Acne, a four letter word

Most of us remember those “acne-ugly” years. Whether it was an occasional break-out or an absolute hormone revolt, it is likely to have left us scarred, literally and figuratively.

The Anatomy of a Pimple

Most of us are aware that Sebum and inflammation are the main actors in this drama. But the exact process (from normal sebaceous gland to comedone, papule, pustule, cyst and scar) bears some examination.

We start with the normal function of a healthy skin.

The skin covering most of your body is scattered with fine (in most cases) nearly invisible hairs, and each of these hairs has a number of attendant glands. The sebaceous gland excretes sebum which reaches the surface of the skin along the hair follicle.  Just the right amount of sebum keeps the skin and hair surface moist and prevents them from becoming cracked/brittle and dry.


Puberty often triggers the process, although acne can be a lifelong affliction.

With all the hormonal changes in puberty, the sebaceous glands are inclined to enlarge and create more sebum than can be effectively used by the skin. In most people, this condition improves with age. Others are less fortunate and suffer their entire adult lives with varying degrees of acne. Should a follicle become blocked (with accumulated dead skin cells and oxidised sebum) the gland still continues to produce sebum which collects in the now sealed hair follicle. Bacteria (which normally occur in the follicle) are also trapped with the sebum and proliferate in the (now) anaerobic environment. The body’s natural immune system responds with inflammation. (There is, however, some debate as to whether inflammation and anti-oxidative stress are symptoms of acne or if they are not underlying conditions which promote acne.) The characteristic pimples, boils and abscesses that affect the skin all begin with a build-up of a mixture of sebum, bacterium and dead leukocytes (white blood cells).


Healthy Living Jan 2015

The immune response plays a significant role in scarring.

When there is an injury to the skin, the body sends out white blood cells to contain and neutralise infection. Neutrophils are the first, and most numerous types of white blood cell to reach the follicles and surrounding tissue. On reaching the site of infection, these cells often self-destruct (apoptosis) to release their contents (anti-microbial molecules, DNA and proteases) into the environment. The proteases (enzymes which break down tissue) are not discriminating and they remove much of the surrounding tissue (including the elastin and collagen matrix) which has been exposed to the invading bacteria. Whilst this effectively sterilizes the area, the underlying structure which supports healthy, normal skin is also destroyed. In cases of persistent infection and inflammation and where the elastin and collagen framework has been damaged, there is no effective guide to direct the regrowth of the complex and delicate skin tissue, so the body does a simple and tough patch-job to heal the wound.

Scar tissue comprises mostly of dense bundles of collagen which are usually aligned in one direction (unlike the normally occurring multi-directional web). The resulting tissue is denser, less elastic and impermeable to the migration of many cell types.  This means that the original hair follicles, sweat glands and blood vessels do not regrow. This also explains why some scars are never replaced with healthy tissue.

In addition to changes in texture and tone, an area which is scarred may show changes in levels of pigmentation. Melanocytes (melanin producing cells) either proliferate or overproduce pigment resulting in spots or patches of skin which are darker than normal (hyperpigmentation). Alternatively, they may be destroyed or depleted tending to give the skin a light or pinkish appearance.

 Prevention is the best Solution

If you adopt the below lifestyle practices, you can go a long way to limiting the damage and scarring that acne can cause:

  • Drink plenty of fresh, clean water;
  • Eat plenty of fresh fruit and vegetables;
  • Avoid overuse of fat and sugar laden, highly processed foods or drinks;
  • Get plenty of exercise, being sure to wash any perspiration off your skin once you are done;
  • Avoid unprotected exposure to direct sunlight;
  • Keep your skin clean;
  • Use clinically proven dermatological skin care products and cosmetics;
  • Investigate the use of oral medications with your medical practitioner.

Whilst your acne is active, you can to seek medical advice as to which topical treatments will best suit your condition.

Dealing with the Damage

At the Aesthetics Centre, we have found the following treatments to be particularly effective in treating many of the concerns that acne sufferers are faced with:

Chemical Peels

When treating scarring rather than active acne, exfoliation is the key. Chemical skin peels help to improve the overall appearance and condition of your skin. As with topical retinol products, the acids commonly used in chemo-exfoliation unlock the chemical bonds of the cells on the surface of the skin. The shed skin is replaced with softer, smoother, more elastic and even toned skin. Chemical peels are also very effective in clarifying the skin, especially those containing salicylic acid.


Microneedling (specifically using the Dermapen®) makes microscopic punctures into the deeper layers of your skin, allowing the applied serums and products to penetrate to where they can be the most effective. In addition, this process helps to stimulate the replacement of damaged collagen with better organised less dense collagen fibres. This in turn softens your scars, and reduces some of the fibrous thickening associated with scarring. Your skin is also stimulated to produce new and more elastin, which makes your scars stretch and move better, giving your skin a better texture.

Laser Resurfacing

If your scarring is extensive and more severe, you may want to consider undergoing laser resurfacing. In this instance, the laser uses light to burn your skin in a controlled environment. These wounds stimulate the accelerated repair and replacement of your damaged skin. As the light is able to penetrate deeply into your skin, the treatment is more intense and the results are more profound and may require fewer repetitions.

Photodynamic Therapy

Photodynamic therapy (PDT) is a non-invasive therapy that utilises light treatments. PDT is used to shrink the skin’s sebaceous glands (decreasing sebum production), to normalise the shedding of dead cells within the hair follicles (thus eliminating the blockages) and to target and kill the bacteria (P. acnes) associated with acne break outs.

In conclusion

You do not have to face acne, or its aftermath alone. Make an appointment with your medical practitioner to discuss your condition and your treatment options. Your program can be tailored to your pocket and your lifestyle, so that you can enjoy a better-looking skin in minimal time. Treat your acne as soon as possible, the longer you leave your condition, the more difficult it becomes to contain and rectify the damage it can cause to your skin. Most of acne’s legacy is more than skin deep, and can prevent you from enjoying your life to the fullest in ways you are not even, perhaps, aware.


Written by Kim Magennis

© The Aesthetics Centre January 2015



AcneNet Jan 2015

AgingSkinNet Jan 2015

Healthy Living Jan 2015

Medical News Today Jan 2015

Natural News, Jan 2015

Skin Medica  Jan 2015

The Journal of Clinical and Aesthetic Dermatology Jan 2015

The Science of Acne Jan 2015

The wiseGEEK Jan 2015

About Health  Jan 2015


*Results may vary per individual on all treatments and products. **The testimonials given are those of the clients and pertain to the results that they obtained and that each individual's results and opinions will still vary. ***The information on this website and specific page is not meant to diagnose any condition or provide conclusive treatment options for a given condition. The final decision on such treatments can only be made after a full history is obtained in person and a physical examination is done as part of a consultation in person. The information contained in this communication is confidential and may be legally privileged.
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