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What is Acne
Acne is an extremely common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and may vary in severity from minor breakouts on the face, back and chest to a more severe problem that may cause embarrassment and physical and emotional scarring. In the majority of patients, acne tends to resolve by the late teens or early twenties but can persist for longer into adult years.
Acne can have a huge impact on the sufferer’s self esteem and in the long term can have a negative psychological effect. Studies have shown that acne can cause depression and low self worth. To compound this acne usually appears during adolescence (89% of teenagers are affected to some degree), which is when people tend to be more socially insecure. The most devastating effect of acne is the severe scarring that may be left once the inflammatory lesions have resolved. It is well recognised that scarring is very difficult to treat and therefore early and aggressive treatment is advocated to lessen the overall impact to individuals.
What Causes Acne
The sebaceous (oil-producing) glands of patients who get acne are particularly sensitive to testosterone levels. This is a hormone present in both men and women and causes the sebaceous glands to produce an excess of oil. At the same time, the dead skin cells that are continually being shed from our skin and line the pores are not shed properly and clog up the follicles. This all results in a build-up of oil causing blackheads (where a darkened plug of oil is visible) and whiteheads.
Furthermore, in this environment, the acne bacterium (known as Propionibacterium acnes), which lives on everyones skin can multiply. This triggers inflammation and the formation of red or pus-filled spots.
What Does Acne Look Like
The classical appearances of acne include the following:
1 – oily skin,
2 – blackheads and whiteheads,
3 – red spots,
4 – pus-filled pimples, and
5 – scars.
How can acne be Treated
Adequate washing and skin care can help to remove bacteria and oils which cause acne. Also, cleaning the hands before touching the affected area can prevent transmission of the bacteria on to the touched skin.
Benzoyl peroxide gel or cream may be applied twice daily, into the pores over the affected region. It is one of the mainstays of acne treatment and works by killing bacteria on the skin surface (p. acnes) by oxidisation. Benzoyl peroxide is not an antibiotic and thus the bacteria do not form resistance to it. Another property is that it dissolves the keratin plugging the pores which can lead to spots forming. However, it can cause dryness, local irritation and redness.
Niacinamide for acne:
Nicotinamide, also known as niacinamide, is the amide of nicotinic acid (vitamin B3 / niacin). Niacinamide is a water-soluble vitamin and is part of the vitamin B group. Whilst niacinamide is primarily known as an immune protectant (guards against skin cancer) and for treating areas of skin pigmentation, niacinamide has also been demonstrated to reduce sebum production and thus is a highly useful treatment for acne. Furthermore, it has a stabilising effect on epidermal barrier function and reduces water loss from the skin, therefore keeping it firm and hydrated. For further information click here. [link to PEB niacinamide page]
Topical antibiotics such as erythromycin, clindamycin or tetracycline kill the bacteria found in the blocked follicles. It is applied directly to the skin in the form of a clear liquid or cream and can be as effective as oral (tablet) antibiotics but without some of the side-effect of tablets. The disadvantage is that if the acne is widespead it may not be practical to apply the cream or liquid to a large area.
Oral antibiotics used to treat acne include erythromycin and tetracyclines such as minocyclin and lymecycline (Tetralysal) to kill the bacteria. However reducing the p.acnes bacteria will not reduce the oil secretion and abnormal inflammation which cause of the blocked follicles. Secondly, resistance to p.acnes is becoming more and more common. It should be noted that it may take several weeks for these medications to cause visible results; in addition, oral antibiotics have interactions with other drugs, such as the contraceptive pill, and side effects such as an upset stomach. Patients often require months or even years of treatment with antibiotics and therefore many patients look for alternative approaches.
In females, acne can be improved with hormonal treatments. This is usually achieved with an oral contraceptive pill called dianette which reduces androgens produced.
These are a family of medicines related to vitamin A. They act by normalising the follicle cell cycle and preventing hyperkeratinization which contributes to blockage of the follicles. They can be highly effective but can cause irritation and also a flare up the acne when first used. Recently some over the counter moisturisers are advertised to contain retinoids; however, this will be in very small concentrations compared to that which is available from a doctor.
These are a family of medicines related to vitamin A. They act by normalizing the follicle cell cycle, prevent hyperkeratinization which contributes to blockage of the follicles. This medication is reserved for only the most severe acne which is  not amenable to other treatments  is at risk or begun to cause scarring or  is having a negative psychological effect on the person. The treatment requires close medical supervision by a skin specialist due to the potential side effects such as dry skin, nose bleeds, liver damage, derangement of triglycerides in blood and depression. For females it is essential that they do not become pregnant for the duration and for some time after the treatment; this is because oral retinoids can severely damage the growing foetus.
Chemical Peels for acne
Chemical peels are an excellent method to maintain clear skin and indeed use in combination with other treatments for active breakouts. Beta hydroxy acid (BHA), also known as salicylic acid is lipid (oil) soluble and is a key chemical in many peels for acne treatments. Its solubility means that beta hydroxy acid is able to penetrate into the pores which contain sebum and exfoliate the dead skin cells that build up. This has an effect of unclogging black heads and reducing white heads. Peels containing BHA are recommended for acneic skin which is prone to ‘break outs’ or spots. Click here to find out more.
Photodynamic therapy for acne
Photodynamic therapy (PDT) is a non-invasive therapy that utilizes light treatments along with an application of a photosensitizing agent, typically 5-aminolevulinic acid (ALA). The photosensitizing agent is applied to the skin, causing the skin to become more susceptible, or receptive, to light. After the photosensitizing agent is removed, a light treatment is administered. Short contact PDT is thought to work by shrinking the skin’s oil glands. This can drastically reduce the amount of oil within the pores, thereby reducing comedones. For those with moderate to severe acne that doesn’t respond well to traditional topical treatments, this is good news. ALA-PDT may also kill bacteria responsible for acne breakouts and normalize the shedding of dead skin cells within the follicle. It also seems to improve the skin’s overall texture, and holds promise in the repair of acne scarring.
High intensity blue light works by killing the acne-causing bacteria, P. acnes, and is being used to treat inflammatory acne vulgaris that has not responded to other acne therapies.” ”>
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