Acne is the most common skin condition, affecting 80% of people at some point in their lives. It usually starts in the teens and goes on into the 20’s, although it can be much longer, continuing well into adulthood for some people.

Understanding Acne

Acne is caused by bacteria that lives in the skin called P. acnes. P.acnes grow predominantly in sebaceous glands, which produce oil called sebum.

  • It typically begins during adolescence, when hormonal changes cause enlargement of sebaceous glands.  Acne may present as both open (whiteheads) and closed comedones (blackheads),  inflammatory lesions such as red pimples, pus filled or cystic .  The condition often results in scarring and pigmented marks (post inflammatory hyperpigmentation).
  •  It is a multifactorial disease

  • Acne occurs in skin that has densest population of sebaceous follicles: facial and upper body areas. In fact, the facial, neck and chest areas have approx. 900 sebaceous glands per cm2 as opposed to less than 100/cm2 over the rest of the body areas. The amount of sebum produced and acne grade are strongly related.


Grade I : comedones only (blackheads)
Grade II: comedones plus papules (blackheads and red pimples)
Grade III: comedones, papules plus pustules (blackheads, red pimples and infected pimples)
Grade IV: comedones, papules, pustules and cysts   (blackheads, red pimples, infected pimples and deep seated infection, often painful )

Each category may be further divided into mild, moderate or severe cases.

(Therapeutic Guidelines: Dermatology 1999 Version 1,Therapeutic Guidelines Limited)

  • The over production of dead skin cells in the follicles causes obstruction.
  • A usually friendly skin bacteria called Propionibacterium acnes (P. acnes) is involved in the pathogenesis of inflammatory acne converting non inflammatory acne to an inflammatory one. P. acnes bacteria incites the wall breach and is involved in the pro inflammatory cascade that follows.
  • Acne Inflammation: the process involves lymphocytes and neutrophils (white blood cells) affecting the wall of the closed comedone,  if breached the extrusion of irritants into the deeper skin (dermis) leads to a variety of lesions The inflammatory acne lesions often result in permanent scars
  • Acne is often painful, disfiguring and permanent scarring is common. (Farrar & Ingham, 2004) For this reason, its effects are not only physical but also social and psychological.  Acne negatively affects quality of life and increases the risk of anxiety and depression. (Yazici, et. al. 2004)

Acne Treatment

At Zen Skin, we offer a unique approach to treating acne. Rather than rely only on medications, Dr. Matiur Rahman Chowdhury’s unique treatment protocol is based on the principle of working on the skin inside and out combining top dermatological treatments.

Traditional Medication

There are several drugs which are regularly prescribed for acne. These include anti-biotics, contraceptives, hormone therapies and isotretinoin (Ro-Accutane). There is a growing concern with the use of some of these therapies particularly due to potential problems and adverse side effects that they may cause. Anti-biotics are commonly prescribed. Unfortunately the use of anti-biotics can lead to the development of antibiotic resistance.  The incidence of bacterial resistance has increased dramatically over recent years and the necessary long-term use of these drugs is likely to contribute to the pool of resistant bacteria.

Teenagers are the main population who suffer from acne and thus may be adversely affected by hormone based drugs and isotretinoin due to their emotional volatility. In fact, acne by itself can be associated with depression, so the combined effect may be amplified due to teenage vulnerability and these drugs which may elicit strong emotions.  Despite their effectiveness, these drugs carry common side effects as well as risks of severe side effects including birth defects and depression.

Today’s treatments

In recent years, advancements in laser and light therapy and clinical treatments have given acne sufferers alternative treatment options. Concomitant use of light therapy or clinical treatments and topical use of vitamin A reduces the sebaceous secretion, inflammation and reduces post inflammatory hyper pigmentation associated with acne scarring.

We at “Zen Skin” target acne and acne scarring using several modalities.  A multifactorial disease such as acne needs a multifaceted approach. Various methods are used to address inflammatory lesions, reduce the obstruction of the follicles, control sebum production and to encourage systemic balance through use of appropriate remedies. Specific combinations of vitamins and other oral supplementation are recommended to improve clearance of acne lesions and to improve skin healing. Our clinicians will develop a clinical treatment program to address your acne condition and any specific concerns you may have.  A homecare program will also be required to further enhance and maintain results. Various modalities may be included in such a program;

Our Treatment Modalities

  • Appropriate Antibiotic (In Severe Case)
  • Chemical Peel
  • Acne Laser Treatment

 Indented scars will require scar revision with Fractionated Laser or Skin Needling once acne has resolved.

Frequently asked questions

Do I need a consultation?

A consultation is time spent speaking with you about your skin concerns.  It is an important time when we can assess the grade of acne, scarring, any medical history, offer advice and develop a program that suits your particular needs.

Will I need to change my skincare products?

Recent advancements in cosmetic science have resulted in more effective skincare. Cosmeceutical ingredients which have been scientifically verified are used in various strengths to treat skin efficiently. The skincare products used and recommended in our clinic are medical strength.  In order to obtain results quickly, it is advisable to use products recommended as they provide daily application of essential cosmeceuticals.  Our clinicians will develop a program of acne treatments and products which will suit your budget.

How long will it take to clear my acne?

A treatment program will address your type of acne condition. We aim primarily to clear acne lesions, reduce inflammation and enhance the healing process. This initial stage may take 4-6 weeks depending on type and frequency of treatments required. Homecare topical treatments, supplements and monthly maintenance treatments will continue to keep the skin clear.

Nutrition and Diet for Acne

Acne is a common skin condition caused by a buildup of sebum by the sebaceous glands. It causes spots to develop on the skin, usually on the face, back and chest, which can become inflamed and infected.

Reduce your intake of omega 6 oils (which are pro-inflammatory) such as vegetable sunflower and corn oils. Olive and rapeseed oils are good to use.

Antioxidants commonly found in brightly coloured orange, yellow and red fruits and vegetables.

Zinc is an essential mineral for skin health, it helps regulates hormone production and can be beneficial for controlling excess sebum production from the sebaceous glands thus preventing acne breakouts and controlling oily skin. It is also good for dry skin as through hormonal activity as it can increase oil production. Good sources are pumpkin seeds, mushrooms, spinach and shellfish.

Acne and Hormones

Acne can be associated with hormonal changes or surges, which can trigger flare-ups which could last for months or years. Consultations with Dr. Matiur Rahman Chowdhury also include a review of any medical or hormonal conditions together with advice on appropriate treatment.

Acne Scarring

If scarring has already developed as a consequence of acne, it can be very difficult to disguise, especially if the acne is still active, where red pustules appear adjacent to pitted scars.

However, modern aesthetic medicine can help with a range of treatments to disguise the scars and improve them for the long term too.

Read more about acne scarring treatments