Our comprehensive guide to identifying, treating and preventing stubborn adult acne.
Pimples, pustules, nodules, cysts, blackheads, whiteheads ... you may not be familiar with all the different terminology attached to these pesky bumps, but you’ll certainly know them when you see them.
Big, red and angry, or small and virtually unnoticeable, if your breakouts cause you bother, that’s reason enough to address them.
The journey to treating acne can be a long and laborious one, with dreaded bumps pushing even the best of us to great lengths to be blemish-free once again.
From slathering toothpaste on our faces, to daubing on harsh chemicals to open sores, the majority of us have resorted to desperate measures in a bid to zap zits.
Sadly, there’s no one-size-fits-all approach to ridding skin of unwanted bumps but the key to achieving skin success may lie in coupling active topical ingredients with in-clinic treatments to help banish blemishes for good.
To help us sort through the complexities of acne and how best to approach each of its forms, Viva turned to Murad educator Linda Sharrem, Caci skin therapist educator Taryn Johnstone, and The Facialist director Ashleigh Scott.
Together, these skin experts break down everything there is to know about breakouts.
What is acne?
Simply put: acne is a skin condition which occurs when pores become plugged sebum, skin cells and bacteria.
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Advertise with NZME.According to Linda, it’s typically caused by a hormonal imbalance which is most common in pubescent teens when their skin begins to produce excess oil. “Hormonal acne can also be triggered by stress, excess cortisol and our adrenals,” she says.
“Other causes usually include not having a consistent skincare regime, it’s really important to cleanse and take off our makeup to keep skin clean and clear. Dehydration and diet can also contribute.”
All forms of acne can generally be broken down into two main categories: inflammatory or non-inflammatory acne.
But before we talk through the different types of acne that may appear on the face and body, let’s first examine what it’s not.
Milia are often mistaken for acne as they’re visually similar to whiteheads, small white or yellow dome-shaped bumps.
They’re actually a hardened build-up of keratin under the skin that cannot be popped in the same way a pimple can.
Milia can often disappear on their own, or by using an exfoliant targeted to treating acne (ironic, we know). Alternatively, book in to see a skin specialist or dermatologist to have it professionally extracted if their appearance irks you.
Non-inflammatory acne
Non-inflammatory acne is also known as comedonal acne or the smaller types of acne like blackheads and whiteheads, which generally appear where your face oilier, like your T-zone, chest and back.
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Advertise with NZME.WhiteheadsAccording to Taryn, whiteheads are typically bacteria-related and appear as little white bumps on the skin. Whiteheads are also known as closed comedones, which describes the thin layer of skin that protect its contents from exposure to air, and so appear white or yellow in colour, the default colour of oil and dead skin cells.
Blackheads On the other end of the spectrum are blackheads, or open comedones, where trapped oil and dead skin cells are exposed to air. This type of pimple gets its darkened appearance from how the air reacts to the sticky gunk in the pore, giving it a literal black head.
Fungal acneFungal acne can form on the forehead, jaw, hairline, chest and back. It is caused by an overgrowth of naturally occurring fungi that live on the skin. Sweat, friction and humidity are the biggest offenders when it comes to fungal acne, so your best line of defence is to rinse skin well after a sweat session and apply products with antimicrobial properties that halt the growth of acne-causing bacteria.
Inflammatory acne
Inflammatory acne is often the result of an overgrowth of P. acnes bacteria on the skin, which can cause swelling, redness and discomfort. It occurs deeper in the skin than non-inflammatory acne and lesions may cause scarring or post-inflammatory hyperpigmentation.
PapulesThink of papules as inflamed whiteheads, says Taryn, red, swollen bumps that are sore to touch. Typically, papules don’t contain any visible fluid (or whitehead) and are usually smaller than 5mm in size.
PustulesUnlike papules, pustules are inflamed bumps with a visible whitehead you may feel tempted to squeeze. But before you pop or pick, Taryn warns pustules may spread when they are ruptured and inflamed, leading to more breakouts. Pustules vary in size between 1mm and 5mm, and are the result of an overgrowth of P. acnes bacteria.
NodulesNodules are hard, painful lesions which penetrate deep into the skin, making them difficult to treat. Unlike other forms of acne, these large, firm bumps don’t contain pus and may cause scarring if left untreated.
CystsThese large, pus-filled lesions look similar in appearance to boils, and form deep under the skin. Like papules and nodules, cysts are painful to touch. Cystic acne is commonly linked to genes or hormones.
How to treat acne
The best course of treatment differs depending on the type of acne you have and your skin type, but all our experts agree you should never strip acne-prone skin of its moisture or oil.
“You will end up encouraging the skin to produce excess oil, which can result in more congestion and breakouts,” Taryn says.
It’s a common misconception that using hydrating products on skin will cause more breakouts, Linda adds. “This is simply not true and not moisturising can actually lead to an overproduction of oil having the complete opposite result for what you were aiming for,” she says.
TOPICALLY
The gold standard of topical acne fighters includes retinol and salicylic acid, which are found in myriad over-the-counter spot creams and pastes.
Salicylic acid has long been a favourite of dermatologists and skin specialists alike for its ability to break down the outer layer of the skin, reducing the likelihood of both non-inflammatory and inflammatory acne.
“Salicylic is best for blemishes as it dissolves the oil not only on the skin’s surface but also the oil and debris trapped in pores. Salicylic acid is found in blemish-specific cleansers, treatments and moisturisers, and is antibacterial and anti-inflammatory, so it’s a win-win,” Linda says.
