Active Acne

Acne vulgaris, or active acne, is a long-term skin condition affecting the hair follicle and oil gland (called the pilosebaceous unit). Lesions can appear as:

• Comedones: blackheads and whiteheads
• Inflamed bumps: papules and pustules
• Larger nodules or cysts in severe cases

Active acne means new spots are forming, not just leftover marks from old breakouts.

Acne occurs mainly where oil glands are largest (i.e. the face, chest, and back). Four key processes cause acne:

1. Excess oil production (sebum) from hormone-sensitive glands
2. Blocked pores due to extra skin cells sticking together
3. Bacterial growth (Cutibacterium acnes) inside the plugged pore, triggering inflammation
4. Immune response turning plugs into red bumps and sometimes deeper cysts

Knowing which factor dominates your acne helps guide treatment. For example:

• Oily, clogged pores: respond best to retinoids (vitamin A creams)
• Inflamed bumps: benefit from anti-inflammatory and antibacterial therapies

Acne is influenced by many interacting factors.

Main Drivers

• Hormones: Androgens increase oil production. Puberty, menstrual cycles, PCOS, and some medications can worsen acne.
• Genetics: Acne severity and scarring can run in families.
• Oil composition: Not just the amount but the type of sebum affects bacterial growth and inflammation.
• Sticky skin cells: Extra keratin can block pores.
• Skin bacteria imbalance: Certain strains promote redness and pimples.

Exacerbating Factors

• Heavy skincare or makeup that clogs pores
• Medications: steroids, lithium, some seizure medications
• Diet: high sugar foods and dairy can worsen acne in some people
• Stress: triggers inflammation
• Friction: masks, tight clothing, rubbing skin
• Lifestyle: poor sleep, smoking, alcohol increase inflammation

The best prevention targets why acne happens, not just individual spots.

Daily Routine Basics

• Gentle cleansing twice a day with mild, non-irritating cleanser
• Non-comedogenic moisturiser to protect skin barrier
• Active treatments:
  • Night: topical retinoid to prevent blocked pores
  • Morning: benzoyl peroxide or azelaic acid for bacteria and inflammation control
• SPF every day (oil-free or mineral-based)
• Avoid heavy occlusive cosmetics
• Hands off: Picking or squeezing increases scarring risk

Lifestyle and Trigger Control

• Keep a diary of diet, periods, stress, and product changes
• Reduce high-sugar foods and consider lowering dairy for a few weeks if other measures fail
• Improve sleep and manage stress with gentle exercise and breathing techniques
• Wash pillowcases regularly and use breathable masks

Managing acne effectively involves a tiered approach, combining home care, prescription therapies, and in-clinic procedures. Medical-grade skincare plays a central role at every stage, supporting barrier health, controlling oil, and preparing skin for more intensive treatments.

1. Mild Acne (mostly blackheads and whiteheads)

For early or mild acne, topical treatments are the mainstay. These focus on unclogging pores, controlling oil, and calming inflammation.

• Topical Retinoids (Adapalene, Tretinoin)
  • Normalise skin cell turnover and prevent plugged pores
  • Best applied at night, starting gradually to reduce irritation
  • Often combined with benzoyl peroxide for enhanced results
• Benzoyl Peroxide
  • Powerful antibacterial and anti-inflammatory effect
  • Typically used in the morning, 2.5–5% concentrations
  • Can bleach fabrics, so be mindful with clothing and towels
• Azelaic Acid
  • Reduces redness, bacteria, and early pigmentation
  • Gentle enough for sensitive skin or redness-prone types
• Salicylic Acid
  • Penetrates oily pores to exfoliate gently from within
  • Helps prevent blackheads and whiteheads from forming

Adjunct measures: Non-comedogenic moisturisers, SPF, and barrier-support serums with niacinamide help prevent irritation and maintain skin health.

2. Moderate Acne (more inflamed or widespread lesions)

When acne becomes more inflamed or covers larger areas, we often combine topical treatments with systemic or procedural therapies.

• Oral Antibiotics (Doxycycline, Lymecycline)
  • Reduce inflammation and bacterial overgrowth
  • Short courses of 6–12 weeks are recommended
  • Always combined with topicals to prevent resistance
• Hormonal Therapy (COCP or Spironolactone)
  • Highly effective for hormonal flare-ups, particularly in adult women
  • Reduces oil production at the source
• Professional Chemical Peels
  • Superficial peels with salicylic, glycolic, or mandelic acids
  • Smooth texture, reduce comedones, and accelerate resolution
  • Safe when performed by trained clinicians

This stage emphasises combining complementary therapies to target different acne mechanisms simultaneously.

3. Severe Acne (nodules, cysts, or high scarring risk)

For severe or treatment-resistant acne, a more aggressive approach is necessary:

• Oral Isotretinoin
  • Reduces oil, prevents pore blockage, limits bacterial growth, and calms inflammation
  • Requires specialist supervision, pregnancy precautions, and monitoring
  • Often produces the most durable results
• In-Clinic Interventions:
  • Intralesional steroid injections for large painful nodules
  • Professional extractions to prevent secondary infection
  • Targeted drainage of cysts when required

Even at this stage, adjunctive therapies like blue light therapy, IPL, or microneedling (post-inflammatory control) can improve outcomes and speed recovery.

