferation, becoming a nutrient for feeding acne colonisations. B12, vitamin D and zinc are nutrients to be looked at when treating at a patient with acne as these can reduce the inflamed lesions [2].

The skin gut axis is one thing talked about abundantly these days. Alterations to the gastrointestinal microbiome has been seen to have links with acne. Intestinal permeability ‘leaky gut’ and systemic inflammation all are reported to play roles in the progression of acne formation. Oral supplementation with probiotics (lactobacilli, bifidobacterial, and enterococci) has been associated with clinical improvement of acne with Lactobacillus rhamnosus GG significantly improving acne after 12 weeks of use [2]

Lifestyles today are different to those years ago. Today’s lifestyle includes passive leisure, such as watching TV, playing video games and working in front of the computer for hours. This type of lifestyle can lead to uncontrolled food intake, especially hypercaloric, high GI, or GL foods. This type of diet can lead to obesity and high body mass index, which have been linked to acne [2].

Omega-3 and omega-6 are great for inflammatory skin conditions like acne as they reduce the inflammatory responses associated with these conditions. Omega-3 is found naturally in fish and seafood, and omega-6 is found naturally in sunflower, corn, and safflower oil. Another great alternative to treat acne is sea buckthorn oil or flaxseed oil for those who are vegan [2].

Probiotics have been proven to be affective in managing acne by controlling the growth of P. acnes bacteria. Probiotics can decrease sebum production and inflammation [9].

Acne vulgaris may be associated with many gastrointestinal disorders. One being hypochlorhydria. This condition allows colonic bacteria to migrate to the small intestine, causing bacterial overgrowth. With bacterial overgrowth changes are seen in the gut microbiome in turn preventing the absorption of nutrients and vitamins. Malabsorption of some foods can cause nutrient deficiency and affect the body’s normal function [6].


Acne vulgaris can affect self-esteem, cause anxiety and embarrassment, and a desire for social isolation. A common treatment in our clinic for treating patients with acne are chemical peels. There are different types of chemical peels available and different depths of penetration can be achieved. These can be very effective in treating acne by reducing inflammation, increasing the turnover of skin cells, dissolving sebaceous blockages (oil build-up) and reducing pain. Common chemical peel ingredients used in treating acne include salicylic acid, retinol, azelaic acid, glycolic acid, lactic acid, mandelic acid, modified Jessner peels and TCA peels [7,1].

Nd:YAG 1064nm lasers are becoming increasingly popular in treating acne presentation, as well as IPL.  It has been reported in research to be beneficial in reducing the inflammatory response in acne effected skin. LED or LLLT is a treatment that is easily used in our clinic to treat acne, either as a standalone treatment or added to other treatments such as peels. This amazing treatment modality has a lot of research to support its use not only for acne, but also for inflammatory skin conditions in general. The 415nm blue light is known for killing off p-acnes whilst the 830nm near infrared light is anti-inflammatory, promotes wound healing and assists with the reduction of scarring within the skin.

Skin needling is gaining a lot of talk and has a lot of current research for post inflammatory erythema (post acne redness) and scarring. This treatment is beneficial for improving the overall appearance of the skin especially after inflammation has reduced in the pustules, papules and nodules associated with acne. Another less invasive treatment that is offered at the clinic is laser genesis. This treatment assists with the reduction of scarring and redness by stimulating neocollangenese – thickening the lower layer of the skin (the dermis) and in turn improving the overall skin texture and tone.


Topical and oral antibiotics are commonly prescribed for the treatment of acne. Today we are starting to see acne become antibiotic resistant [8,9]. Hormonal treatment may be required to balance hormones that cause acne breakouts on the skin. Hormonal breakouts are seen regularly in menopausal women and during puberty [1]. Topical retinoids include tretinoin, tazarotene, and adapalene can be prescribed from the GP or dermatologist to help with clearing up acne [10].

Things to remember:

A common misconception with acne is that the skin must be exfoliated and stripped of its oil. This usually involves using harsh ingredients, which in turn strip the skin from its natural oils, so it does not feel as oily or potentially even clearing the acne. A lot of the time this kind of skincare procedure does more harm than good. We have a protective layer on the skin called the stratum corneum. This protects the skin against external environmental assaults and if it is damaged or stripped on a regular basis without having time to heal, it can cause it to become impaired leading to redness, inflammation, stinging, burning, infections, and even further acne. With our patients in the clinic, we assess the overall skin health at the initial consultation, followed by a tailored customised treatment plan. Depending on the presentation of acne, we will determine the course of the treatment that will follow, whether its treatment with us or a referral to a GP/ dermatologist which may be required depending on the classification of the acne. We also refer to naturopaths and nutritionists if further support is needed.

