Acne Q&A: Your Questions Answered

The most frequent topic I’m asked about is… acne

Over the years, I’ve seen countless individuals struggle with breakouts and the frustration they cause. With my extensive experience in treating and healing inflammed skin like acne, rosacea and redness, I’m lifting the lid on some of the most common questions —offering in-depth answers that can help you better understand your skin concerns. Whether it’s tips for managing flare-ups or addressing underlying causes, I’m here to teach you a little more about what your skin is trying to tell you.

Q: What’s the difference between a white head and a yellow head spot?

These two common terms describe quite different types of spots. A whitehead is a closed comedone where the pore is blocked and not open to the air. There is no inflammation (redness). A yellow head suggests a spot with pus in it. The medical term is a ‘pustule’. Whiteheads may become yellowheads if the blocked pore becomes infected.

Q: My doctor talked about my acne being moderate, what does this mean?

To assess the severity of acne, it is graded into different levels. It is easiest to look at three or perhaps four degrees of acne:

MILD – Mainly comedones with perhaps a few papules and pustules

MODERATE – Papules and pustules

SEVERE – Deeper lesions, nodules, and some cysts

VERY SEVERE – Many nodules and cysts with scarring 

These four grades take into account the numbers and types of lesions (‘spots’) as well as looking at scarring or pigmentation changes seen. Each area of the body should be graded separately, and consideration should also be given to the degree of psychological impact. For example, if you only have mild acne but feel very upset by it, you should be considered as ‘moderate’ because this will affect which treatment is chosen for you. An exception to the grading rule is in people with pigmented skin. Acne is one of the most common skin diseases in darker-skinned people and can cause a lot of damage. There is always much more inflammation going on under the skin than would seem likely, so mild-looking acne in someone of Asian or African-Caribbean origin should be treated as if it were moderate.

Q: My forehead is all spotty, but I don’t have acne anywhere else, why is this?

It is difficult to give you the right answer without seeing you, but it is helpful to think about what is different about your forehead. 

One problem can be your hairstyle. 

There is a type of acne called pomade acne- it can be a serious annoyance, especially when it causes you to develop severe or persistent breakouts. 

The right pomade can make styling your hair easy, but it can also clog the pores on your hairline and forehead, potentially contributing to breakouts. Although the pomade doesn’t have any impact on your skin’s production of sebum or new cells, many pomades are made with oils and waxes that can build up on your skin and, just like sebum, mix with mature skin cells to clog your pores. 

If you wish to continue using these hair styling products, clean any items that touch your scalp. Oils from pomade, wax, and other hair styling products can easily soak into pillowcases and other items that come into direct contact with your hair and scalp. Make sure to wash these items regularly to prevent oils and other residues from building up, as these substances can potentially make their way onto your skin and cause breakouts.

If your hair is naturally greasy, wash it more often (but don’t strip it!) with a shampoo designed for oilier hair, and consider using products on your forehead that are formulated with salicylic acid that unclogs pores, skin-brightening niacinamide, and antibacterial azelaic acid.

Q: I am 29 and I have just started to get spots, is this the same as teenage acne?

Yes, it is but, although the same basic process is going on in your skin, it could have a different cause.

Three questions need to be asked about acne appearing in someone over the age of 25:

Is it a recurrence of acne that clears up after adolescence?

Is it a flare-up after settling down for some reason (e.g. being pregnant)? 

Is it a first presentation with no previous history of acne?

If it truly is a first for you, we must do a little bit of investigation before treating you- ‘Adult onset acne’ could be due to many reasons such as:

– Drug treatment for other conditions, such as lithium for some types of mental ill health, epilepsy drugs, drugs used to treat TB, and steroids (by ‘Steroids’ we mean both those prescribed by doctors and the anabolic steroids used (illegally) by some athletes).
– ‘Mechanical’ causes should also be considered, as any constant friction or pressure on the skin can induce acne. 
– There are also some diseases that upset the balance of hormones in your body, leading to acne.
– Another possibility is that you might have just finished taking a long course of the contraceptive pill and your skin is now reacting to the changing hormones. This may settle in time, although you should still be able to get effective treatment to keep your skin under control.

