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courtesy of Instagram/@lilireinhart

What to do if you suffer from acne

TextLouisa Northcote

#freethepimple creator Louisa Northcote speaks to her dermatologist about acne, the myths that surround it and whether it can actually be cured

Almost everyone has been afflicted by bad skin at some point in their lives, for Louisa Northcote, however, the problem became so bad that her acne began affecting both her career as a model and her mental health, suffering from depression and insecurity so severe it left her unable to leave the house. After appearing as a finalist on Britain’s Next Top Model in 2017, Louisa started posting about her experiences with acne on Instagram, which ultimately inspired her to create #freethepimple, a movement aiming to de-stigmatize acne and empower others to embrace the skin they’re in. Taking over The Professionals column this week, Louisa speaks to her dermatologist Dr Firas Alwahabi about acne, the myths that surround it and whether it can actually be cured.

I have suffered from acne since I was a teenager, however, it’s only recently that I decided to see a dermatologist – an epiphany that really helped me on my journey to clear skin. Going to the dermatologist, or just showing any doctor your acne, can be scary which is why it is so important to get over that fear and find someone who makes you feel comfortable. I was lucky enough to find Dr Firas Alwahabi, a dermatologist at SK:N clinics on Harley Street who not only has amazing knowledge but also makes you feel so comfortable when you sit in that chair with your acne exposed.

Did you or any of your family suffer from acne when you were younger?
Dr Firas Alwahabi: I didn’t but my sister did and it affected her emotionally and caused an avoidance of social activity. She was very self-conscious and it affected her emotional well being. She was upset most of the time.

Did your sister's acne make you want to become a dermatologist and help others with their skin?
Dr Firas Alwahabi: I think it made me more aware of the speciality at a very young age because she was using cream from a dermatologist. So I was very aware of what a dermatologist does and what being a dermatologist is all about. It was just one factor, though, of course, there are other factors.

What qualifications do you need to become a dermatologist?
Dr Firas Alwahabi: Well, first you complete an undergraduate degree in medical school. Then you do three-five years of general medical rotations in various sub-specialties at different hospitals. Once you pass certain exams you enter a specialist training program for dermatology which is four years. All in all, I think I did seventeen years of studying.

What would you say is the best part of your job?
Dr Firas Alwahabi: One of the best parts of the job is that you don’t have very sick patients so I'm not dealing with sad news, I'm not dealing with death. I also get to see all different people and age groups – the young, the old, the pregnant – which is great, I love the variety.

Do you believe as a dermatologist that acne can be cleared forever?
Dr Firas Alwahabi: Yes, for sure. 100%.

What is the best procedure to clear acne would you say, in your expertise?
Dr Firas Alwahabi: The best thing is a good consultation. To see a dermatologist with an interest in acne who can diagnose the type of acne and the severity and then develop a regime. Maintenance is also very important, whether that’s cleansers, diets, creams or certain lasers for a little bit after. The thing that most people miss out is maintenance.

Have you ever had a patient come in that you couldn't clear their acne?
Dr Firas Alwahabi: No.

What makes someone a good dermatologist?
Dr Firas Alwahabi: Being interested in people and their stories is very important because there is always an emotional component to it. So if you just look at the acne in terms of the spots and ignore the wellbeing behind it, then that’s a problem. The second thing is that dermatology changes fast. It's a broad specialty with many different treatments and it changes constantly so you need to keep up to date, keep reading, keep going to meetings, keep reflecting on your practice.

It's quite a personal job, as you say you want to know the person's story. As a patient, you really want someone who understands and makes you feel comfortable as well...
Dr Firas Alwahabi: Exactly, because part of the success is the acceptance of the treatment and how the patient deals with it. If a patient rejects the diagnoses of the treatment or doesn't want to adapt or adjust to the treatment, then it’s much harder.

You travel the world, educate people, give talks on skin. Why do you believe that this is important?
Dr Firas Alwahabi: It’s because this is one way I learned a lot of stuff. Learning from others, people's experiences, different systems, different countries. And I'm sharing knowledge. You also have to know that medicine is an international job that crosses countries and cultures and sometimes you know different healthcare systems have different challenges and different exposures and we can all learn from each other.

Is the myth that eating chocolate causes acne true?
Dr Firas Alwahabi: 
There are some patients whose acne can be triggered by diet for sure, so far the strongest evidence points towards dairy products. It really depends on the sugar and dairy content in the chocolate. That's why in some cases it does, in others it doesn't.

What is some advice that you can give someone who is suffering with acne?
Dr Firas Alwahabi: The first thing to do is think about what you as a patient can control. Look at if your skin is very oily, and if that's the case get advice about the right cleanser to help the pores open and take off the oil. See if there's a pattern in your acne that could be hormones for example if your skin flares up before your period, then you can get advice accordingly. Be aware of some of the dietary factors that could contribute to your acne – high intake dairy products, milkshakes, a lot of carbs. Trial some diet changes and be aware of if your acne reduces. Check your make-up, make sure that it’s oil-free or non-comedogenic. These are the factors I would want my patient to be aware of: make-up, diet, and the skincare products they may use. Know that you can get help and it doesn't have to be scary. Early intervention is better.

I read quite recently that there's soon going to be a vaccination to treat acne. Have you heard about this and if so what do you think?
Dr Firas Alwahabi: Yes I have heard about it but we’re still far away from that. Acne is a multifactorial condition so there are different mechanisms that are involved. First, the grease gland over-produces oil, the second mechanism is the pores getting clogged up, the third is an overgrowth of bacteria in the skin which drives the inflammation. So the idea behind that vaccination is if you reduce the population of this bacteria then you can also limit that link with the overactive grease gland and the overproduction of oil in the pores. The problem, in reality, is that there are subtypes of this bacteria – different strains – and we don't actually know which one is the best one to have a vaccination for. That's why it's difficult.

There is a lot of stigma around showing acne because our society does not view it as “beautiful.” What do you think about this?
Dr Firas Alwahabi: The problem sometimes is that people think skin conditions like acne or psoriasis can be contagious, although that’s not the case. That’s something that we as dermatologists have to educate people on. People shouldn’t be ashamed of acne, it is one of the most common conditions it affects almost 90% of young people. I think people should do what makes them feel comfortable and there may be social situations where covering up can be a coping method, although sometimes heavy foundation can also worsen acne and clog up the pores. I don't think that society is there yet to completely accept it, there are still some idiots who will say something.

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