Spots, blemishes and acne are all normal – and something everyone deals with. But if you’re someone who struggles with acne on a regular basis, finding information that can help you can be a minefield. Do you strip back skincare, and go the gentle approach? Or should you be ramping up the salicylic acid and retinol, tackling blemishes head on? Maybe there are lifestyle factors playing into your acne – and would a holistic overhaul be best? 

The skincare space can be confusing – with misinformation rife. Securing a dermatologist appointment is always the best way to go – but these can be hard to come by and expensive. So, we spoke to leading consultant dermatologist Dr Anjali Mahto, to help explain the differences between cystic and hormonal acne – and suggest some of the best treatments available to you…

“Hormonal acne primarily occurs in response to fluctuations in hormone levels, particularly androgens like testosterone,” explains Dr Mahto. “It commonly manifests as papules, pustules and is typically found around the jawline, chin, and cheeks. Hormonal changes during puberty, menstrual cycles, pregnancy and menopause can trigger hormonal acne. Additionally, conditions such as polycystic ovary syndrome can exacerbate hormonal imbalances, leading to acne flare-ups. Stress can also influence hormone levels, potentially worsening hormonal acne.”

“Cystic acne is characterised by deep, painful nodules and cysts, often leaving behind scars. While hormonal factors can contribute to cystic acne, it’s not exclusively driven by them. Genetic predisposition plays a significant role, as does excessive oil production, which can clog pores and lead to inflammation.” 

“Diet, particularly high-glycemic foods, dairy and certain fats, may potentially exacerbate cystic acne by influencing insulin levels and increasing inflammation. Environmental factors such as pollution and humidity can also aggravate acne by affecting skin barrier function and promoting bacterial growth.”

“While hormonal acne is primarily influenced by hormonal fluctuations, cystic acne involves a more complex interplay of genetic, environmental, dietary and hormonal factors.”

“Some individuals are more prone to acne than others – and age can also play a significant factor. In adolescence, hormonal changes during puberty play a primary role in the development of acne. Increased androgen levels stimulate the sebaceous glands to produce more oil, leading to clogged pores.”

“Genetics also contribute significantly – those with a family history of acne are more likely to develop it themselves. As we move into adulthood, hormonal fluctuations continue to influence acne development, particularly so for women. Fluctuations in hormone levels throughout the menstrual cycle, pregnancy and menopause can trigger/exacerbate acne.”

“Beyond hormones, lifestyle factors can also influence acne. Stress, dietary choices and environmental factors can all impact skin health.”

When it comes to treating acne, a holistic approach under the guidance of a consultant dermatologist is often necessary to address the various underlying causes.

Topical treatments:

• Retinoids – these derivatives of vitamin A help unclog pores, reduce inflammation, and promote skin cell turnover
• Benzoyl peroxide – an antibacterial ingredient that can help reduce acne-causing bacteria and prevent further breakouts
• Salicylic acid – helps to exfoliate the skin, unclog pores and reduce inflammation.

Medications:

• Antibiotics – these can help reduce inflammation and kill bacteria contributing to acne
• Oral contraceptives – these are particularly beneficial for women with hormonal acne as they can help regulate hormone levels and therefore improve acne.
• Isotretinoin – for severe cases of acne, isotretinoin can reduce oil production, prevent clogged pores and has long-lasting effects.

In-clinic treatments: 

“Then there are also some robust in-clinic procedures we can offer acne patients. One particularly exciting development is the introduction of the AviClear laser. AviClear uses laser therapy to selectively target the sebaceous glands, suppressing their activity. This halts the overproduction of sebum, knocking out a key trigger for the onset of acne, much as oral medications such as isotretinoin aim to do. The AviClear protocol consists of three 30-minute treatments spaced 3-4 weeks apart, with no downtime after each; it provides a convenient and highly effective solution for acne sufferers who don’t either don’t want or can’t take medications.”

Images: Getty