Acne & Rosacea

What causes acne and rosacea?

Acne occurs when there is excessive secretion of an oily substance (called sebum) in the skin. The hair follicles or pores are clogged with oil and dead skin cells, causing bacterial overgrowth and inflammation. Hormonal changes during puberty and around menopause can increase the skin’s oil production, and trigger acne. When there is a strong hormonal influence, acne tends to affect the areas around the mouth, jaw and neck areas. Rosacea occurs when there are dilated blood vessels and inflammation in the skin, causing flushing, redness and spots on the skin, commonly in the central face. Some individuals with rosacea may also experience skin sensitivity and facial dryness. Although we do not know the exact cause of acne and rosacea, both genetic and environmental factors play an important role. People who have a family history of acne or rosacea, tend to develop the same condition.

What can I do to control my condition, and prevent flare ups?

You may notice that certain factors in your daily life may trigger your acne or rosacea symptoms. Indeed, there are several factors which can worsen acne and rosacea. Avoiding these factors can help to prevent disease flare ups. Below are lists of common triggers for acne and rosacea.

Common triggers for acne:

• Hormonal changes during your menstrual period or pregnancy
• Milk, daily products and high sugary food
• Cosmetics In general, when choosing a cosmetic product, looks for labels that specify ‘non-comedogenic’ or ‘oil-free’
  • It is important to remove make-up completely before going to bed every night
• Certain medications such as steroids
• Excessive sweating *Always wash to remove sweat and dirt after sports.

Common triggers for rosacea:

• Cold or hot weather
• Spicy food
• Alcohol, especially red wine
• Stress
• Sunlight

What are the different types of acne?

There are three main subtypes of acne:

1. comedogenic (blackheads and/or whiteheads)
2. papulopustular (red and/or yellow spots)
3. nodulocystic (cysts)

Papulopustular and nodulocystic acne, if not treated early, can lead to permanent scars.

What is the difference between acne and rosacea?

Acne tends to affect teenagers (although late-onset acne can occur), whereas rosacea tends to affect adults aged between 30-60 years. Acne spots are often accompanied by blackheads and/or whiteheads, which are not seen in rosacea. Also, rosacea tends to have the associated symptoms of redness, flushing, and burning sensations which are not seen with acne. Rosacea tends to cause redness and red spots in the central face.

What are the different types of rosacea?

There are four main subtypes of rosacea:

1. facial redness, flushing and visible blood vessels
2. acne-like pustules
3. thickening of the skin (most commonly on the nose)
4. eye involvement (watery or blood shot appearance, may have a gritty feel)

What are Dr Nicole’s top tips for fighting acne?

1. Treat acne lesions early and aggressively to prevent long-term scarring
2. Control sebum production
3. Thoroughly remove make-up every night before going to bed
4. Avoid potential triggers (see common triggers for acne listed above)

What are Dr Nicole’s top tips for fighting rosacea?

1. Repair the skin barrier function
2. Target treatments according to the type of rosacea
3. Avoid potential triggers (see common triggers for rosacea listed above)
4. Daily sun protection with a non-comedogenic (non-pore clogging) sunscreen

What if I have acne scars?

Scars are the results of the body’s wound healing and formation of new collagen following damage to the dermis (the deeper layer of the skin). There are several types of acne scars: boxcar scars (similar to a chickenpox scars), ice-pick scars (narrow with deep tracts), rolling scars (superficial ‘rolling’ appearance), keloid/hypertrophic scars (thickened, lumpy scars). Boxcar and rolling scars can be improved with minor skin surgery, dermal fillers, chemical peels and lasers. Icepick scars are better treated with minor skin surgery. Lumpy scars such as keloid or hypertrophic scars are treated with steroid injections into the skin. The red marks that are left behind after the acne spots resolve tend to improve over 6 months to a year. Pigmentation left behind after acne spots can also improve with time, or with light chemical peels. For optimal results, a combination approach is often needed, together with a good skin care regime to stimulate cell renewal. It is also important to avoid smoking as it delays wound healing and affects collagen production.

What treatments are available for acne?

Acne with blackheads and/whiteheads can be treated with comedone extractions, specialist skin care products with targeted ingredients, and prescribed topical treatments. Papulopustular and nodulocystic acne can be treated with a combination of specialist skin care, chemical peels (only suitable for mild cases) and oral treatments (eg. oral antibiotics, hormonal treatments and isotretinoin). For oral isotretinoin, you must not be pregnant, breastfeeding or intending to be pregnant during the course of your treatment (including 6 weeks after stopping your treatment). Oral isotretinoin is currently the most effective treatment for acne. A thorough discussion of the benefits and risks need to be carried out and the course is generally 4-6 months long.

What treatments are available for rosacea?

As rosacea can present in many ways, treatments can range from topical creams, oral medications to laser/light-based treatments. In general, rosacea which causes persistent redness on the face can be improved by a prescription cream. If there is troublesome flushing, this can be controlled with anti-flushing medications. Dilated blood vessels or prominent blood vessels on the skin usually require lasers, light-based or vein-based treatments. If there are red or yellow spots, there are a range of treatments to target the spots, from prescription creams to oral medications. Dr Nicole will assess which elements are present in your rosacea and tailor your treatments accordingly.