Wondering how to treat acne blemishes? We asked TONIC15 skincare school expert, Dr Ayah, for the answers

Did you know that more than 90% of the world’s population will experience acne at some point during the lives? While a staggering 85% of people aged 12-24 [1] suffer with spots, whether mild, moderate or severe?

Yup, acne affects a lot of us and is one of the most common complexion concerns.

Unfortunately, it can have significant negative effects on an individual’s mental health, knock their confidence and leave them frustrated as they try product after product that doesn’t make a difference.

Without proper knowledge, it can feel like the search for a resolution is always just out of reach.

However, taking the time to understand the science behind acne can help equip you with the tools and knowledge for how to treat it.

So, we’re going to help you sift fact from fiction, zero in on the ingredients that are right for blemish-prone skin and recommend the products that’ll take you one step closer to a clear complexion.

￭ What causes acne?

To understand acne, we need to explore what’s known as the pilosebaceous unit. This is a hair follicle which contains a sebaceous (oil) gland, the opening of which is known as a pore.

There are four steps in the formation of acne, each of which we’ll reakdown to make it clear how blemishes and spots form – and subsequently, what you can do to stop them before they take hold.

1. Follicular Hyperkeratinisation

First, something (we’ll discuss this more thoroughly later) causes the follicles to become enlarged. Then cells within the follicle become sticky, inflamed and cannot shed properly.

2. Androgen mediated increased sebum production

Next, hormones within your body bind to receptors in the oil gland and cause excess oil to be produced. The excess oil and sticky cells clump together.

3. Obstruction of sebaceous follicle

This causes a blockage of the pore.

4. C Acnes follicular colonisation and inflammation

Bacteria then thrive in this environment by feeding off the oil, as well living in a reduced oxygen environment, which then causes inflammation which leads to redness and pus forming. If this continues for a prolonged period of time, the bacteria penetrate lower into the dermis and cause further issues within the skin which can lead to scarring.

￭ Some common acne triggers

There are several factors that can cause acne – and it’s not just the reserve of teenagers. Our age, lifestyle and hormonal state can all lead to spots.

• Puberty:

During puberty, there’s an increase in androgen hormones throughout he body, which cause an enlargement of sebaceous gland. This leads to an increase in oil production and subsequently more blockages.

• Menopause:

• Stress:

An increase in the stress hormone Cortisol also increases amount of testosterone in the body which causes an enlargement of sebaceous gland. This leads to an increase in oil production and subsequently more blockages.

• Menstrual cycle

The menstrual cycle sees the increase of a hormone called Lutenising after you ovulate. which cause an enlargement of sebaceous gland. This leads to an increase in oil production and subsequently more blockages.

• PCOS

PCOS leads to higher levels of testosterone being released which cause an enlargement of sebaceous gland. This leads to an increase in oil production and subsequently more blockages.

As you can see, all of these factors alter the hormone levels in the body which has a direct impact on skin. From increasing oil production to enlarging the sebaceous glad, all of these blockages that occur within the pilosebaceousleads to increased breakouts.

￭ Common types of acne

What is a comedone?

 A comedone is a skin coloured acne papule (bump) commonly found on the forehead and along the jaw and can be broken down into different types:

• Blackheads: (Open comedones) This is a plug of cells and oils that is open to the skin surface. The mixed plug can be oxidised by the sun to give it the black colouring.
• Whiteheads: (Closed comedones) This is a plug of cells and oils that is closed to the skin surface. The closed plug encourages bacteria to grow which instigates a local irritation and inflammation. This is why you can see the redness and it can start to feel painful.

Other types of acne include:

• Papules – small, red bumps that may feel tender or sore
• Pustules – similar to papules, but these have a white ‘tip’ in the centre, caused by a build-up of pus
• Nodules – large, hard lumps that build up beneath the surface of the skin and can be painful
• Cysts – the most severe type of spot caused by acne. They're large pus-filled lumps that look similar to boils and carry the greatest risk of causing permanent scarring. Abnormal production and degradation of collagen during the healing process leads to alterations in collagen amount. In 80 to 90 percent of cases, there is a net destruction of collagen in the dermis that results in atrophic scars (ice-pick, rolling and box scars). These are seen as depressions in the skin. Less commonly, there is a net gain of collagen that results in hypertrophic or keloid scars – which is seen as thickening of the area. [2]

So, let’s think about this logically.

There are three different factors that combine to cause acne: blockages caused by excess oil, sticky sells that haven’t shed properly and then bacteria – if you work to control those factors, you’ll start to see an improvement in your skin.