Try it in cleansing form with Skinnies The Acne Bar, $30, which contains two per cent salicylic acid to clean out pores and prevent acne from forming.
Follow the golden rule of low and slow (in percentage concentration and frequency of use) if you’re new to retinol, another ingredient which Linda recommends adding to your acne arsenal to treat non-inflammatory acne.
“Retinol works to help to reduce the effects of over-excited sebaceous glands and speed up cell turnover all reducing congestion and build up on the skin’s surface,” she says.
“It also helps with skin texture and the appearance of pores, while supporting the production of collagen helping with scarring that can often be the result of acne.”
Try Murad Retinol Youth Renewal Serum, $189, which sees retinol and hyaluronic acid combine, or Verso Blemish Fix, $153, which contains a stabilised vitamin A complex, pore-minimising niacinamide, and zinc PCA to control oil production.
Hyaluronic acid is also a must for keeping skin hydrated and better equipped to tolerate acne-fighting products.
"The more hydrated our skin can be the better," Tarryn says, adding that moisture is important for balancing overactive sebaceous glands from over-producing oil. Try using a water-based moisturiser containing hyaluronic acid like the Murad Clarifying Oil-Free Water Gel, $102, or the recently renovated Kiehl's Ultra Facial Oil-Free Gel Cream, $55.
If you feel a painful cyst beginning to form, reach for a pimple patch. Skyn Iceland Blemish Dots, $37, are virtually undetectable on skin, and deliver beneficial ingredients like salicylic acid and tea tree to help purify pores and shrink spots.
Consider incorporating a facial cleansing device into your nightly routine, like the Foreo Luna 3 Combination, $336, which is dotted with antimicrobial silicone bristles.
Not only will it help remove makeup, dirt, oil and impurities, but the device pulsates 8000 times per minute to gently vibrate debris out of the skin.
Other skin tech to factor into your anti-acne regime include a blue-light device, like the new Dr Dennis Gross limited-edition Pewter DRx SpectraLite FaceWare Pro, $768, which is fitted with 100 red and 62 blue LED lights to combat discoloration, blemishes and wrinkles. It is available from March 30.
If you’re after a more holistic approach, Ashleigh recommends seeking out products that support healthy skin function.
"When the skin is functioning healthily it will be in a better position to be able to heal itself. Focus on hydrating the skin daily, using gentle cleansers that will clean skin without stripping, clay masks to help draw out impurities, hydrating serums for overall skin health, targeted treatments with niacinamide for healing, and spot treating with AHAs," she says. Try Nuori Clarity Mask, $78.
IN THE CLINIC
When it comes to treating acne in the clinic, you’ll often need a combination of treatments to target both the bacterial breakouts and the scarring and post-inflammatory hyperpigmentation left behind.
Long-term maintenance needs to be the goal, and any treatment plan should be reassessed every three months as the skin changes.
LED light treatments using a combination of red and blue light work two-fold at targeting bacteria and healing skin in one fell swoop, Linda says. “It involves all the steps to clear breakouts and assist the skin with healing.”
Blue light is anti-bacterial to P. acnes bacteria in the skin, while red light is a known anti-inflammatory to help soothe redness and discolouration on the surface layers of the skin.
“LED is amazing at healing acne and helping with scarring,” Ashleigh adds. “LED is a light treatment that boosts the skin’s production of collagen, significantly helping heal and repair skin.”
For acne scarring, Linda recommends a course of micro-needling (also known as collagen induction therapy). This non-surgical treatment boosts collagen production by creating tiny pricks on the surface of the skin that triggers the body’s own wound healing response.
Medium-strength chemical peels are an excellent option for superficial scarring, while very deep, pitted scarring may require a combination of chemical peels, micro-needling and fractional C02 laser.
Stubborn acne lesions like cysts and nodules that are deeper in the skin may call for a visit to your dermatologist.
Prescription topicals, oral antibiotics, steroid injections or even an incision and drainage are all options that can be offered under the guidance of your medical professional.
The cover-up
Our experts agree it’s best to let congested skin breathe, but if you absolutely cannot bare leaving your blemish bare, look for a mineral-based or natural concealer containing antimicrobial ingredients like zinc or titanium dioxide to promote skin health.
“These ingredients will help to heal the skin and can be non-comedogenic, meaning they won’t clog your pores,” Taryn says.
Viva loves Aleph Beauty's Concealer/Foundation, $60, which contains natural extracts to protect, nourish and hydrate skin while perfecting its appearance.
To pop or not to pop?
So, you caved and popped or picked a pimple. Now what?
“It’s fine to squeeze a pimple if you do it in the right way,” says Ashleigh, adding the best time to do it is straight after a steamy shower when your skin is its most hydrated.
“Make sure your fingers are wrapped in tissue and never overdo it (if you have to squeeze too much and it doesn’t come out easily, stop!). Afterwards apply an acid toner to the area and, if it’s inflamed, an ice cube to reduce swelling,” she says.
Whatever you do, Taryn warns against picking or touching a pimple after it’s been popped.
“Leave it be and keep it clean and hydrated,” she says. “When we pick or pop blemishes the skin is very fragile to bacteria and the breakout spreading, resulting in more blemishes.”
STOCKISTS: Alephbeauty.com; Dr Dennis Gross, Foreo, Skyn Iceland and Verso from Mecca or online from Meccabeauty.co.nz; Murad from Caci clinics or online from Caci.co.nz; Nuori available from The Facialist or online from Thefacialist.co.nz; Skinnies available from selected pharmacies or online from Skinnies.co.nz.