Skincare at home is a very important part of the puzzle. As clinicians, we delve deeper into ingredients in products rather than brands and help each patient with recommendations to ensure they are equipped with the best skin care for their budget and skin needs. Once inflammation has reduced, the introduction of retinol or equivalent vitamin A products can be beneficial for controlling acne long term. It is important to have a gentle cleanser and moisturiser. Cleansers remove makeup, dirt, and grime on the skin whilst moisturisers hydrate and protect the skin from the external environment.

Another misconception is that acne skin does not need to be moisturised…this is not true. If the skin is not appropriately hydrated, the skin’s protective layer can become impaired and dehydrated, causing other issues, and the cycle continues. Salicylic acid is a wonderful ingredient that is recommended with the treatment of active acne. What this excellent oil-loving ingredient does is reduce inflammation, pain, exfoliates, dissolves oil within the pilosebaceous unit where the acne is presenting and dries up the area of concern. This powerful topical ingredient can be used just on the affected areas to assist with the management of the acne.  The strength of the product will determine on how often it should be used.

Acne is a multifactorial skin condition and usually requires a combined approach to achieve results. A wholistic approach to the skin is needed to achieve the best outcomes for patients and to get to the root cause of why it is happening. If you want to find out further information regarding your acne or someone whom you know that is suffering with acne, contact our reception team on 6282 1155 to make your consultation with one of our professional and qualified dermal team.


Brooke Worthy BHSc (Dermal Sciences)









[1] Calvisi, L. (2021). Efficacy of a combined chemical peel and topical salicylic acid-based gel combination in the treatment of active acne. Journal of Cosmetic Dermatology, 20(2), 2–6.

[2] González-Mondragón, E., Ganoza-Granados, L., Toledo-Bahena, M., Valencia-Herrera, A., Duarte-Abdala, M., Camargo-Sánchez, K., & Mena-Cedillos, C. (2022). Acne and diet: a review of pathogenic mechanisms. Boletín Médico Del Hospital Infantil De México, 79(2). doi: 10.24875/bmhim.21000088

[3] Dagnelie, M., Corvec, S., Timon‐David, E., Khammari, A., & Dréno, B. (2021). Cutibacterium acnes and Staphylococcus epidermidis : the unmissable modulators of skin inflammatory response. Experimental Dermatology, 31(3), 406-412. doi: 10.1111/exd.14467

[4] Leja, D., Dziedzic, K., Chilicka, K., Golombek, M., Niestrój, K., & Połednik, H. (2022). The use of hydrogen purification and mixture of cosmetics acids, and the influence on acne skin parameters: a case report. Medical Science Pulse16(1), 1-7. doi: 10.5604/01.3001.0015.8342

[5] Falodun, O., Medugu, N., Sabir, L., Jibril, I., Oyakhire, N., & Adekeye, A. (2022). An epidemiological study on face masks and acne in a Nigerian population. PloS One, 17(5), e0268224.

[6] Demirbaş, A., & Elmas, Ö. F. (2021). The relationship between acne vulgaris and irritable bowel syndrome: A preliminary study. Journal of Cosmetic Dermatology, 20(1), 316–320.

[7] Abdullah, Zuberi, M. H., Haroon, U., Tajammul, A., Tabassum, A., & Sultana, A. (2022). Development and evaluation of herbal formulation AKIGTU01 and AKIGCL03 against acne producing microbes. Pakistan Journal of Pharmaceutical Sciences, 35(3), 819–825.

[8] Aoki, S., Nakase, K., Hayashi, N., Nakaminami, H., & Noguchi, N. (2021). Increased prevalence of doxycycline low-susceptible Cutibacterium acnes isolated from acne patients in Japan caused by antimicrobial use and diversification of tetracycline resistance factors. The Journal of Dermatology, 48(9), 1365–1371.

[9] Goodarzi, A., Mozafarpoor, S., Bodaghabadi, M., & Mohamadi, M. (2020). The potential of probiotics for treating acne vulgaris: A review of literature on acne and microbiota. Dermatologic Therapy, 33(3), e13279.

[10] Drake, L., Reyes-Hadsall, S., Barbieri, J. S., & Mostaghimi, A. (2022). New Developments in Topical Acne Therapy. American Journal of Clinical Dermatology, 23(2), 125–136.

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