Case study: How can I help you with your acne?
When a new patient comes to me with a skin concern such as acne as in this case, we go on a journey together. I do not post before and after images on my social media because I don’t feel that it is a true reflection of what goes into achieving the snapshot you see in a before and after, so with that in mind I have written this case report of a client I have seen in clinic. This is really only part one of the journey.
The Client
The lovely Jenny is a 27 year old midwife, working long shifts for the NHS and a dear colleague (and Friend) of mine. She came to see me initially in December 2020 as she had been suffering with acne vulgaris for the previous 2+ years.
The Initial Consultation - 18th December 2020.
Jenny presented with acne vulgaris, which included congested pores with come open comedones (blackheads) and some closed comedones (whiteheads), she also had inflamed papules and pustules to her cheeks, jawline and chin. Acne is a common skin condition that is caused by inflammation of the pilosebaceous unit, and according to the NHS effects approximately 95% of people aged between 11 and 30 years.
What causes acne?
Excess production of sebum which is a naturally occurring substance produced by the sebaceous glands to provide moisture and to waterproof the skin and hair. In acne, sebum can be thicker and stickier.
Normally old skin cells are shed from the follicles, however in acne, this normal process is impaired causing a blockage.
Increase of propionibacterium acnes (P. Acnes) bacteria due to the clogging of the pores, therefore a reduction in oxygen creating an optimum environment for infection and inflammation to develop.
A full medical assessment including any medical conditions, medications and any allergies was carried out to determine any contraindications and suitability for treatment. At this point, the determination was made that the current oral combined pill (Rigevidon) may not be suitable as one of the most common side effects is acne (BNF). My suggestion at this point was for Jenny to discuss alternative, more appropriate options with her GP. Potential dietary triggers were also discussed.
As Jenny had not been using any significant active ingredients in her skincare routine up until this point, we agreed that we would start slowly by introducing four homecare products initially, an acne targeted cleanser; a daily exfoliator; a serum to enhance the skin's protective barrier and SPF to protect against UV radiation.
The products I prescribed aimed to target bacteria, reduce inflammation, increase cell turnover and protect the skin. We then agreed to schedule a follow up appointment to review the treatment plan after 4 weeks.
The possible outcomes were discussed, and Jenny accepted that she would need to fully commit to her skincare and even still I could not guarantee it would be successful. And here the journey began.
Follow ups
30th December 2020 - messaging
Jenny reported she was loving the products and had experienced no sensitivity or other issues.
30th January 2021 - Video call
Due to lockdown, the follow up appointment was carried out over a video call. At this point Jenny reported having a significant flare up of acne lesions in the previous week, which you can see in the photographs, however generally the lesions had not lasted as long and were less inflamed.
It is expected that the skin will often get worse before it gets better when a new routine is introduced, this is known as purging and occurs when the skin cell turnover increases and all of the excess sebum, clogged skin cells and inflammation is pushed to the surface of the skin.
Jenny also reported that she was in the process of changing her hormonal contraception as previously suggested, to one specifically indicated in patients suffering with acne vulgaris.
At this point the skin was less sensitive and Jenny reported tolerating the homecare products well. Normally at this point I would consider adding in a course of in clinic chemical peels, however, due to lockdown Jenny and I agreed to add in an acne targeting serum and a retinol. Both products contain ingredients that are scientifically proven to reduce acne and pore size. In addition, once these new products were tolerated well, an at home enzymatic peel was provided to be used once a week.
21st February 2021 - messaging.
Jenny reported the acne balancing serum and Retinol had initially caused some redness and sensitivity, however she had backed off for a few days and reintroduced it slowly, this was absolutely the best course of action. Once her skin had settled and she was tolerating the new additions to her daily routine, she applied the enzymatic peel as suggested.
23rd March 2021 - Jenny is very happy with her progress and at this point is looking forward to coming for an in-clinic treatment.
30th April 2021 - These are the latest photographs of Jenny, taken prior to an in-clinic treatment, further tweaks to her routine have been suggested, in this case reducing the usage of some products due to dryness and redness experienced in some areas of the face. However overall there has been a marked improvement, with a reduction in congestion and acne lesions, along with overall skin quality.
As I said before, this is only part one of this journey and there have been a few setbacks and tweaks as we have gone along which should be expected. Jenny’s treatment is ongoing as she has been left with some residual pigmentation and scarring, which we are looking to treat with a mix of chemical peels and Microneedling, however so far we have achieved fantastic results just by looking at medication, lifestyle factors and introducing a robust home skincare routine.
All of the home skincare products used were from AlumierMD