Acne and the management
A long one….but rewarding, I promise.
I know acne (pimples) bothers a lot of people. It is one of the most common skin disorders and can affect the self esteem. It also comes with complications of post inflammatory hyperpigmentation and scarring. This happens as the skin is trying to repair itself and with the processes that happen in acne (especially the ones we call inflammatory acne). Sometimes, the complications happen because you keep fiddling with your skin and you go to the wrong places to get procedures done from people that don’t know what they’re doing.
If you have anything on your skin…better to leave it alone than to do the wrong things. It usually doesn’t end well.
I want to talk about these complications of acne – Post inflammatory hyperpigmentation (PIH) and scarring. A lot of people often use the word scarring wrongly. PIH is NOT scarring. For a scar to occur, something we call fibrous tissue must have formed or some part of the skin is lost (called atrophic scar). It is important to distinguish the two because while PIH can go on it’s own with use of creams that can repair the skin like retinoids and liberal sunscreen use, scarring cannot go on it’s own WITHOUT being assisted by procedures.
Post inflammatory hyperpigmentation
For PIH, apart from the creams, you can also hasten its clearance by doing procedures like chemical peels, microdermabrasion or microneedling.
For scars, it depends on how bad it is before you know how well the treatment will turn out. Sometimes, it may not be possible to completely eliminate the scars but you can only improve the appearance. Procedures like the ones for PIH can help but the one that may likely take it out completely (that induces collagen formation to fill out the skin in atrophic scars like box scars, rolling scars, pits) is LASER. Especially the ablative type of LASER like CO2 LASER. There are also newer ones that can help. The earlier procedures I mentioned too will reduce the appearance as much as possible.
For keloid and hypertrophic scars, you will need some injections into the scars at intervals. Some also combine with LASER. If you are a keloid former, know that it can/may recur even spontaneously. Don’t go and attack your doctor or aesthetician when it does.
Be realistic in your expectations. Don’t go to your doctor with badly scarred skin and tell them you want to look like Agbani Darego afterwards.
If you’ve had bad scarring from acne or chicken pox, it may be more realistic for improvement and not total removal of scars. I have rejected private patients with grandiose expectations before. They give so much trouble because they have an expectation you cannot meet and they’re usually the ones that can’t even pay for aesthetics sometimes.
Acne is one disorder that is both rewarding and sometimes frustrating to treat. It is a combination of different factors so it is manageable rather than treatable. That you have treated it once, doesn’t mean it cannot recur. You may still have occasional breakouts. If you see someone promising you that when you use their cream, it is byebye to acne forever, take it with a pinch of salt.
Atrophic and keloid scars
Skincare regimen for acne prone skin
Have a good skin care regimen. A mild facial cleanser preferably a cream cleanser to wash your face with salicylic acid or benzoyl peroxide (not more than 5%) to wash your face. Don’t leave it on the face for a long time like nixoderm or shirley (those funny things we used then) and be walking around with it o. It will end in tears Just wash it off immediately. Most of them don’t lather, so don’t be expecting any foaming. If you don’t have acne, you can do a mild facial cleanser for normal skin like Cerave, LaRoche Posay or Eucerin.
Then a hydrating or exfoliating toner (like glycolic acid) afterwards if you like. The exfoliating one can be thrice weekly so you don’t dry out your skin.
You then moisturize liberally with a cream that has hyaluronic acid (or other moisturizer that you like e.g with mucin complex, ceramides) and SPF of at least 30. Most people don’t do that and you dry out your skin that way which the body recognizes as a signal to produce more sebum (oil).
You can then apply a retinol cream at night. A treatment retinol cream such as Tretinoin 0.05% cream (popular brand is Retin A) which you can get by prescription. Or an over the counter retinol cream (a retinol cream can also be used by those that don’t have acne at night or a vitamin C cream). Retinoid derivatives should be started gently and you ease it into your routine as it can be irritating to the skin especially when it is foist started. You can start with three times a week at night and increase gradually.
Once your skin is calm, you can stop the salicylic and benzoyl peroxide wash so that you don’t dry out your skin. A gentle face wash like Cerave or Olay will do.
If you have acne prone skin, always have your products available just in case you start breaking out again.
Do not be deceived by some funny adverts that show a stunning and flawless face touting one cream or soap as the answer to all your prayers. Most of the people they use in such adverts don’t even use the cream and soap.
