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Why the way we think about acne is changing

What if we told you that a lot of what you thought you knew about acne was wrong? It turns out that familiar common causes – like eating a triple-choc fudge brownie or forgetting to wash your make-up off before you hit the treadmill – aren’t as detrimental to your skin as you thought and aren’t responsible for your breakouts either. Shocked? Us too. And that’s not the only info that’s come to light.

You’ve probably heard of the gut microbiome and its link to everything from digestive health to chronic disease. Now, new research has found that your skin’s microbiome – the community of bacteria living on your body – has a huge impact on your skin quality and, in particular, acne. Based on these findings, the way you approach and treat acne needs to change.

In a bid to learn more about the latest findings, we travelled to New York to speak with acne-treatment pioneers Dr Katie Rodan and Dr Kathy Fields, dermatologists and founders of Rodan+Fields.

They were also the brains behind acne-busting brand Proactiv, so they have a long history with and deep knowledge of the condition.

Here, they share their advice to help you understand acne once and for all.

Acne redefined

If like us, you thought the term ‘acne’ was reserved for serious breakouts or hard-core nodules, you’d be wrong. In fact, the term covers every blemish or spot you’ve ever had.

“Blackheads, whiteheads, pimples, papules, pustules, nodules, cysts… they’re all acne,” says Dr Fields. “It’s a whole range of different bumps at different ages, including those you get once a month.” So it makes sense that 85 per cent of teenagers have it and 40 per cent of women experience acne as adults.

How does a breakout occur? Simply put, it all starts when a hair follicle inside a pore becomes blocked with oil and dead skin.

Then, due to myriad causes – a change in hormones, genetics, stress – the oil inside the pore becomes too sticky and forms a plug. While science hasn’t ignored the role bacteria plays in acne, for decades it’s focused on one type in particular:

Propionibacterium acnes (P. acnes, more recently known as C. acnes). Scientists saw C. acnes proliferating in the blocked pore and causing inflammation, so acne treatments focused on getting rid of this ‘bad guy’ of skin bacteria.

“We used to believe it was all about how much C. acnes bacteria there was on the skin. We’d focus on that and go in to kill it and gain control of the acne,” explains Dr Rodan. “But we’ve now learnt that people who don’t have acne have the same number of C. acnes bacteria as those who do.” A recent research review published by the University of California stated that not only is C. acnes found in all skin types, but also that it interacts with other microorganisms – in other words, this bacteria can be good or bad, depending on who its neighbours are.

Here’s how the experts now explain the acne-forming process: “The bacteria living on the skin surface forms a colony inside a protective shell that’s made of a gluey, sugary substance [polysaccharides],” says Dr Rodan. “The microbiome goes down into the pore and a transformation begins when the pore gets blocked. The C.acnes bacteria that was friendly on the surface of the skin then becomes angry due to a lack of oxygen. It kills all the good bacteria and your body responds with inflammation and that’s when you get a red, angry bump.” Based on these new findings, the team at Rodan + Fields has reformulated its Unblemish adult-acne line and created an entirely new line for teens, Spotless.

Both lines use revolutionary new technology and hero ingredient benzoyl peroxide to kill the bad bacteria and stabilise the biome.

The triggers

What’s behind the bump is where it gets complicated as it can be any one or a combination of lifestyle aggressors.

“Genetics, hormones, stress, diet, pollution or a change in temperature can all trigger acne,” says Dr Fields.

Genetics plays a large part in your skin’s condition – if your parents had acne, it’s likely you’ll experience it, too – and can also affect your inflammatory response.

Hormones also play a large role. “It’s a trigger for everybody,” says Dr Fields.

“Women can have a bumpy ride when they’re young, and then when you hit your 20s and 30s it may even out and you get breakouts premenstrually.” Taking birth control pills or other hormone-altering medicine can help manage acne but it won’t cure it on its own, she adds.

If you’ve reluctantly cut sugar and dairy from your diet, you may be relieved to know you can put it back on the menu. “Eating the wrong food is not the be-all and end-all,” says Dr Rodan, who adds that while certain foods can have an impact on your skin, “it’s not going to be the cure – you can’t eat your way free of acne”.

Both experts believe that, given the variety of triggers, a multi-faceted approach to acne works best, with a strong emphasis on being disciplined with your skincare regimen.

Breaking down your breakout

1. Blackheads

Black dots that often appear along your T-zone. The clogged pore is open, so it begins to oxidise and turn black.

2. Whiteheads

Look like little bumps on the skin’s surface. They’re similar to blackheads but are covered by the skin, so don’t oxidise.

3. Cysts

Deep pockets of white-blood cells under the skin that can’t be popped.

Don’t pick – they have a high chance of scarring.

4. Nodules

Tender, inflamed lumps under the skin with no head.

They can cause severe scarring and are painful to touch

Prevention is paramount

“The temptation has always been to treat the bump, but that doesn’t make sense because the whole process happened weeks before you ever saw that bump,” explains Dr Rodan. “It’s what you do every day that makes a big difference to your skin both today and in the future.” Dr Fields adds: “Eighty-five per cent of people self-treat, which means they fall into scenarios such as trying a new product and getting irritated, so they stop using it; or [the acne] may start to clear up and they think they’re cured, so again they stop; or they don’t see immediate results and they stop. It took two weeks for that pimple to show up – it’s going to take a little while for it to go away. It’s a chronic condition, so when you find something that works, you need to stay on it to stay clear. You may not be in control of the problem, but you are in control to treat and prevent it.”

Test your treatment

Try this simple test to work out whether your new products are working for you

Dr Fields says it’s as simple as snapping a few selfies. She suggests taking a picture before you start using any new products, and again four to eight weeks later (which is a full acne cycle, or two). “If you’re not seeing a visible transformation in the quality of your skin, then that’s your clue to try something different or to see a dermatologist,” she says.

Let’s talk treatment

Here are the latest acne-fighters worth knowing about

The MMT skincare approach

The multi-med therapy approach is a system of skincare products that uses the right ingredients, in the right formulations, in the right order.

Based on the latest findings, R+F’s new line for adult acne follows the MMT approach and harnesses the breakout-and-bacteria-balancing powers of benzoyl peroxide and salicylic acid. “Benzoyl peroxide is the most effective molecule for acne treatment,” says Dr Fields. The line consists of an exfoliating wash, a toner, a treatment lotion and a mattifying SPF 15 lotion. And since acne isn’t the only adult skin concern, the range also includes an array of anti-ageing ingredients.

RODAN + FIELDS UNBLEMISH REGIMEN ($254 for four products,

In-clinic care

The latest in-clinic therapy on our radar is SGA, or sebaceous gland ablation. It’s a long-term, permanent in-clinic treatment that destroys the gland that secretes oil and sebum into the pore. A fine needle is inserted into active acne lesions and a gentle electrical current melts the gland. The process can take anywhere between six to 10 treatments over 12 months, but promises to stop the acne cycle.

DR McCAFFERY’S ACNE TREATMENT ($129 per session, clearskincare

At-home gadget

This handheld gadget uses multiple wavelengths of red and blue LED light to kill the bacteria that causes acne, reduce inflammation and even add radiance to dull skin. Used with skincare products, it can aid in helping to heal blemishes and prevent future breakouts.

Just a few minutes a day will do the trick.