Q: Is acne an allergy to something? I’m convinced our bodies try to tell us that we shouldn’t be doing something when it starts to go wrong.

There is no evidence of allergy as a cause of acne.

The C. acnes bacterium was once thought of as a cause rather than a factor in acne.

Doctors felt this could be an allergy and tried to make vaccines against the bugs.

Like a lot of other old beliefs, this was wrong and failed.

Q: How can cream with antibiotics work? I thought you could only take antibiotics as tablets.

Some creams are used widely in treating many different skin diseases, because they can get through the layers of skin cells by dissolving in some of the natural oils that help bind the cells together. They therefore reach the part of the skin where acne occurs and have a ‘local” effect.

But cream is only suitable for mild to moderate acne.

Tablet treatments allow much more of the antibiotic to get into your body and skin, so higher concentrations can be reached but sometimes fixing the problem at hand, antibiotics can have adverse effects on microorganisms that we want in our bodies. Usually, if someone is taking antibiotics, I’d sometimes recommend that they take probiotics at alternate ends of the day.

Probiotics are foods that contain live microbes, which can replace and bolster lost microbial communities in the gut.

Probiotic foods include yoghurt, kefir, sauerkraut, miso, kombucha, and kimchi.

Q: I can’t seem to stop my skin looking like an oil slick. I wash 4-5 x a day, but it still gets really greasy, what can I do?

Sebum production is greater than normal in acne and greasiness is a problem for many people but washing that many times per day is asking for imbalance and possibly a compromised barrier. 

Oily skin can be caused by several factors, including (but not limited to): 

• hormonal fluctuations
• genetics
• weather, 
• and certain skincare products

Consider, 

• Retinoids, which are formed from vitamin A, are very good at dealing with greasiness; there are many creams, gels or lotions should help you a lot. 
• Saying goodbye to any sulphates 
• Keeping your skin healthy and hydrated will keep it happily in balance
• There’s a difference between having oil in your skin and having moisture in your skin-
  When you’re dehydrated, you’re lacking moisture and hydration.
  When you’re dry, you’re lacking oil.
  It’s two separate things.
  i.e  even if your skin looks oily, you could still be dehydrated and lacking moisture so even oily skin types could benefit from a light moisturiser (my fav is Dermaviduals classic, or – even better- prescriptive classic) so treat your skin to moisture applied with love. 
• Alcohol is not the best news for oily skin because it can harm the protective surface and deplete substances for healthy skin. And it can stimulate oil production at the base of the pore, so you produce more oil.
• Despite sounding counterintuitive, using an oil on your skin can help balance out oil production. Opt for lightweight oils like jojoba, argan, and squalane oil. If you have acne-prone skin, rosehip seed oil is a great option, as it can also reduce acne scarring.

Led – (read about the best options here) helps to balance oil production and improve skin clarity.

Q: I was very happy taking my antibiotics for acne and they worked well. When I stopped though my acne flared up badly again and I am as bad as ever. What else can I do?

Your doctor may say that you need to go back on the antibiotics and take them for longer, or your they might consider referring you to a dermatologist. 

That is fine if that is the path you wish to take. 

Alternatively, visit me for a consultation- I work beyond the limitations of the NHS by supporting my clients as a leading Corneotherapist through tailored facials and treatments, and specialise in acne and rosacea, and the pain that inflamed skin can cause. But people don’t only come to me with problems: many of my clients are simply committed to achieving healthy, balanced skin – because the confidence it leaves them with is life-changing.

Combining proven scientific methods with my unique aesthetician approach to balancing internal and external stressors, I’m famed for delivering transformative aesthetician skincare that’s grounded in real results. No BS. Just visible change, and clients who walk away with more confidence than they’ve had in years.

Q: When I apply my acne cream it stings and burns. It made my skin worse, and I don’t want to go to the doctor again. It’s just a waste of time, so what can I do?

