In partnership with La Roche-Posay.
Year round, acne is without question the subject I’m most frequently asked about- however, given that acne is a medical condition, these questions are always best reserved for an expert.
Dr Jo-Ann See is at the forefront of acne treatment in Australia. She is invited as the sole Australian representative to the International Global Alliance to improve Outcomes in Acne and, together with like-minded colleagues, she spearheaded the formation of non-profit health initiative All About Acne and has been its long standing co-chair since its foundation- making her one of this country’s leading experts in acne.
In this extract from the Glow Journal podcast, Dr Jo-Ann See answers your questions on adult acne- from whiteheads, blackheads and blind pimples through to hormonal acne, recurring facial acne and acne on the body.
To listen to the full interview, subscribe to the Glow Journal Podcast now on iTunes or Spotify
GLOW JOURNAL: A broad question to start off with, but what actually is acne? When we see a pimple appear on our skin, what are we really seeing?
DR JO-ANN SEE: Acne is actually the medical term, and what you’re seeing are pimples. The term is acne vulgaris, which sounds pretty awful! But you’re seeing pimples, and you’re seeing a variety of pimples. Superficial ones that we call open or closed comedones- closed comedones are blackheads and closed comedones are whiteheads. And then we get inflammatory ones, they’re your papules, postules, the pinky spots, and then you’re getting deeper pimples and they’re nodules or cysts.
This is perfect, because a lot of people were asking if there is, in fact, a difference between whiteheads, blackheads and those red blind pimples- but I suppose yes, there is a difference.
Yes, because one of the differences is the depth in the skin. So if they’re very superficial, they’re comedones, and if there’s an inflammatory component that can point to a more difficult to treat acne. So that’s your pinky spot, your deeper angrier lesion and often the one that tends to recur and often the one that tends to scar.
While we are talking about these different forms that acne can take, a listener asked “How do you get rid of those pesky little bumps on the forehead?” And she’s added “They’re not not acne, but they just won’t go away.”
What you’re actually looking at is something called millia. Millia are very, very superficial. And I explain it to people- they’re like a grain of sand. They typically occur in women, and what they are a tiny flakes of skin or keratin that are in these microcysts. So if you have gone through a bit of magnifying mirror you can see them, but you can feel them. They’re not pimples and you can actually treat them. People will definitely say “I know they’re not pimples, but they’re like pimples.” I don’t like people to do this, but sometimes you can open them up and express them with a sterile needle or a blade. I don’t really advocate that, but I know it’s done. Other times you can use some chemical peeling agents in a superficial chemical peel, something like glycolic acid, and if it’s very, very widespread, some people will actually consider microdermabrasion.
The vast majority of the listener questions that were sent in were submitted by adults about their own acne, so I would love to focus specifically on adult acne today. What are some of the most common causes of acne in adults?
Acne in adults is extremely common. I think we’re seeing more and more of it globally. So you have your patients where there’s a genetic influence. So they come from a family that has difficult acne, long-standing acne, and the thought is that these people perhaps have oil flow that is more than the average person. So they inherit that.
The other group of people have hormonal triggers. And what we’re actually seeing is our body’s natural hormone stimulating the oil gland, and we’re pumping out more oil and that can be in our adult years because of stress. It can also be because of hormonal fluctuation. Sometimes as a teenager, as a 20 year old, you’re on the pill, and then you want to have a family and stop the pill, and then you get post-pill acne. So the causes are really genetic and hormonal, but then there’s also the stress element that we see. And for some people it’s using a lot of makeup and that can make things worse.
I imagine we’ll have a bit of an overlap with this question and the last, but let’s spend a bit of time on hormonal acne because that was, without question, the topic that popped up the most. A number of listeners have asked why they are still getting hormonal acne as adult, because they thought they were in the clear having made it through puberty.
It seems so totally unfair doesn’t it?! Often people think of acne as a teenage issue, a teenage medical problem that they’ll grow out of. But the issue is that your oil gland is constantly triggered by your body’s natural hormones. And therefore, even as a young woman or maybe a more mature woman, you still have the hormones that give you your menstrual cycle. Hormones, when they rise and fall, stimulate the oil gland. So that’s why, and that’s often why in mature women, women who are in their twenties, thirties, forties, they’re still getting pimples because their hormonal situation is still happening. They’re still getting their periods.
One listener writes “I have acne brought on by PCOS. What is the best way to treat this?” She’s added that this is specifically around her face, her chest and her back.
I think it’s really important to point out that hormonal acne can look like regular acne. And when you have adult acne, it can be persistent. So you can have acne in your teens, it can then go into your twenties and thirties, or you’ve got the scenario where you don’t have acne as a teenager, and you get it later on in life as an adult. So you can just have facial acne, but then people who have facial acne, they say 50% or possibly more have truncal acne so they have spots on their chest and their back. So it can look very much the same. There is the thought, and some people think that hormonal acne is more on the jawline, but it can look just the same, it can be superficial, or they can have really deep recurrent lesions that tend to last forever and stay longer.
Another listener has asked “Why do I get pimples in the exact same spot every month, right before my period?”
That’s sort of two questions because they get it before their period- it’s really common. Most women, when they had this hormonal cyclical acne, get it in the week before their period.
And that’s the time when their androgens are increasing. And those androgens, we’re all yin and yang, we’re all male and female hormones. So we get this natural rise in progesterone that triggers our oil gland. And the other time you get it is when you ovulate. So some people will notice that. So that’s because they’re still getting their periods month in, month out. They’re still getting pimples.
However the distribution is interesting. So you get it in the same spot. Say for instance, you have a deeper lesion, you’ve got a nodule or a cyst that is going to live there. That’s like a balloon that opens and closes, and is stimulated before your period, and then it settles down when you have your period, and then you have your period again and it blows up and then it settles down.
So that’s because you’ve got a deeper lesion. There is some thoughts of why you’re getting it in your T zone around your jawline is because that’s where a lot of the oil glands are. So it’s a factor of distribution that you have more oil glands there.
And then, possibly, is the scientific thought that maybe those oil glands are triggered by your hormones. As a, like a homing pigeon- when your hormones are there, they will be the ones that preferentially start causing trouble. Now I can’t quote any great articles on that, but I have read in the past that that’s a thought, it’s a trigger where your hormones stimulate and they always are coming back to the same place.
While we’re on that distribution, I had a number of listeners writing regarding recurring pimples on the chin. This is obviously a really common place for breakouts, so is this, is this the same thing? The fact that the oil is through the T zone?
Yes, very much so. I guess the other thing is sweating, where people are putting on a lot of makeup.
but that lower third of face was classically described as the hormonal acne problems area.
To listen to the full interview with Dr Jo-Ann See, subscribe to the Glow Journal podcast now on iTunes or Spotify
