The truth about acne: we explain why your acne cream does not work

Examine your first wrinkles and try, at the same time, to make your pimples : paradoxical? Yet this is what happens to many women today. Because acne is far from just a teenage thing. It is even more and more frequent in adult women: 25% are affected in France*. If the physiological mechanisms are known and treatments exist, the causes remain rather vague. Often unpredictable and difficult to get rid of for good, acne leads to a feeling of weariness, even fatality. “Acne is the first reason for consultation in dermatology, observes Audrey, dermatologist known under the name of Dermato Drey on social networks, and author of the book “Making peace with your skin” (ed. Larousse). It is a multifactorial pathology whose severity and duration can vary enormously. You can also feel acne with only a few pimples. It is better to arm yourself with patience: the fight against acne is more of a marathon than a sprint. True-false decryption.

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Only the birth control pill can overcome hormonal acne: false

Subject to hormonal upheavals, such as menstruation or pregnancy, women are more affected by acne than men. “Acne can be the consequence of hyperandrogenism (excess male hormones similar to testosterone). It should be noted that women also secrete androgens – in much lower quantities than men, explains Dr. Laura Bessiène, endocrinologist at Cochin Hospital in Paris. Very often, this is part of a disease called PCOS – for polycystic ovary syndrome. It is the first cause of so-called hormonal acne that we meet in consultation. Symptoms (irregular cycles, hirsutism and therefore acne) often occur in overweight patients and/or with cholesterol abnormalities. In 30 to 40% of cases, the establishment of regular physical activity can reduce the symptoms. This associated with a balanced diet indeed reduces insulin resistance and, consequently, the level of androgens. What about the estrogen-progestogen pill? In the absence of contraindications, it is the first-line medical treatment by lowering androgen levels. However, a resurgence of acne may occur when treatment is stopped.

It is essential to eradicate the bacteria responsible for pimples: false

Thousands of microbes, viruses and bacteria live on the surface of the skin. It is the skin microbiota. “Until recently, we had a very bacteriological vision of acne which would be linked to the proliferation of a bacterial species, notes Marina Alexandre, dermatologist and scientific consultant for La Roche-Posay. From now on, we see things in a less simplistic way. When you have acne, it means that the good bacteria are underrepresented. This leaves room for the proliferation of Cutibacterium acnes – the bacteria found in acne lesions. Thus, it is not enough to eradicate this bacterium, but to consider a more global approach which does not only consist in prescribing antibiotic or antibacterial treatments. Instead, we try to restore a quality skin flora, that is to say varied, which will prevent the excessive proliferation of Cutibacterium acnes. How ? By adopting probiotics and prebiotics – especially in the form of serums, developed to rebalance the skin flora.

The link between diet and acne has not been clearly demonstrated: rather true

Can acne be caused by too rich a diet? Anthropologist and author of “100,000 years of beauty” (ed. Decitre), Élisabeth Azoulay is cautious: “In history, we have seen all sorts of explanations for acne. And we see that there is a great temptation to give it moral explanations made up of three main families: sexuality (notably in the 19th century, since discarded), lack of hygiene and unregulated or excessively abundant food. These presuppositions remain somewhat in the atmosphere. Recently, in France, it was NutriNet-Santé** that showed a probable link (already suspected) between acne and the consumption of foods with a high glycemic index: sugary drinks, ultra-processed foods and dairy products. . To be taken in hindsight? “The studies are contradictory and controversial,” says Marina Alexandre. There’s probably a connection, but it’s not true for everyone and it doesn’t explain everything, especially that adult women have more acne than men. “How to avoid feeling guilty?

Acne Can Damage Mental Health: True

The psychological repercussions of acne are real. “In general, women have more pressure on their physique than men,” says Audrey, alias Dermato Drey. And the demand for clear skin is also increased tenfold by social networks, which give a biased view. As part of a study published in 2021 in the “Jama Dermatology”, around fifty women aged 18 to 40 with moderate to severe acne were asked about its consequences in their daily lives. states of depressionanxiety and social isolation are reported, having repercussions both in their professional and private settings.

Local treatments require a lot of perseverance: true

Derived from vitamin A, oral treatment with isotretinoin is very effective against severe acne. It was formerly prescribed under the name Roaccutane. Its indications are precise and it involves rigorous medical monitoring. Other derivatives of vitamin A are applied topically and also prove to be excellent anti-wrinkles. “We can thus prescribe topical tretinoin on prescription”, specifies Marina Alexandre. Unfortunately, it is not always well tolerated, and even less so by adult women because their skin is often less oily, more sensitive and finer than that of younger people. Thus, the star ingredient for acne in adult women remains retinol (also a star in anti-aging). Much better tolerated than tretinoin, it also requires patience and an appropriate dosage: we recommend starting at 0.3% two or three evenings a week, then gradually increasing the frequency of application. When you tolerate it well every day, you can then try higher doses of 0.5% or even 1%. Don’t forget to moisturize your skin.

* Source ** Study published in “Jama Dermatology”, in June 2020.

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