Vogue Arabia, April 2020. Photo: Emily Soto
According to the NHS, a huge 95% of people aged 11 to 30 experience acne, and studies show that it is becoming more prevalent among adults – particularly women – too. It can have a debilitating impact upon self-esteem, so finding the best acne treatment, whether via skincare products, diet, or holistic methods, is crucial.
What are the main causes of acne?
An inflammatory disorder of the skin, acne comprises blackheads, whiteheads, papules (small red bumps that feel tender), pustules (like papules but with a pus-filled head in the centre), and nodules (large, hard lumps beneath the skin), and they can show up everywhere from the face and neck to the shoulders and upper chest. “It is caused by excess sebum, sluggish old skin cells and cutibacterium acnes (or c.acnes) bacteria, which already live on the skin, compounding within the pores,” explains Dija Ayodele, skin specialist and founder of West Room Aesthetics. “When pores become clogged with this sticky concoction of sebum and dead skin cells, c.acnes bacteria become trapped in the pore and begin to multiply, resulting in inflammation.”
One of the biggest causes of acne is hormones, which might go some way towards explaining why women are more likely to suffer from acne than men. Anecdotally, many of us also probably see this each month as we suffer breakouts the week before our period starts. “Excess oil is a common cause of acne and your hormones play a huge role in how much oil you produce,” says facialist Teresa Tarmey. Stress plays a big part, too: “When we’re stressed we produce more androgens, which stimulate the oil glands and hair follicles in the skin, leading to outbreaks,” she adds.
Aside from stress, other lifestyle factors include poor diet and sleep, exposure to pollution and other environmental aggressors, and a poor skincare regime that is over or under-zealous, or simply not right for the individual. Ayodele points out that all of these things put the body in an inflammatory state, which is when skin conditions like acne and eczema can take hold. “We are using too many products now which is greatly compromising skin barrier health, and I think social media has a lot to do with it,” she continues. “I have seen more clients coming to me with breakouts due to ingredient overload, simply because they have piled too much on their skin and their skin barrier is shattered.” It isn’t acne in the traditional sense, but to you and I, it looks and feels the same.
What foods cause acne?
Much of what happens to our skin actually starts internally, in our gut. “Foods that contain a lot of refined sugars and simple carbohydrates are very quickly broken down into glucose, causing the body’s blood sugar levels to spike,” explains naturopathic skin health coach Jessica Shand. “Elevated blood sugar triggers the body to pump out insulin at a fast rate which, as a result, wreaks all sorts of havoc on your hormones, including increased levels of the androgens which prompt sebum production.”
High glycaemic load (GI) foods like pastries, bagels, white bread and rice, processed meats, sugar-filled sauces and condiments are all culprits. Shand recommends opting for low GI foods to help balance blood sugar and lower androgen levels in the blood. “Forgo refined carbohydrates in favour of 100 per cent wholegrain alternatives, which offer a slow release of energy and won’t spike your blood sugar in the same way. Meanwhile opt for good quality, lean meats that have been cooked at home by you,” she advises.
Dairy is another food that has been linked to acne, and while there isn’t a solid explanation for this, Shand explains that it is thought dairy can cause hormone fluctuations, prompting an overgrowth of skin cells that block pores and trap bacteria, eventually causing acne. “Consider swapping cow’s milk for a plant-based alternative,” she recommends as a first port of call, but be sure to seek advice from a health professional before making any long-term changes to your diet.
The onus is very much on eating a balanced diet, including an abundance of colourful fibre-rich foods, and taking the same kind of approach to meals as our (healthier) Mediterranean counterparts. That includes plenty of fresh fruit and vegetables, lean protein, wholegrains, pulses and beans. The more anti-inflammatory foods and spices – think ginger and turmeric – the better.
What is the most effective acne treatment?
