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Why we care about acne?

At South West Sydney Dermatology we take acne very seriously. We know, and have seen far to often, the consequences of incorrect advice and inadequate treatment:

  • low self-esteem and depression
  • permanent scarring
  • good money is wasted over and over again on bad treatment without improvement

That’s why South West Sydney Dermatology has established a one-stop specialist acne treatment centre, where our team of Dermatologists, Dermatology Nurses, Dermal Therapists and Skin Pharmacist together treat over 1000-2000 cases of acne annually.

South West Sydney Dermatology guarantees:

  • rapid access to specialist acne treatment
  • no hype or pseudoscience
  • only scientifically proven treatments that produce results
  • a total acne solution including dietary, skin care and lifestyle
  • a team, led by a Specialist Dermatologist, dedicated to eliminating “your” acne
  • the highest cure rate possible; our success rate is over 95%

How common is acne?

Acne is the most common skin condition in Australia with up to 95% of people being affected to some degree at some stage of their life.

Why bother about acne?

Acne is the most common skin condition in Australia with up to 95% of people being affected to some degree at some stage of their life

All too often people (including Doctors), trivialise a person’s acne

Comments such as “when I was your age I had pimples too” or “don’t worry they will eventually go away” or “the scars are not that noticeable” are unhelpful and plainly ignorant of the severe psychological and physical side effects that acne may bring

The consequences of either not treating or incorrectly treating acne are multiple:

  • permanent scarring
  • low self-esteem and depression
  • good money is wasted over and over again on bad treatment
  • difficulty in forming relationships and finding employment

Who gets acne?

Whilst most people who get acne are undoubtedly teenagers, acne can occur at any age. Acne can occur in infants and a growing number of women are developing acne in their 30’s and 40’s

What does acne look like?

Acne on close examination has any one of a number of features:

  • Excessively oily skin
  • Blackheads and whiteheads.
  • Papules (a small, raised, solid swelling)
  • Pustules (a small blister on the skin containing pus.).
  • Cysts (a fluid-filled bump lying just underneath the skin)
  • Nodules (a raised solid lesion more than 1 cm)

Acne can appear on the face, back, chest, neck, shoulders, upper arms and buttocks.

Acne (comedonal, papular and pustular)

Acne (comedonal, papular and pustular)


Acne (cystic)

Acne (cystic)

What causes acne?

Under normal circumstances, the upper layer of our skin (the epidermis) which also lines our skin pores that connect the oil glands (sebaceous gland) to the surface, is continuously being reproduced, with the dead skin cells on the surface and lining of our skin pores shed from the surface without our knowledge.

Increased oiliness of the skin which usually occurs when hormonal androgen levels rise at puberty unfortunately makes these skin cells stick together forming a small plug, which then blocks the skin pore.

Bacteria living on the skin in oily areas such as the face and body soon become trapped deep within the skin pore and oil (sebaceous) gland where they begin to multiply happily in this warm oily protected environment. The oil gland soon becomes red and swollen (papules and pustules) and with time large inflamed nodules and cysts develop. When these cysts or nodules eventually rupture the pus and inflammation within penetrates deep into the dermis of the skin where collage, elastic and other supportive tissue are damaged leading to irreversible scarring.

What is adult acne?

Adult acne affects up to 15% of women

The acne is present after the age of 25 years and is either a continuation of adolescent acne or has commenced for the first time in adult life

Whilst adult acne usually presents as typical teenage acne it often has the following specific characteristics:

  • The acne is very persistent and may continue into the 30s and 40s.
  • It tends to be mild to moderate in severity.
  • Affected women often complain of large pores.
  • Inflammatory lesions are common on the lower face (“bottom heavy acne”) especially around the jawline and neck but may be seen anywhere on face, neck, chest or back.
  • Acne breakouts just before menstruation are a common complaint
  • Large whiteheads (macrocomedones) are more common than in teenage acne, and are mostly found on chin, cheeks and forehead.
  • External factors have been shown to contribute to comedonal break outs in some adult women, particularly poor skin care products and smoking
  • Dietary factors, particularly a high GI diet are thought to be one reason for an increasing prevalence of adult acne
  • Onset of inflammatory lesions (papules and pustules) may be associated with stress

Adult acne may be associated hormonal factors such as pregnancy, polycystic ovary syndrome, and medications and supplements that promote androgenic (male hormone) activity and sebaceous gland stimulation.

Is diet important in acne?

Interestingly Acne is a disease of Western civilisation and is absent in populations consuming Paleolithic diets without refined sugars, grains, milk and dairy products.

The Glycaemic Index (GI) is a way of ranking carbohydrates according to their effect on blood sugar levels. The lower a food’s GI value, the slower and less severe it causes blood sugar to rise when you eat carbohydrate-based foods.

A diet with a low glycaemic load has been shown to reduce the size of the sebaceous glands (reduces sebum production), decrease inflammation in acne, reduce acne lesion count (less comedones, papules and pustules) and diminish production of inflammatory chemicals produced in the skin of acne sufferers

On the other hand research has shown that when a diet with a high glycaemic load is consumed the levels in the blood of insulin and another hormone called Insulin Growth Factor 1 (IGF-1) become elevated. Insulin and IGF-1 both increase androgen hormone levels, which increase sebum (oil) production, as well as increasing production of skin cells around the skin pore making blockages more likely.

Acne scarring

What causes acne scarring?

Scarring results from injury to the deep dermal layers of the skin.

Acne scars most commonly are associated with severe (nodulocystic) acne and occur as a result of intense inflammation within oil glands that leads to rupture resulting in damage to dermal collagen by bacteria, pus and inflammatory chemicals.

Collagen is the scaffolding of the skin that gives it strength, tone and flexibility; once damaged, unsightly scarring results.

Are all acne scars the same?

Acne scars are of many different forms, with each often requiring a specific treatment approach.

Acne scars include:

  • Rolling scars: these scars appear as rolling undulations in the skin and occur as the result of tethering of otherwise normal appearing surface skin to the underlying deep dermis and fatty layers by underlying fibrous and scar tissue
  • Icepick scars: are sharp and narrow scars that extend deep into the lower layer of the dermis.
  • Box car scars: these are depressed wide scars that can be round, oval or linear and often occur around the temples and cheeks.
  • Macular scars: are characterized by flat areas of altered pigmentation either reddish or brownish and often with a shiny smooth surface
  • Hypertrophic and keloid scars: appear as thickened lumpy scars that result from excessive abnormal irregular collagen production after injury from acne

Types of acne scars

Acne scarring (cheeks)

How can damaged dermal collagen be repaired?

To repair the damage done to the dermis (collagen), one must remodel old collagen and reform new collagen. Essentially you need to breakdown already damaged collagen, which then stimulates the skin to form newer collagen, which is healthier and unaffected by previous scarring

The reason that treatments such as superficial chemical peels and microdermabrasion may improve pigment but have no effect on acne scars is that these treatments  do not penetrate deep enough for any permanent results.

What treatments are available for acne scarring?

There is no one size (one treatment) fits all when treating acne scarring, nor can the same dose or strength of treatment be used on each patient.

A patients skin type and the type, number and severity of acne scars present on the skin means a number of different options will usually need to be considered.

These options include:

  • laser treatment of acne scars
  • high strength TCA peels
  • skin needling (Dermastamp)
  • subcision
  • salicylic acid peels
  • dermal fillers / dermal grafting
  • blue and red light treatments
  • corticosteroid injections

It is important to realize that patients will often have a mixture of scars and choosing a Specialist Dermatologist skilled in performing all procedures will give the best outcome.

Can acne scarring be completely eradicated?

Unfortunately no cases of acne scarring once established can be completely cured

On average, using the maximal available therapies under the care of a Dermatologist who specialises in treating acne scarring, an improvement in acne scarring of up to 60-70% is the maximum currently achievable.

How much does treatment of acne scarring cost?

The cost for acne scar treatment will depend on the type and number of acne scars on the skin which then determines the number of treatments you will require and how complex these procedures are.

Some patients for example may require only a handful of treatments which may cost as little as $500.00 whilst others may need more than 8-10 treatments including laser and other therapies which may amount to over $5000.00

Your Specialist Dermatologist at South West Sydney Dermatology will inform you of what procedures are required and their costs during your initial consultation.

Private Health Insurance does not cover the treatment of acne scarring.