Acne Management and Post Acne Hyperpigmentation

Acne is something we all suffer from, even well into our adult lives (for some of us) and it's perfectly normal! When managed well, it becomes second nature and you won't even think about it (until you have a break out!). 

It is important to note that acne can be caused by many factors, hence management is also a multi-facet approach. Stress can play an important part by affecting hormone levels, which indirectly can cause an increase sebum production. 

From the diagram, you can see when there is an increase in sebum production and dead skin cells blocking the pores, this causes a plug and the inflammatory process begins. Once the bacteria on your skin start to multiply, the inflammation becomes worse. 

This is going to be a very long article but it's quite comprehensive!  Drop us DM or comment if you have a question. 

First and foremost:  

• avoid excess dairy
• avoid excess sugar - sugar raises your insulin levels which causes a rise in inflammatory markers
• avoid high intake of processed food such as refined carbohydrates - these too can raise insulin levels, leading to a rise in inflammatory markers
• incorporate foods which are high in antioxidants as these are also anti-inflammatory
• Zinc supplements have been shown to assist in the management of acne and skin repair. Studies have shown 20mg-40mg daily is sufficient, just remember to take these after food to avoid nausea

• Important to identify which form of acne you have as hormonal acne requires more specialised treatment to prevent scarring
• In general, a wash containing Salicylic Acid (has anti-inflammatory properties and breaks up cohesion in dead skin cells) is quite successful in management and prevention of acne. We like the Neutrogena Acne Wash or La Roche-Posay Effaclar Foaming Gel
• Simple over the counter creams include Salicylic Acid 5% or Benzyl Peroxide (trade name is Benzac). Benzyl Peroxide has antibacterial and anti-inflammatory properties which is useful in the management of acne. If you are in the US, Adapalene is available without a prescription. Studies have shown then Adapalene is combined with Benzyl Peroxide, it can improve acne by up to 80% in patients. It is important to note Adapalene should not be used during pregnancy. 

POST ACNE HYPERPIGMENTATION

When there is trauma to the skin (e.g. Inflammation), it causes the melanocytes in your skin to produce more melanin (or pigment). This is what causes the post acne hyperpigmentation and they can last weeks to months. 

Excessive picking or squeezing can worsen the inflammation which is why we have always been told not to squeeze our pimples! 

Using the right combination of cleansers and moisturisers containing either Alpha Hydroxy Acids, Retinol, Vitamin C or Niacinamide can assist to restore your skin tone back to normal more quickly.

For severe pigmentation or deep acne scaring, see your dermatologist for the best outcome. Acne scarring is more severe and treatment will usually require laser resurfacing, dermal fillers or skin needling.

Author: Helen Huynh 

Pharmacist and Editor for ellé derm

References:

1. Gollnick HP et al (2009). Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. British Journal Dermatology. Date viewed: 27th February 2020

https://www.ncbi.nlm.nih.gov/pubmed/19466959