Emma Hobson is the Education Manager for the International Dermal Institute and Dermalogica, and she recently shared her extensive knowledge with us on the subject of acne. :
What is the difference between blackheads and whiteheads?
Answer: A blackhead (comedone) is an over active oil gland (sebaceous follicle) that is clogged with oil (sebum), dead skin cells, tiny hairs, and sometimes bacteria that combine to make a plug. The surface of the plug being in contact with the air at the opening of the follicle oxidizes and turns black. That’s why when you remove a blackhead the top is back but the rest is a creamy colour. They occur due to dirt, oil debris accumulating in the follicle often from poor skin cleansing and exfoliation and incorrect product use, especially when using comedogenic ingredients in makeup, hair care and skin care.
A whitehead (known as a closed comedone or a milia) is where a plug of congestion (sebum and dead skin) has hardened in a follicle and a cap of dead skin cells has grown over the opening/surface of the follicle, or, the follicle opening is very small trapping the congestion inside the skin. Hence the top does not turn black like a black head. Whiteheads are commonly found where the skin is finer e.g. around the eyes and tops of the cheeks. They are non-inflamed lesions.
Is it ever OK to pop?
Answer: Definitely leave a whitehead to the professionals to remove, either a Dermatologist or a Skin Therapist who is licenced to remove them. Whiteheads need to be lanced if severe. The best way to help treat them is through regular exfoliation, applying a hydroxy acid product – ideally containing Salicylic acid and Lactic Acid, found in boosters, concentrates and masks.
If you are referring to popping a spot my answer is absolutely NEVER squeeze a spot. This is an inflamed lesion filled with bacteria, if you squeeze you can spread the infection, cause damage to the very delicate skin around it and end up having not only more spots but a scar as a result.
Removal of blackheads: You can with caution extract blackheads. However I recommend you leave it to the professionals and take a visit to a skin care therapist as they can remove them quickly and effectively without causing any trauma or damage to the skin. Since a blackhead is the precursor to a spot they are better out than in! Instead look for treatment products that clear and decongest the skin such as overnight clearing gels, antibacterial skin wipes, and oil absorbing clays and products that mattify that can be used throughout the day. Look for products that contain Salicylic acid, this is the only exfoliating ingredient that can work on the ‘inside’ of the follicle losing the impaction so the blackhead is released.
What causes acne?
Answer: The major culprit for acne is our hormones. The major hormones that affect skin are the sex steroid hormones, thyroid hormones, stress and growth hormones. In addition to hormones, our lifestyle e.g environment, diet, the medication we take, our product usage e.g. comedogenic products all are contributing factors.
For those with scarring from pimples is there any way to fix this?
Answer: Treating acne scarring is not easy nor quick, it takes patience and regular use of products and sometimes medical treatments. Whilst the skin still has a red residue from where the spot has just been I’d recommend using products that contain a high volume of anti inflammatories this will help heal the lesion, reduces the incidence of scarring and since inflammation is associated with pigmentation (the discolouration of the skin) you will also reduce the chances of a darker, pigmented scar.
Using pigmentation lightening products containing ingredients such as Oligopeptide 34 and 51, Vitamin C and Liquorice are all of benefit. Incorporating products such as masks and serums with Vitamin B5 (panthenol) to improve skin healing will also be of benefit. It’s important to use a sun screens SPF30-50 + every day to help prevent the discolouration of the skin. Exfoliation is important, the best option is using Lactic Acid as it has skin lightening properties as well as being a very effective exfoliant and will help slough off the pigmented tissue and speed up the cell turn around for a brighter looking skin. If the scar is deep and has been there for some time going via the medical route is probably the best option, with treatments such as deep peels, laser or light therapy.
If you are long past your teens and still experiencing acne, what is your advice? What at home products would you recommend for those who are concerned about acne?
Answer: I’d advise using skin care that is designed to address adult acne VS teen (and is non comedogenic), in addition receive regular professional skin treatments, since stress is a major factor to this type of acne look at reducing your stress levels through yoga, exercise, meditation etc. Eat a balanced nutritious diet. All these will help to ensure you keep the condition at bay, however never say never!
Skincare: When having a professional treatment: Look for customised skin treatments that have a professional range specifically tailored for adult acne, this would be an anti-bacterial range of products. Have regular professional exfoliation treatments. Try a light therapy treatment using ‘blue light’ which targets acne breakouts. Avoid professional product ranges that don’t guarantee they are non comedogenic.
Don’t try and strip your skin with harsh cleansers, clarifying lotions, toners that contain SD alcohol, they may dry your skin temporally but they can sensitise the skin and encourage the skin to produce more oil. They also dehydrate the skin so can cause a further issue that result in skin congestion.
Cleansing: Cleansing is such an important step in skin health and preventing breakouts, so dedicating a minute or two on your cleansing routine will be of great benefit. I’d recommended cleansing twice in the morning and twice in the evening. First with a cleansing oil, these are terrific at really deep cleansing the skin and the second with either an antibacterial facial gel was or if you are very oily, a clay based cleanser. The clays act like a mini mask and can absorb the excess sebum/oil off the skin without drying the skin out. Remember to cleanse into the hair line and around the ears and down the neck focus on areas of congestion. Wash your cleanser off then repeat the process one more time. The second cleanse you’ll need even less cleanser and you will really feel this clean the skin.