This is a common problem with many different types of topical treatments for acne. You must return to whoever prescribed the cream to you and explain the problem and use another cream or the same cream in a different way.

Topical treatments come in different strengths and in gel, cream and lotion form, so you will be able to try them until you find one that suits you.

For example, benzoyl peroxide can be quite irritant- you could try applying the creams less often… just at night or every other night, so that your skin gets used to it without becoming too red and irritated. It may also help to use an oil free moisturiser about 15 minutes after applying the benzoyl peroxide to help reduce any dryness. 

What is imperative however is that you are aware of what you are using, question whether your skin really needs it… what the rest of your skincare regime is – is it supportive or not … and ensure you do not compromise your barrier- read more:

https://ingridraphael.com/insights/impaired-barrier-function-101/

Q: I read everywhere that you shouldn’t sit in the sun for too long because of skin cancer but my acne does seem to get better in the sun, why is this?

Many years ago, sunlight was recommended as a treatment, but times have changed, and we now know more about skin cancer and premature aging of the skin. Having a suntan may help you mask some of the inflammation in your skin but any tan should be achieved slowly and safely. If you want to be out in the sun and you are taking antibiotics or retinoids, talk to your doctor or pharmacist about this – some antibiotics make the skin much more sensitive to the sun. Your skin probably gets better for a short time because UV light can reduce inflammation, redness, and swelling in the skin but this tends to be short-lived.

Q: I know that I am not supposed to squeeze my spots but some of them look horrible. Are there any spots I CAN squeeze?

Although I could tell you, quite sensibly, that squeezing spots should be avoided at any cost, there are still too many people who find it difficult not to squeeze their skin. If you are going to squeeze or pick at your skin, you might wish to follow this simple traffic light guide to squeezing spots:

If your spot is Red (with no yellow heads) STOP. 
Do not be tempted to squeeze or pick at this kind of spot, as you are likely to cause more damage because there is nothing to squeeze out. This spot will probably hang around for a bit longer and may even scar if you try to squeeze it.

If your spot is Yellow, it is READY, and you may squeeze gently… this is how to do it in a way that minimises damage: 

1. Wash your hands thoroughly with an antimicrobial soap like Hibiscrub
2. Pop on some sterile gloves
3. Wipe over the spot and surrounding skin with clinisept antimicrobial cleanser
4. Gently squeeze the spot with your gloved fingers and a soft sterile gauze:

First, gently pull the skin apart, rather than squeeze and pinch the skin together. If the spot is ready, it will burst with gentle pulling apart. This should be all the pressure and force that is necessary. Any forced squeezing may then result in blood (which is red, therefore STOP).

1. Wipe over the squeezed spot and surrounding area with a clean cotton pad and clinisept 
2. Apply a hydrocolloid patch to prevent infection and promote healing – OR dab with a Q tip or cotton pad with clinisept until the bleeding subsides
3. Allow to air dry, and be careful when applying skincare because it is an open wound 
4. NOW LEAVE THE SPOT ALONE!
5. Sleep on a CLEAN pillowcase

If your spot is Green, GO to the doctor. (it is rare to have green spots, and very unlikely to be acne – We are just cheating because of comparing spots to traffic lights!).

Blackheads can be squeezed gently, but whiteheads should be left alone.

Squeezing at your skin will usually only add to your problems, so, ideally, leave your skin alone and let the treatment get to work on it.

The ‘never, ever, do this’ guide to squeezing spots.

I have seen some people have written to the Acne Support Groups describing what they have used to try to help ‘clear’ their skin of spots or blackheads. Under no circumstances be tempted to use any of the following:

Tweezers

Needles

Pins

Sandpaper (to help smooth the skin – not a good idea, and VERY painful)

More on the subject of ‘to pick or not to pick’. 

Q: I am going to a big family wedding in 10 days and a big cyst has come up on my face. I just know it will still be there on the day. Can I do anything to get rid of it?