Treating acne effectively requires a 360-degree approach, because what’s going on internally affects what’s happening externally. “The best thing you can do for acne in the first instance is seek a professional assessment,” says Ayodele. “That will determine your treatment route and whether you need more medical involvement.” While the internet can yield great information, it is important that any treatment advice is bespoke to you – and you can only get that from a one-to-one appointment. It is worth the money.
Look at your diet
Take time to look at your diet. Shand advises her clients to note down what they ingest (both food and drink), as well as their stress levels and menstrual cycle in a food diary to start with. Consider whether you’re consuming too many high GI foods, or overdoing it on the dairy. Start a good course of probiotics, like Symprove, to ensure the gut is in good health, which will lead to better skin and a reduction in inflammation.
Nail your skincare regime
What to do when a spot surfaces? “Remove any products containing oil from your skincare regime,” says Tarmey, who also warns against drying out the skin. “Keep skin hydrated with a good serum and spot treat with salicylic acid.” Applying toothpaste, unfortunately, will not work.
Instead of overcomplicating it, follow a stripped-back skincare regime that “prioritises strengthening and rebuilding of the skin barrier”, says Ayodele, who advises using a cleanser made for oily skin and containing ingredients like mandelic and azelaic acid to gently exfoliate. “I also advise adding in a product called Clinisept+, which greatly helps reduce bacteria on the skin. You spray it on immediately after cleansing.”
Both experts advise incorporating a retinoid for healthy cell turnover, and making sure that the products you use on your face – make-up included – are non-comedogenic as well as oil-free. While a gentle and consistent skincare regime can work wonders, don’t be tempted to throw all manner of spot-busting and oil-reducing formulas at the skin all in one go. “Patience is key because most of the time skin will get worse before it get better. My advice is to take it slowly and just use a few products at a time to understand what is working effectively,” says Ayodele.
Meanwhile, to help calm inflammation and boost the skin’s ability to heal itself, look not only to barrier building ingredients like niacinamide and ceramides, but also LED light, which can be deployed at home. While red light helps take down inflammation, blue kills bacteria on the skin – if you can afford it, invest in a good mask like Dr Dennis Gross’s DRx SpectraLite FaceWare Pro. It’s well worth incorporating into your regime.
The in-clinic treatments to try
It always pays to work with a professional – whether a dermatologist or facialist – on your skin. They can give you advice on what you should be doing at home, but will also often recommend in-clinic treatments which can help immeasurably with issues like acne, particularly if it is severe.
“When clients come to see me, we always start to strengthen the skin and calm inflammation, which involves four to six weeks of just home care,” explains Ayodele. “After that, it will be a mixture of chemical peels, using glycolic, mandelic or salicylic acid. And sometimes vitamin A peels.” She will always include LED as a post-treatment soother.
Laser treatment can also be a game-changer. Tarmey offers a ClearSkin Laser treatment at her clinic, which works with the skin’s biology to destroy overactive sebaceous glands, acne bacteria and sebum, without damaging the surface of the skin or the collagen beneath. “You can see a big difference instantly and it’s really popular with my clients that suffer from stubborn acne,” she says. Debbie Thomas is another great facialist to visit in London for her excellent laser treatments.
For acne scarring, there are also a number more treatments that can help (and fend off future breakouts). Fractional Frequency by Venus can help resurface the skin, and helps soften the appearance of scars, enlarged pores and uneven skin texture, while microneedling can also help kickstart the skin’s healing process for smoother skin.
The best skincare products for acne-prone skin
If you are oily or acne prone, look out for ingredients such as AHAs, BHAs and PHAs in your formulas; however, be careful not to over-use them, as this can disrupt the skin barrier and potentially lead to further congestion. Don’t scrimp on the moisturiser, either. A common mistake made by those with oilier complexions is forgoing topical hydration in an attempt to dry out the skin – to its detriment. And finally, be consistent but listen to your skin – if it’s irritated, pull back on the actives and opt for gentler formulas.
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Originally published in Vogue.co.uk
