AcneWhat it is, and what we can do about it.

What is happening inside the skin

Acne starts in the pilosebaceous unit, which is the hair follicle and the oil gland attached to it. Four things go wrong there, usually at the same time: the gland produces more oil than it needs to, the cells lining the follicle become sticky and fail to shed properly, a normal skin bacterium called Cutibacterium acnes multiplies in that trapped environment, and the immune system responds with inflammation.

That is the whole mechanism, and it explains almost everything people find confusing about acne. It explains why blackheads are not dirt (they are oxidised oil and keratin). It explains why scrubbing harder does not help, because the blockage is below the surface. And it explains why acne so often runs in families and follows hormonal patterns rather than following how careful you are with your skincare.

The different forms it takes

Comedonal acne is blackheads and whiteheads with little redness. It responds well to treatments that clear the follicle and normalise cell turnover.

Inflammatory acne is the red, sore papules and pustules most people picture. There is an active immune response involved, so calming inflammation matters as much as clearing congestion.

Nodular and cystic acne sits deeper, feels painful, lasts longer and carries a significantly higher risk of permanent scarring. This is the type where waiting it out is the worst option, because the damage accumulates while you wait.

Teen acne and adult acne are not the same problem

Teenage acne is usually driven by the surge in androgens at puberty and tends to affect the forehead, nose and chin, often with a lot of comedonal congestion. It responds to a fairly straightforward approach centred on decongesting the skin and controlling inflammation without stripping it.

Adult acne, which affects women more often than men, tends to concentrate along the jawline, chin and lower cheeks, to be more inflammatory and less comedonal, and to fluctuate with the hormonal cycle. Adult skin is also usually drier and more reactive than teenage skin, so treatments that would be fine on a sixteen-year-old can leave a thirty-five-year-old red, sore and worse off. This is why we treat the two differently rather than running one protocol for everybody.

How we approach acne here

The consultation comes first, and it is mostly listening: what your acne does, when it flares, what you have already tried, what made it worse, and whether it is leaving marks or texture behind. That last point changes the urgency, because scarring is the part that cannot be undone later.

In-clinic, the tools we use most often for acne are medical-grade peels to clear the follicle and regulate cell turnover, HydraFacial for gentle decongestion and extraction, BBL broadband light to target inflammation and the bacterial component, and the Hollywood Carbon Peel for oily, congested skin. Microneedling has a role once active inflammation is under control, particularly where marks and early texture have been left behind.

Alongside that, we will look honestly at your home routine. A common finding is that someone has been using too many active products at once, which strips the barrier and drives more inflammation. Sometimes the most useful thing we do is take products away.

Our Medical Director, Alex Dinovich, FNP-PHC, is a Nurse Practitioner and an authorised prescriber, so where acne warrants prescription treatment or onward referral, that conversation can happen here rather than sending you back to square one.