Although the pathogenesis of acne remains unknown, some of the most probable causes are:

  • Increased sebum production,
  • Ductal keratinisation, (piling up of dead skin cells)
  • Bacterial colonisation of the pilosebaceus ducts
  • and inflammation

Acne can also be defined  as a chronic skin condition, in which blockage or inflammation of the hair follicles and accompanying sebaceous glands (known as pilosebaceous units) occurs.

See earlier posts on Acne here

Acne vulgaris grading

There are three grades of acne: mild, moderate and severe

  • Mild acne consists mainly of non-inflammatory comedones and is typically limited in its extent;
  • Moderate acne consists of a mixture of non- inflammatory comedones and inflammatory papules and pustules, and may extend to the shoulders and back;
  • and severe acne is characterised by nodules and cysts (nodu- locystic acne), as well as a preponderance of inflammatory papules and pustules, and may be extensive

Topical treatments

  1. Benzoyl peroxide

There is good evidence from placebo- controlled trials showing that benzoyl peroxide reduces both inflammatory and non-inflammatory lesions.

P. acnes cannot live in the presence of oxygen, and benzoyl peroxide can reduce 99.9% of them almost instantly.

Benzoyl peroxide is the only medication that can penetrate into the skin and deliver oxygen  however, for this therapy to completely clear acne vulgaris, it must be applied generously, and in 2.5% strength .

By doing so, most patients are able to suppress acne symptoms until their bout of acne naturally subsides. Moreover, due to its bactericidal properties, benzoyl peroxide produces rapid improvement in inflammatory lesions and prevents the development of antibiotic resistance .

The main side effect of this medication is skin irritation, so patient education and use of other complementary soothing products is advisable.

2. Azelaic Acid

Like antibiotics and benzoyl peroxide, azelaic acid is bacteriostatic against several anaerobic and aerobic microorganisms, including P. acnes and Staphylococcus epidermidis .

Similar to benzoyl peroxide, it does not induce bacterial resistance . It is also a cytostatic agent similar to tretinoin, and decreases the thickness of the stratum corneum and the production of keratin .

Azelaic acid is an oxygen free radical scavenger, which could also lead to an anti-inflammatory effect . It may cause less adverse effects than benyzol peroxide or topical retinoids  and may also be an alternative to benzoyl peroxide or to a topical retinoid for treating mild-to-moderate comedonal acne (particularly of the face).

Some patients prefer using azelaic acid because it is less likely to cause local irritation than benzoyl peroxide.

BSN Clear skin serum is a 10% solubilised Azelaic Acid combined with other skin nourishing agents and ingredients to help deliver desired results in terms of acne reduction .


Topical tretinoins are useful for treating comedones and inflammatory lesions in mild-to-moderate acne; they help to normalise excessive production of skin cells which can clog the pores, while demonstrating significant anti-inflammatory effects.

Topical retinoids also have the potential to indirectly reduce the risk of antibiotic resistance , which can happen especially for patients who apply topical antibiotics to help with the acne.

However, retinoids have no impact on acne causing bacteria  (P. Acnes),so need to be combined with a good  topical anti bacterial like Azelaic Acid to be more effective.

Therefore, treatment with both a topical retinoid and topical antimicrobial is warranted.

Topical retinoids are contraindicated in pregnancy, largely due to concerns based on the known teratogenicity of oral isotretinoin, so pregnant women are advised to stay off retinoids for the period they are pregnant.


Topical antibacterial agents are indicated for mild-to-moderate acne and are most effective against papules and pustules . They are a useful alternative for patients who cannot take systemic  antibacterials, and are probably best reserved for patients who wish to avoid oral antibacterials, or who cannot tolerate them

Treatment with a topical antibacterial preparation should be limited to 12 weeks duration where possible .

Topical antibiotics should not be used as monotherapy (alone) for acne, as resistance is likely to develop .

If topical antibiotic therapy is used, it is recommended to be given in combination with benzoyl peroxide to reduce the likelihood of resistance


Systemic antibacterial treatment is useful for inflammatory acne if topical treatment is not adequately effective .

Oral antibiotics have antimicrobial and anti-inflammatory properties, as well as reducing the P. acnes within the follicles, thereby inhibiting production of bacterial-induced inflammatory cytokines.

The absorption of tetracycline is reduced by food and dairy products, and therefore it must be taken on an empty stomach . Adverse effects include gastrointesti- nal tract dyspepsia, vaginal candidiasis in women, and a small risk of photosensitivity.


Daily skincare Guide for Adult Acne Management

The use of  PH balanced cleansers, mostly formulated around PH 5.5, used twice daily and  OIL FREE moisturisers and  Non- comedogenic make up has been shown to have a positive effect on treatment adherence, and should be an essential component of any therapeutic regimen for adult female acne.

Moisturiser should be used in the morning, regardless of acne subtype.

Aqueous non-comedogenic moisturisers containing minimal allergenic ingredients are recommended. ( Click  link for suitable product

Sunscreen is recommended for all patients. In patients with PIH or darker skined  in whom the risk of PIH is increased, daily use of Tinted sunscreen is recommended.

All skin care products and cosmetics should be anti-comedonal and oil free.

Kindly contact us for our Adult acne Kit Bundle if you have adult acne and would love to start a treatment routine to manage it.

Below is a link to all the products in our Adult Acne Management Bundle: