September is Acne awareness month, which is important because it can affect your self confidence and it is something that people of all ages. Acne can be mild, moderate, or severe and can be caused by inadequate exfoliation, excess sebum production, hormones, fungal infections, or bacterial infections. The root cause can go even deeper — some people swear by certain diets to help them overcome their acne concerns.
Types of Acne spots
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Milia are small white or skin-coloured bumps that hang out just below your skin’s surface. Unlike comedones, they do not have heads or opening parts to them and rather than being a collection of skin cells and sebum, it is mostly skin cells, making them rough/hard to-the-touch. They are not usually itchy and are often found on the forehead, eyelids, and cheeks.
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Comedones are well-known as many skin products and makeup brands focus on “non-comedonegenic” ingredients in order to appeal to those of us who are prone to acne. Comedones are either black-heads, which occur when the build-up inside the hair follicle is exposed to air and oxidizes, creating a dark appearance inside the pore. White-heads are mini acne papules that have a white head to it as the comedone has a roof to it, unlike a blackhead that has no roof to it.
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Pustules present as comedones that are larger in size and are often surrounded by erythema (redness). They are sometimes described as inflamed comedones that grow in size.
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Papules are sore, inflamed bumps that lurk beneath the skin’s surface. These sores bumps don’t always surface, so will not develop into whiteheads.
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Nodules are like papules, but begin a little deeper in the skin tissue and are more painful than papules. From my experience, nodular acne can at times cause one side of the face to swell due to the inflammatory nature of them.
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Cystic acne is the most severe type of acne spot. They are deep-rooted nodules, but with even more inflammation behind them and can cause tunneling beneath the skin and develop into severe acne scarring.
The best way to prevent acne scarring is to treat acne early. Unfortunately, there are many barriers to receiving treatment for acne. Particularly in my neck of the woods, where dermatologists are so sparse that they only address significant and severe skin issues, such as MRSA infections, or severe treatment-resistant acne. On top of that, there is a lack of primary care physicians and family practitioners in my area, so seeing a doctor is a barrier in and of itself. Even if you are able to get a prescription, there is also the factor of being able to afford the prescription that you are given. Then there is the time and dedication that is required for treatment to be effective.
Some Common Types of Acne
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Hormonal Acne: Hormonal acne is most common amongst women and those living in XX chromosome bodies due to the cyclical nature of their hormone cycles. You may notice acne showing up along your chin and jawline, particularly around menstruation or during times of extreme stress. This type of acne is most commonly treated with prescription oral contraceptives, retinol, and/or benzoyl peroxide.
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Fungal Acne: This type of acne is more common that you might think. It presents as clusters of acne along the forehead, cheeks, or body. This kind of acne doesn’t respond to common acne treatments and may in fact be made worse with OTC acne treatments. If you suspect you have fungal acne, it is best to see your doctor for a proper prescription anti-fungal.
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Friction Acne and Maskne / Mascne / Masknee : This type of acne, as you might have guessed, is caused by friction. This can be related to things such as helmets, hats, facial coverings, masks, or abrasive scarfs. To reduce this, try to reduce the amount of friction by using soft fabrics between your skin and whatever might be pressed against your skin. For example, using a silk or satin fabric between your helmet and your skin may help reduce friction. Another thing you can do is use salicylic acid to spray the inside of your face covering.
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Cell turnover issues: Milia, closed and open comedomes can be a result of skin turnover either being quick or not effective. To help with this, use chemical exfoliants such as salicylic acid or glycolic acid toners. Alpha-hydroxy acids and beta-hydroxy acids are the chemical exfoliants that are most commonly recommended by dermatologists. Another thing you can use to help increase the effectiveness of your skin’s turnover is to incorporate a retinol to your night time routine.
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Over treatment acne: As odd is it might sound, sometimes we over-treat our skin and cause irritation. This irritation can turn into acne on our face. When it comes to skin care, the less you use, the better it can be. Over-exfoliating can cause acne as can under-exfoliating. Avoid mechanical exfoliation (looking at you, apricot scrub) and instead opt for chemical exfoliants. When you are introducing new products into your skin care regimen, introduce only one product at a time and allow your skin to adjust to it before you decide to either add more or remove items. Consistency is also key!
Basic Over-the-Counter Methods of Acne Treatment
This is a very important topic, which will be dived into in more detail in future posts and podcast episodes. Here is a basic list of things that can help you with your skin now! Just remember to research these items before using them and talk with your pharmacist or doctor to make sure that they will work for you.
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Benzoyl Peroxide — useful for moderate to severe acne or for spot-treating mild acne. This is incredibly drying and irritating. If you are new to acne treatments, make sure to start off slow and work your way up to 1-2x daily application. Cleanse your skin, dry, apply benzoyl peroxide and allow it to dry before moisturizing.
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Alpha-hydroxy and beta-hydroxy-acids — use once daily or every other day to help exfoliate your skin. Use after washing your face and allow to dry before continuing on to other items in your regimen. Don’t forget to moisturize appropriately and allow your skin time to adjust. Don’t start off using it every day as you have to make sure your skin builds up a tolerance.
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Retinol-containing serums, creams, or moisturizers — use at night but not at the same time as benzoyl peroxide as the two inactivate one another. If you have moderate or severe acne, it is best to see your doctor for a prescription grade retinol.
Feel Like You Need to See a Professional?
Make an appointment with your doctor to be assessed by a professional. If this is not something within your reach, there are a few telehealth options available to you now. In BC, there are a number of MSP-covered telehealth options available to you. I just tested this one to see if it works: https://medimap.ca/Virtual-Care It is a free service that connects you with a doctor through the Internet. I used my Chrome browser and web camera to visit with a doctor. The wait time was about as average as you would expect from a (virtual) doctor’s office. For me, it was a 25 minute wait to see the doctor. The doctor was able to assess me quickly and kindly through video and had I required a prescription, they would fax it directly to the pharmacy that I selected.
In order to be seen by a doctor through MediMap, you will need your public health care number and will be required to give your address, telephone number, full name, and select a reason for your visit. You do not need to create an account with them, but they will ask you for your email address.
Another service I have used in the past and particularly love because they were able to give me the prescriptions I was hoping for (you can tailor it to your needs within reason) is Felix. I was able to submit all of my information and send it off to them online through their website. The cool thing about this service is their own pharmacy mails the prescription to you and they do direct billing to extended medical services. The downside is that they do charge a fee for each new visit, but not for follow-up requests. It is $40.00, which I feel makes it worth it because you only have to dedicate enough time to fill out their visit request forms then the doctor or practitioner will review the request and contact you. This means that there is no need to wait to talk directly with the clinician. You can use Felix anywhere in Canada by clicking this link.