In addition to topical and systemic therapy, device-based and adjunctive treatments can accelerate recovery, reduce inflammation, and prevent scarring. They are usually combined with medical-grade skincare to maximise results.

Blue Light Therapy

• Uses specific wavelengths of light to kill Cutibacterium acnes, the bacteria that drive inflammation in acne.
• Helps reduce red, inflamed lesions and pustules.
• Best for: Mild to moderate inflammatory acne or as a supportive treatment alongside topical therapy.
• Note: Results are gradual and multiple sessions are typically needed.

Pulsed Dye Laser (PDL) and Intense Pulsed Light (IPL)

• Target the blood vessels that feed inflamed acne and post-inflammatory redness.
• Reduce redness and visible marks, improving skin tone and comfort.
• Can also aid in mild post-acne pigmentation.
• Ideal for: Red, inflamed acne, early post-inflammatory erythema, and those prone to redness.

Fractional Lasers

• Deliver energy into deeper layers of the skin to stimulate collagen production, remodel texture, and reduce early scarring.
• Often used once active inflammation is under control.
• Best for: Persistent nodules, patients with high scarring risk, or those wanting early correction of residual bumps.

Microneedling

• Involves tiny controlled skin injuries to stimulate repair, collagen, and texture improvement.
• Should only be used once active lesions are under control to avoid exacerbating inflammation.
• Can be combined with growth factors or polynucleotides to enhance skin healing.

Skin Boosters and Polynucleotides

• Hydrating injectables that restore barrier function, improve elasticity, and reduce redness during recovery.
• Especially useful after aggressive topical therapy or procedural interventions.
• Provide supportive care rather than primary acne treatment, improving patient comfort and long-term skin health.

Managing sensitive or easily irritated skin is critical because inflammation can worsen acne and increase scarring risk.

• Introduce active ingredients slowly: Start with every third night for retinoids or benzoyl peroxide.
• Support the barrier: Pair with calming moisturisers, niacinamide serums, and non-comedogenic hydrators.
• Avoid harsh routines: Alcohol-based toners, abrasive scrubs, or excessive exfoliation worsen inflammation.
• Gentler alternatives: Azelaic acid is anti-inflammatory, antimicrobial, and generally well tolerated for sensitive skin.

Early specialist input can prevent scarring and chronic inflammation. Consider professional assessment if you have:

• Nodules, cysts, or painful deep lesions
• Acne not responding to consistent topical therapy after 3 months
• Signs of early scarring
• Suspected hormonal acne, especially adult-onset or monthly flares
• Significant psychological distress linked to acne

At Dr Hass Clinic, patients receive personalised assessments, hormonal screening where appropriate, structured prescription plans, and access to specialist procedures including isotretinoin and clinic-based interventions.

The key to avoiding permanent marks is early and aggressive control of inflammation:

• Treat inflammatory lesions promptly with topical anti-inflammatory agents or intralesional steroid injections for large nodules.
• Hands off: Avoid picking, squeezing, or rubbing lesions.
• Use topical retinoids long term: They not only prevent new comedones but also remodel early scarring.
• Post-acne procedures: Once active acne settles, consider microneedling, fractional lasers, subcision, or professional peels to improve texture and residual marks.

Even with professional treatment, daily routines matter:

• Gentle cleansing twice daily with pH-balanced products to remove excess oil without disrupting the barrier.
• Nightly topical retinoid (start gradually to reduce irritation).
• Morning benzoyl peroxide for microbial control.
• Spot treatments with 2.5–5% benzoyl peroxide or sulphur-based products for isolated pustules.
• Non-comedogenic moisturiser and mineral SPF daily to protect skin and prevent post-inflammatory pigmentation.
• Avoid oil-based makeup, and remove makeup each evening.
• Cold compresses for tender nodules can reduce swelling and discomfort.

Understanding expected side effects ensures patients use treatments safely and avoid unnecessary worry:

• Topical retinoids: Can cause dryness, peeling, and temporary irritation.
• Benzoyl peroxide: May bleach fabrics and irritate mucous membranes.
• Oral antibiotics: Can cause gastrointestinal upset and increased sun sensitivity.
• Hormonal therapies: Require monitoring for blood pressure, hormone levels, and potential side effects.
• Isotretinoin: Requires specialist oversight due to systemic effects and teratogenicity.

Common myths debunked:

• Chocolate or greasy food: Minimal direct effect; high glycaemic diets and dairy have more consistent associations.
• Poor hygiene: Over-washing worsens acne.
• Sun exposure clears acne: May temporarily dry lesions but worsens inflammation and post-inflammatory pigmentation over time.

• Acne arises from oil, clogged pores, bacteria, and inflammation.
• Prevention focuses on barrier care, consistent topical therapy, and trigger control.
• Treatment ladder: topicals → systemic/hormonal therapies → isotretinoin.
• Clinic procedures accelerate resolution and prevent scarring.
• Early specialist input improves long-term outcomes and patient confidence.

Active acne is treatable, and the best outcomes come from a personalised, tiered approach combining medical-grade skincare, prescription therapies, and clinic-based procedures. Early intervention reduces inflammation, prevents scarring, and improves overall skin health.

At Dr Hass Clinic, we provide tailored programs addressing hormonal drivers, barrier health, and inflammation, integrating prescription medication, professional procedures, and follow-up care for lasting, visible results.