Acne is not a new ailment. It was described in ancient writings by the Egyptians who called it “Aku-t”, but it’s likely that humans have been battling spots and blemishes since prehistoric times*. The exact causes remain a mystery to us, but one thing we know is that acne does not discriminate. The boy Pharaoh himself, Tutankhamun, is thought to have suffered from acne and was entombed with preparations against the disorder.** Various animal by-products including honey were popular treatments among the ancient Egyptians, while the Romans were said to bathe in sulfur for blemishes of the skin. For the more adventurous patient, an alternative treatment is the “intestines of a crocodile that has feasted on aromatic plants”**. If you’re fresh out of crocodiles or aromatic plants, why not explore some modern treatment options?
While we don’t know all the details, we do know a bit about some of the processes involved. If you could peer down inside your hair follicles, you would see, like a tunnel branching off to one side, a sebaceous gland, whose job it is to produce sebum. This oily substance plays a role in waterproofing and protecting the skin, but high sebum levels have a strong correlation with acne.³ Acne-prone skin also exhibits a process known as hyperkeratinisation, where the cells inside hair follicles cling together and can’t be pushed out in the normal way. This is a problem for the same reason it’s a bad idea to go down a narrow water slide holding hands with five of your friends—things inevitably get stuck. This leads to the formation of a closed comedone, where the sebum being produced cannot escape the hair follicle and builds up under the surface. To complicate things, this environment seems to be perfectly suited for certain strains of the bacteria P. acnes, leading to infection and inflammation.³
There are a number of treatment options for acne, depending on the type and severity, each with its own pros and cons. For moderate to severe acne, it’s important to discuss the available options with your dermatologist as prescription medication may be required.
However, for mild acne, two common over-the-counter treatments are benzoyl peroxide and azelaic acid.
Benzoyl peroxide has been around since the 1930s, and works by launching an oxidative attack on the stratum corneum layer of the skin, forming free radicals that help reduce acne-forming bacteria.⁴ Benzoyl peroxide is considered the standard treatment and works quickly, however, this comes at a cost. One study showed that vitamin E is lost from the skin barrier during treatment with benzoyl peroxide which, coupled with the oxidation of skin lipids might explain the frequent side effect of skin dryness and irritation.⁴ Benzoyl peroxide also has the unfortunate effect of bleaching coloured fabrics and many a t-shirt, towel and pillowcase have been ruined as a result—casualties in the war on spots.
Azelaic acid, while it doesn’t work as quickly as benzoyl peroxide, is considered the better option for sensitive skin as it has fewer side effects.⁴ It takes a multi-pronged approach in its attack against acne. It has an antikeratinising effect, meaning it helps break up blockages in the hair follicle, significantly reducing open (blackhead) and closed (whitehead) comedones.⁴ Azelaic acid also has antimicrobial activity, was shown to reduce the concentration of the bacteria P. acnes and S. epidermidis, and has an anti-inflammatory effect
Azelaic acid is suitable for pimples, acne, and blackheads.⁵