Johanna, 30 years old. Papulopustular and comedonal lesions on the face.

Absence of comedonal lesions

The absence of comedonal lesions (comedones and microcysts) goes against the diagnosis of acne.

Acne excoriée

Lesions caused by excessive handling of the skin on the face, leading to erosions.

What dermatological treatment:

• This is a case of mixed comedonal and inflammatory acne, so you need to fight both components.
• You should recommend cleansing with a gentle gel purifying cleanser for combination to oily and acne-prone skin.
• Several treatment options can be proposed, for example: oral doxycycline and local treatment (benzoyl peroxide, adapalene, or retinoid).*
• A soothing, blemish-fighting, and moisturising cream is suggested to limit the irritating effects of the treatment (non-comedogenic O/W cream, in small amounts).
• The patient should be encouraged to stop using foundation (which is comedogenic) and use instead a tinted mattifying cream.
• You should provide advice on external photoprotection for acne-prone skin:
  • preferably avoid sun exposure
  • if exposed to sunlight, apply sunscreens with a SPF of at least 30.

* Doxycycline is administered at a dose of 100 mg/day, taken with a meal and a large glass of water. The patient should be informed that this treatment must be stopped if she becomes pregnant. Sun exposure should be avoided (photosensitising product).

What follow-up should be given?

It is advisable to see the patient again after 3 months of well-followed treatment.

You can then assess the efficacy and patient’s tolerance of the product:

• Irritating effects are most often felt in the first 3 weeks of treatment, when positive effects are not yet visible.
• Treatment should not be discontinued in the event of mild irritation
• You should recommend the application of moisturising or softening creams, combined with gentle facial cleansing.

It is important to continue the hygiene and skincare routine even after stopping treatment:

• Continue to cleanse with a gentle purifying gel cleanser for combination to oily and acne-prone skin and to moisturise with an appropriate soothing, blemish-fighting treatment.

Should blackheads be removed?

It is preferable not to handle acne lesions to avoid scarring.

I'm stressed... does stress stimulate acne?

Stress is not the cause of acne, but it does seem to worsen it.

Stress can lead to the stimulation of hormones, such as cortisol or androgens, which can potentially encourage hyperseborrhoea.

Can toothpaste be used to treat acne?

Some people think that applying toothpaste to their acne can help cure it. This is false (one of the many misconceptions spread on social media).

The ingredients in toothpaste can irritate and dry out the skin, with no positive effect on acne. So, toothpaste should only be used… for your teeth!

My acne seems to get better with the sun... is this true?

The sun is a false friend for acne.

At first, it dries out the lesions by increasing the thickness of the skin (particularly the stratum corneum). As a result, the lesions seem to disappear. What’s more, they are less visible because of the tanning. But once the sun has gone, the lesions flare up again.

What’s more, many medications prescribed for acne contraindicate sun exposure. So, it’s best to protect yourself and, of course, not to use tanning oil…

Is there a link between diet and acne?

An association has been suggested between the consumption of very sugary foods and acne. The potential explanation is that sugar induces excess insulin production, which increases sebum production and inflammation.

The best diet is therefore a varied and balanced one (“eat your 5 fruits and vegetables a day, Johanna”).

Current studies show no link between acne and consumption of charcuterie, but the main preservative in charcuterie (and other processed foods) is sugar, so it is advisable to limit.

Do I need to stop wearing make-up?

The right make-up (free of comedogenic ingredients) does not aggravate acne. And it’s vital to restore a positive self-image, so if make-up can help…

Another point: patients are less likely to manipulate their facial lesions when they are covered. “So, Johanna, you can wear make-up”.

There are special make-up ranges with noncomedogenic (oil-free) tinted creams, available from personal-care product retailers, which do not aggravate acne. If that’s not enough, there are products offering stronger coverage, such as concealer treatment sticks or camouflage bases.