Genetics is very important in skin and hair. Some people use Insha Allah and lux soap only. And they look like a glazed doughnut. Some are products junkie, yet they still don’t have a good skin. Just have a good skin care regimen.
Same with hair. Healthy hair is what is important. I have people that use just shampoo and conditioner and their hair looks like it’s on steroids. While some do all the deep conditioning and apply food on their hair like they’re feeding their ‘eleda’, yet the hair is still not up to shoulder length.
No matter how much products I use, I can NEVER be Rapunzel. I know that and there’s peace. So if you know that you have little or no hair in your family genes, better marry someone with an abundance of it in their genes and pray your children take after him or her. Genetics is important and it is then modified by environmental factors of how well you take care of your skin and hair.
Acne scars again…improved after treatment but not completely gone
Further care of acne prone skin…
STOP PICKING YOUR FACE!! Take those hands off your face please. Before you go for facials or any of those procedures….be SURE the person knows what they’re doing.
Complications can occur with any procedure, but if it is someone that knows what they’re doing, be calm. Don’t panic to the point that you start applying all types of nonsense on your skin. Just let the person walk you through how the complications will be fixed. Which you still need to pay for, by the way. Because it is likely a complication they must have discussed with you before. Except it is due to proven negligence.
I have acne prone skin and this is adult acne (acne after age 25 and above) that can be so recalcitrant to treatment. Unfortunately, I also have skin that pigments easily. I have managed my acne well to the point where I’m okay with it. I did a microneedling some months back (not by myself) and developed horrible PIH. I didn’t panic. I gradually repaired it by myself with some creams and a series of peels. I’m much better now and I like where I am with my skin.
This brings me to the next point. Quality of life (QoL) is a combination of all the factors (emotional, psychological, physical, financial, spiritual) that an individual considers necessary for him to live a good life. So for example, someone may have three pimples and is so bothered by it that her QoL is affected. Another may have dozens and it doesn’t affect her one bit. It also stems from environmental factors and the people that surround them.
I had a patient once that the acne affected her self esteem so much and some guys that she dated told her she can see they’re just helping her with how bad she looked (Thunder faya those guys…just small one sha). She was a wreck. By the time we were done with her in LUTH then, she burst into tears after her final procedure and she saw how improved her face was. She told Dr. Otrofanowei, “Thank you for giving me my life back”.
We’ve had other patients that came with another thing on the skin with their face full of acne, yet they were not bothered and they said nothing about the acne. So it wasn’t exactly affecting their QoL.
I am that doctor that listens to what exactly my patients want. I am not out to do heroic things that they are not asking me for.
I also think the kind of environment you are raised in and the type of people you associate with determine your self esteem. I have hirsutism (hair growth in androgen dependent areas like a man e.g chin, chest and back). But it doesn’t bother me one bit. When it gets to more than 12 strands, I just carry my husband’s shaving powder and take it off every month. I know LASER will give me longer time in between hair growths but I don’t have money for the LASER sessions and the hair doesn’t bother me. My partner thinks I’m the finest woman and even me…I tell myself pe “mo fine pa”. So it doesn’t affect my QoL.
I hope you know it is LASER hair reduction and not complete removal? Because the hair grows back after some time(just a longer time). There’s something called the stem cells that usually regenerates hair so if it is not destroyed, hair would still grow. And it doesn’t get destroyed easily. The hair growth might stop completely after several sessions of LASER.
I think that confidence is the most important beauty secret. It runs in my family. My younger sister when she was about 10 years would tell you she’s more beautiful than Omotola, Genevieve and Stella Damasus all combined together. She said the only reason that they appear finer than her is because they use make up. Abe ma ri nkan?
Don’t let ANYONE trample on your self esteem. You are more than enough even with the acne.
I have made this in depth post and even threw in the managment for acne (you know how much I don’t do SM consultation) as a gift
I don’t know why I find Instagram so stressful. My patients keep telling me they think Instagram is the best platform for me. Maybe because I love to write and Instagram is more about pictures and videos. Finally, the Instagram – @skinandall, Facebook -@skinandall_ , Twitter -@skinandall and Youtube -skinandall are all up and running now. Follow be on all social media platforms…See you there!
Here’s a link to my YouTube video where I had an extensive talk on basic skin care for black skin and acne prone skin.
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All pictures accessed via Google images.