￭ How to treat acne

If there are three factors that cause acne, there are three opportunities to try and treat it:

1. Reduce the excess oil
2. Help the sticky cells to shed
3. Manage the bacteria

Okay, lets break this down even further:

How to regulate oil on the skin’s surface

• Retinoids (Retinol, Retinal, Tretinoin etc). These help regulate sebum production, have an anti-inflammatory effect, stimulate collagen production and improve cell turnover.
• Using Beta hydroxy acids (BHAs) like Salicylic acid and betaine salicylate that can breakdown the oil plug. It works by loosening and breaking apart the attachment between cells in the outer layer of skin (demosomes). This desmolytic action encourages exfoliation of the skin and unclogging of pores.
• Hormonal control – taking the contraceptive pill. When there are higher levels of androgens (explained above) there is increase in the amount of oil/sebum produced. If we can regulate hormones, we can stop the oil glands from being excessively triggered to produce excess oil and subsequently less chance of blockages.
• Sulphur– such as that found in the By Wishtrend Sulphur Clean Gel absorbs excess oil rather than allowing it to sit and clog the pore

How to manage the sticky sells

• Alpha hydroxy acids (AHAs) like lactic acid, mandelic acid (Think By Wishtrend’s Mandelic Acid 5% Skin Prep Water), glycolic acid that help the body naturally shed cells better. These are unable to penetrate through oils, so are not as effective as BHA for clogged pores.
• Beta hydroxy acids (BHAs) such as salicylic acid and betaine salicylate. (Think Make P:rem Radiance Me Mild Essenttial Peeling Gel and Dr. Ceuracle AC Care Blue One)
• Retinoids

HOW TO BANISH BACTERIA

Just think if the bacteria can’t grow and multiply, there is less chance of inflammation.

• Benzoyl peroxide which works to inhibit the bacteria
• Topical antibiotics like Clindamycin

￭ Where does K-beauty come in?

Korean skincare has a number of ingredients and products than can help with acne.

1. Numerous acid-based products containing Alpha hydroxy acids (AHAs) and Beta hydroxy acids (BHAs) – these work to unclog the pores.
2. Tea tree - which has known antibacterial and anti-inflammatory effects. It’s worth nothing antimicrobial properties are when the products contain 5% tea tree, and most skincare contains less than 0.5% to minimise the potential skin irritation.
3. Green tea extract – reduces the amount of oil produced and had anti-inflammatory properties
4. Bamboo extract – This helps the body to retain water for natural repair and cell cycle renewal.
5. Centella Asiatica – anti-inflammatory and antibacterial properties. It won’t prevent new acne from forming, but it will make a difference to how inflamed your skin becomes when youre breaking out, which in turn will affect how you scar. (remember less inflammation = less scarring)
6. Mugwort – anti-inflammatory and antibacterial properties
7. Propolis – anti natural antiseptic substance which helps reduce inflammation. It works by inhibiting the growth of bacteria.

8. Snail mucin – antibacterial properties which helps keep the bacteria at bay. It also helps your skin barrier which means less inflammation and faster healing.

￭ A tried-and-tested K-beauty acne beating regime

Knowing exactly what products to pick to help treat your acne can be tricky, so we’ve put together a blemish-busting bundle teeming with the spot-fighting ingredients we’ve covered in this blog. From an oil-balancing cleanser to a sulfur gel, each is designed to help you achieve a clearer complexion.

  |Cleanse|

    |Treat|

[1] Bhate K, Williams HC. Epidemiology of acne vulgaris. The British journal of dermatology 2013;168:474-85.  [2] . (Connolly D, Vu HL, Mariwalla K, Saedi N. Acne Scarring-Pathogenesis, Evaluation, and Treatment Options. J Clin Aesthet Dermatol. 2017;10(9):12-23.)

Dr Ayah is an aesthetic doctor and dentist with a passion for all things skin. Having spent more than a decade studying biomedicine, biochemistry, anatomy, dentistry and physiology at University, she’s skilled in many a complexion concern.

While studying, Dr Ayah worked as a makeup and skincare consultant for numerous brands at Harvey Nichols and Selfridges. After graduating, she decided to align her two interests – science and skincare – by completing studies in medical-grade skincare, facial treatments and aesthetics.

Over the years, Ayah has developed a personal passion for K-beauty and how it amalgamates the worlds of beauty and science. When she’s not discussing aesthetic treatments with friends and family, you’ll find her either playing with mounds of makeup to create bright and colourful looks or helping people through life coaching. She, like all of us at TONIC15, is a big believer in the power of self-care, education and kindness.

With her science-based skill set and knowledge of all things skin, Dr Ayah will be working with us through #SkincareSchool decoding ingredients, products and formulas.