A fantastic product to use are medicated cleansing wipes designed for adult acne, they can clean and decongest and skill any surface bacteria easily and quickly off the skin during the day, especially great after sports or any outdoor activity. Exfoliation is a key step in the treatment as well as maintenance of breakouts as it helps keep the skin from becoming congested. I’d suggest using Hydroxy Acids in particular Salicylic Acid (great for blackheads/breakouts as it is a fantastic decongestant of follicles) or digestive enzymes (pineapple or papaya) in products that are daily leave on (lotions/serums/overnight treatment products) and focused exfoliants such as cream mask based, multi vitamin exfoliants, resurfacing lotions.
Masking: I’d recommend using a deep cleansing sebum controlling mask at least once or twice a week. There are some fantastic masks available, for adult acne (congested oily skin with breakouts) try using a clay based masks that draw out impurities, absorb excess oil and help decongest the skin.
Treatment products: Overnight Clearing Gels, Mattifying lotions and moisturisers that control excess sebum, purifying wipes used during the day to keep the skin clear and the sebum flow and in check. There are some fantastic products that you can put directly on a spot to help heal it quickly and effectively. Some are used at night some throughout the day. A great daily treatment is an active spot recovery treatment that also contains a mineral/natural conceal make-up so it hides the spot but is not comedogenic as the majority of concealers are in make-up ranges. The best way to reduce pore size is to control the oil flow and the best way to reduce oil flow is to use an ingredient called Enantia Chlorantha Bark which has a 36% in reduction in pore size, 49% reduction in sebum flow and 55% less skin shine.
Don’t avoid using sun screen, there are some sun protection SPF products make the skin feel oily and shiny and are comedogenic (give you breakouts), but not all! There are some amazing sun protection products that double up as a moisturiser, are non comedogenic (so no worries about breakouts) and actually are designed specifically for oily skin with congestion and breakouts. They are super lightweight; oil free and actually matiffying (so no shine!). In addition they have acne fighting ingredients that work on preventing congestion and breakouts leaving the skin hydrated, protected and clear.
What ingredients should we look for to help with pimples?
Answer: As a guide find products that have some or all of the following ingredients:
Niacinamide and Nordihydroguaiaretic Acid which help with oily shine. Salicylic Acid and Lactic Acid stimulate natural exfoliation to eliminate the congestion. To control bacteria look out for Spirea Ulmaria Extract, Cinnamon Extract, Zinc Gluconate.
To keep inflammation caused by acne under control apply products that contain topical anti inflammatories, these include, Green Tea, Camphor, Allantoin and Oat Extract. Calendula, Green Tea, Horse Chestnut, Liquorice and Chamomile help treat breakouts while shooting and calming irritation Hyaluronic acid is a great ingredient that helps prevent the dehydration and dry patches associated with clearing products.
Biotin, Tea Tree, Zinc Gluconate, Yeast Extract which are all fantastic at purifying the skin and promoting clarity and preventing breakouts. Hyaluronic acid is a great ingredient that helps prevent the dehydration and dry patches associated with clearing products.
Benzoyl Peroxide; is a chemical that introduces oxygen into the follicle thereby killing the anaerobic bacteria. It also has the added benefit of causing a drying and peeling to pustules and papules. This treatment may be used at the 5% concentration (max concentration for and OTC cosmeceutical) directly over the affected at 8 hourly intervals
What should we avoid?
Answer: Ensure you become an ingredient reader; avoid ingredients like Mineral oil, Lanolin, S.D Alcohol, Artificial colours and Fragrances. A word of caution, many make-up’s actually contain what are called ‘comedogenic ingredients’ that are known and proved to clog the pores, commonly D & C coal tar dies found in loads of makeup are the culprit, or Isopropyl myristate which is often used to give make up a velvety feel and smooth spread ability. How to avoid this, simply ensure you only use products both make up and skin care that state they are non comedogenic, they are not hard to find there are now so many mineral based make up ranges and this will eradicate the skin problem that is actually called ‘acne cosmetica’. There are many skin care companies have foundations and primers or tinted moisturisers that are treatment products for adult acne AND a makeup combined, all non comedogenic.
If you experience breakouts after a facial is this normal?
Answer: Yes it can be, especially if you are doing a deep cleansing treatment or one that contains many actives, these breakouts should clear quickly and not be persistent, the better your skin health the less likely this is to occur.
Is there anything in your diet that could contribute to pimples?
• Avoid processed foods where possible.
• Avoid chocolate for those that recognise it as a trigger, due to the stimulating effect on acne prone e.g. in milk chocolate. Caroline Caperton, MD, MSPH, senior clinical research fellow in dermatology at the University of Miami states “Some of the ingredients in pure chocolate that might exacerbate acne are caffeine and its cousin theobromine, which is known to have pore-clogging properties”
• Sugar can promote acne by elevating blood sugar levels, resulting in a cascade of hormonal effects, including increased androgens (acne-causing hormones), excess oil, and increased skin cell production, all of which lead to clogged pores and breakouts, so avoid foods with processed sugars.
• Cow’s milk (even organic) contains its own hormones (including androgens, the male hormones found in both male and female bodies), and growth factors (including bovine IGF-1). Every time you drink milk or eat dairy products, the cow hormones are absorbed by your body and remain active in the bloodstream, so they can affect your skin (and produce acne) in the same way as human hormones.