As a skincare consultant, I would always recommend seeing a trained professional for tailored advice on healing your skin; however, if that’s not an option for you right now, there are products that you can buy (or make) to help combat inflammation and expedite the healing process. 

Drying the skin out to excess can create real issues, so instead, I’d recommend: 

• Hydrocolloid patches absorb fluid from your blemish and protect your skin from infection.
• A super gentle, pH-balanced cleansing milk that protects against dryness, flakiness, redness, and sensitivity (my personal recommendation is this Dermaviduals DMS Cleansing Milk).
• A gloriously brightening, cleansing, and rejuvenating face mask for beautiful, glowy skin. And guess what? You can easily make your own with a little expert guidance!
• Some doctors are experienced in injecting cysts with a steroid. It must be done by a doctor with experience, as it can cause damage to the skin if the correct technique and strength of steroid are not used. 

The very best if you are prone to acne is to make sure that it is under control in advance of any special occasion.

Q: Does LED treat acne?

Yes!

Take a look at my Instagram page to see progress pictures. 

My state-of-the-art North London clinic offers the next generation of Dermalux Tri-Wave Medical Device LED Phototherapy treatment. Using Dermalux’s revolutionary Tri-Wave MD LED technology (the absolute gold standard in LED light treatment), I help clients boost skin recovery and increase collagen production for a noticeably healthy glow. But as well as supporting the anti-ageing process, this treatment also helps to reduce inflammation for long-term relief from conditions like acne, and rosacea. 

If you were ever wondering what ignited my passion for the skincare industry, this is it. As a little girl, I saw the power of self-care transform my mother – she became brighter and shone with confidence. That’s what I wanted to give people: greater confidence, from the inside out. And that’s why I’m, so passionate about treatments that are rooted in real results.

So, if you’re ready to illuminate your skincare routine and discover the transformative power of LED light therapy, book your in-depth consultation for professional advice on the best treatment plan to help you age with confidence. 

Q: I visit a sauna regularly, is this bad for my acne?

The theory is that they open the pores of the face, allowing the trapped ‘debris’ to be released and remove toxins. 

This is a myth. 

The truth is:  

Sweat is 99% water and is released to regulate body temperature. It does not contain significant quantities of toxins. 

Saunas are meant to warm the body after a cold swim or during winter. The idea that saunas detoxify the body is a long-standing myth. In addition, once the skin has cooled, sweat is still trapped in the follicle, together with the sebum and mature skin cells and this combination could make matters worse. 

It’s fair to say that some people find it relaxing and refreshing to use a sauna, but my advice is to stay away from them if you have a problem with acne eruptions. If you want to use Saunas – use them responsibly and use clean cotton pads soaked in gentle cleanser to help remove any excess sweat once you have used the sauna. 

If you use a sauna too regularly, you may find that the skin starts to ‘break out’ (as it finds it hard to keep up with such direct heat and sweat) and excess sauna use can cause dehydration which impairs the body’s own detoxification processes.

Q: I have acne on my chin, but my cheeks are quite dry. I am confused about what skincare products to use.

It’s quite amazing how the skin can vary on just one small area of the body – from a greasy chin and, just a few centimetres away, dry cheeks. 

Scan the shelves (or online) and you will find a huge range of products claiming to help ‘combination’ skin. 

However, be warned. 

When you have active acne, even if it is confined to one area of your face, it is not merely a ‘greasy skin’ problem. 

The acne needs to be treated, and these products may be of little real benefit. 

Firstly, ensure your cleanser is PH balanced – this helps to prevent stripping the skin of its natural acid ‘mantle’ and will therefore reduce further drying and the very best is a tailored skincare regime prescribed specifically for your unique skin. 

Dermaviduals is one of my bestselling brands in the clinic – Dr Hans Lautenschlager created these products to contain DMS (Derma Membrane Structure) which resembles the membrane structure of the natural skin barrier- in other words, the skin identifies with the ingredients. This allows the actives to be easily absorbed and accepted by the skin.

There is an array of product choices in the range, but by prescribing a tailored skin regime we can truly face map in accordance with what your skin needs, and where.