Acne: Skincare Bible Review- Dr Anjali Mahto
Skincare Bible Review: Acne
Hi there, it’s Tina here again, today with another piece of our “Skincare Bible” book review. This time about a very common skin issue: acne. Around 80% of people suffer from acne during their lifetime! In the adolescence it is more men than women, after that the ratio gets reversed. For some, acne comes only after the age of 25. Dr. Mahto reminds us with these numbers that although it can feel very lonely, most of the people around us have gone through the experience of having it.
What is acne
Acne is simply an inflammation of the oil gland or its blockage. It can manifest in a number of ways – as blackheads, whiteheads, small red bumps. More severely – cystic acne, when deep red, tender spots occur. These can be combined and it is actually quite common that one person has several forms.
What are the causes of acne? They are multiple. Number one are the usual suspects – hormones. We talked about them in more detail last time. Once we reach puberty, our bodies start to produce male hormones, called androgens, particularly testosterone. This in turn increases the oil production in the skin. Skin cells around the hair follicles become sticky and, together with the excess oil, block the pore. Then a specific kind of bacteria, which live on the skin, can spread in the blocked pores and start their ugly work, resulting in inflammation. Genetics also plays a role, as we tend to inherit the number, size and activity of our oil glands from our parents. There are also other factors in play, such as some cosmetic ingredients (lanolin, beeswax,...), medical conditions or medication that influence the hormonal levels, or physical factors, such as wearing backpacks or headbands, where the skin is covered and tends to sweat more.
Dr. Mahto urges everyone who suffers from acne to seek some advice from a properly trained professional and warns about all kinds of self-proclaimed professionals, whose expertise cannot be supported by sound scientific evidence. One example of this is a theory that spots in distinct parts of our faces can have different causes. Instead, she offers alternative explanations. For example, spots on the forehead are often caused by hairstyling products, wearing hats and caps, or wearing fringes. This kind of acne, caused by rubbing and irritation is called acne mechanica. Lower cheek and jawline can be affected by using smartphones – the pressure, which activates the oil glands, combined with the heat and bacteria, inhabiting the screen of your phone are the perfect place for starting a blemish. A remedy is simple – clean your phone regularly and, when possible, use hands-free options. For men, shaving and in-grown hair are a common cause of acne in the area of cheek, jaw and neck.
There are two types of adult acne: one which is persistent, or, in other words, it has been a problem since the adolescence and it did not fade away even after entering the third decade of life. And the other one is “late-onset”, which appear usually after the age of 25 for the first time. It still remains to be explained, why some people suffer from the adult acne. However, treating acne is possible and it does not make a difference if one is 14 or 35.
Knowing that hormonal imbalances are a cause, would it be useful to get a blood test to check the hormonal levels, then? Dr. Mahto says a clear no. Usually, the overall levels of androgen hormones in our body are okay, they are only increased in the affected areas of our skin. It is, however, a different story if you suspect you might suffer from a polycystic ovarian syndrome. In that case, it is worthwhile to speak to your gynecologist and arrange a check.
Many women also notice that their acne gets worse before or during their period. This is due to the relative drop of female hormones. Testosterone, on the other hand, remains relatively constant throughout the whole cycle, which means it is proportionally higher in these days.
Role of the diet
Your diet also plays a role. Not just your common sense (do not forget your skin mirrors the overall health of your body!), but even scientific studies indicate that food with a high glycaemic-index (such as sweets, white bread, soft drinks etc.) tend to aggravate acne. For some people, cow milk can cause problems. Dr. Mahto recommends taking notes about your diet and observe what seems to impact the blemishes for you individually. An “ideal diet” for acne would be one low in sugars and refined carbs, rich in fruits and vegetables and good protein (e.g., from fish with a high content of omega-3 fatty acids, which have anti-inflammatory effects). You can also try food supplements, such as vitamin B3, vitamin A, zinc, or the above mentioned omega-3 fatty acids
Recently, acne has gradually started to be recognized as a chronical problem. This can be, in fact, a huge relief for those people who are frustrated by the repeated “truth” that they will eventually grow out of it. Maybe they will not. Instead, they will just have to focus on treating it the right way and minimizing the inducing factors to keep it at bay. And if it reappears, turn to the trusted and tested ways to get rid of it.
Dr. Mahto gives a detailed overview of different ways of treating acne, including specific ingredients. The treatments range from topical ones (gels and creams used on your skin), to oral medication and light treatments. She also discusses the options for dealing with acne when pregnant or planning a pregnancy. She also provides answers to a number of common concerns and myths related to acne, such as whether to use sunscreen if sun exposure makes your blemishes disappear (the answer, by the way, is a firm and loud “YES”! Just make sure you pick one that has a light, oil-free formula, suitable for acne-prone skin. There is a number of those available and Dr. Mahto also gives tips for specific brands).
Acne leaves scars. Not only the ones on your skin... The one thing that touched me deeply in this chapter was a story how a young Anjali Mahto, desperate about her acne, went to consult a dermatologist, who handled her in a very insensitive way. Those lucky among us, who equal acne with a few blemishes which go away after a few days, might not be aware of how difficult it is for someone, who suffers from a more serious form of acne. How it can affect their self-esteem, their interaction with others, their mood. Please remember that next time when talking to your teenager or anyone else dealing with this skin condition and do not underestimate it. A little support and a kind word goes a long way!
Physical scars on the skin can affect about 20 per cent of people who have acne, especially if deep spots occur (picking and squeezing the spots does not help, as you might guess). There are different kinds of scars and, luckily, also a variety of ways how to treat them. They are, however, not cheap, so it is worthwhile to invest into prevention and consult a dermatologist early, so that scars can be minimized. If they appear, again, a consultation with an expert should be a starting point. Any kind of skincare will not save you at this stage! What kind of professional are we looking for? The best choice is a cosmetic dermatologist or plastic surgeon. They will be able to suggest treatment tailored to your specific situation. The options include steroid injections, chemical peels, surgical treatments, subcision (releasing tethered fibrous bands with a needle), dermabrasion or micro-needling. Dermal fillers can be used, as well as a variety of laser therapies. A good dermatologist will also provide you with all the information about the pros and cons of the treatment.
An important thing with regard to scarring: it should not be done if acne is still ongoing, otherwise the scars will continue to occur!
Some people can have red or brown marks on their skin after acne. This is called post-inflammatory change and is not a type of scarring. It usually fades away in a few months without any treatment. If you want to speed up the process, you can get over-the-counter products with niacinamide, glycolic acid, kojic acid, arbutinin, vitamin C, azelaic acid or retionids. The spots can also be treated with micro-needling, laser or peels.
Ok, I have to admit that this was a long read, but I hope you found some useful information here! Next time, I will go on writing about specific skin concerns Dr. Mahto talks about in her book, this time about rosacea and pigmentation issues.