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The Medik8 Guide to Blemishes

What is a blemish?

A blemish can be any kind of spot, discoloration or mark on the skin, but in most circumstances ‘blemish’ refers to breakouts. A blemish is a clogged pore which can be raised, red and sore.

What is ‘blemish-prone skin’?

If you get frequent breakouts, then you likely have blemish-prone skin. Blemish-prone skin can refer to anyone who is susceptible to whiteheads, blackheads, pustules and more; from those who get the occasional pimple or blackhead, to those with high-grade acne.

Blemish-prone skin can be oily, however it can also be dry or dealing with other skin concerns such as hyperpigmentation or signs of ageing.

While traditionally associated with teenage skin, blemish-prone skin is common in all ages and unfortunately doesn’t always go away when you hit your 20s. You may find you experience blemish-prone skin all throughout your life, or it may be associated with life events such as menopause or high-stress periods.

How do blemishes form?

Simply put, a blemish is a clogged pore caused by four circumstances: excess sebum, the build-up of dead skin cells, inflammation and the accumulation of blemish-causing bacteria, (C. acnes).

Excess sebum

Excess sebum can occur when the sebaceous glands go into overdrive, producing more natural oils than the skin requires. This is sometimes the result of hormonal changes, and is common during puberty and in women before the peak of the menstrual cycle and during menopause. The trouble starts when the excess sebum starts to clog pores rather than flowing freely onto the skin’s surface. This marks the birth of a pimple and it can happen weeks before you actually notice a blemish appearing.

Dead skin cells

Your skin renews itself every 30-40 days. But when excess sebum is trapped inside the pore, dead skin cells can get stuck in all that extra oil, creating an airtight blockage within the pore. Oxygen can no longer flow freely through the pore, which means that blemish-causing bacteria are able to thrive.

Blemish-causing bacteria (C. acnes)

In a normal, healthy complexion, C. acnes live happily on the skin without causing a problem. This is because oxygen from the air keeps them at relatively low levels. But in the midst of an air-tight, oil-filled pore, C. acnes begin to rapidly multiply. As they increase, they begin to feed on the excess sebum, converting it into irritating free fatty acids.

Inflammation

These irritating free acids are what triggers the body’s immune system and consequently the red, sore inflammation that we refer to as blemishes.

What causes blemishes?

There is no single cause of blemishes, and often a multitude of factors combined cause blemish-prone skin.

A key factor in formation of blemishes is hormonal changes, particularly during puberty, pregnancy, menopause or changes in hormonal contraceptives.

Medications and stress can both play a part in hormonal changes and trigger blemishes.

Environmental factors such as hot and humid conditions and sometimes changes in diet and an impaired skin barrier function can also cause blemishes to occur.

Types of blemishes

Dealing with a problematic skin can be challenging as there are many factors which need to be taken into consideration. To begin, identify the type of blemish you are experiencing.

There are two major types of blemishes; inflamed and non-inflamed.

Non-inflamed blemishes are usually referred to as comedones and can be open or closed, corresponding to either blackheads or whiteheads.

Open and closed comedones occur when sebum and dead skin cells combine to clog a pore, without causing any inflammation. Black heads contain sebum which is oxidised to a darker colour, and white heads are sealed which look paler on the skin.

Comedones tend to be easy to control with skincare, in particular with salicylic acid and vitamin A.

Inflamed blemishes can come in many forms. The most common type experienced are papules and pustules. Papules are small red bumps which may feel tender or sore. Pustules are very similar to papules, but have a white tip corresponding to a buildup of pus in the pore.

Papules and pustules in most cases are improved by a blemish-prone skincare regime, including a gentle cleanser, leave-on BHA and vitamin A.

The most severe form of inflamed blemishes are nodules and cysts.

Nodules are large, inflamed bumps which feel firm to the touch, while cysts are large pus-filled bumps. Cysts tend to be softer than nodules. Cysts and nodules can be painful and can leave scarring if not treated correctly.

In most cases, topical blemish treatments are unlikely to have a significant effect on nodules and cysts, and a doctor or dermatologist should be consulted.

Skincare for blemish-prone skin

Find your bespoke, personalised regime here…

Recommended Blemish Regime:

AM

Clarifying Foam

Blemish Control Pads (can also use PM)

Daily Radiance Vitamin C

PM

Clarifying Foam

Clarity Peptides (can also use AM)

Crystal Retinal

Balance Moisturiser

Bi-Weekly: Glycolic Acid Activator

If dealing with comedones, papules and pustules, a blemish-busting skincare routine is likely to help minimise the causes of blemishes. We need to normalise every contributor to the formation of blemishes; excess sebum, dead skin cells, bacteria, and inflammation.

As always, we recommend to build your skincare routine around CSA for visibly healthy, clear skin:

VITAMIN C

A powerful antioxidant, vitamin C is able to neutralise free radicals which can oxidise sebum, the main cause of blocked pores.
Recommended product: Daily Radiance Vitamin C, use as last step in morning skincare regime

SUNSCREEN

Exposure to UV rays can cause the formation of free radicals, which can oxidise sebum to form blemishes. Sun exposure can also cause inflammation and redness which can exacerbate blemishes. An SPF 30, broad spectrum sunscreen can help to minimise and sun-derived blemishes.

Recommended product: Daily Radiance Vitamin C, use as last step in morning skincare regime

VITAMIN A (RETINALDEHYDE)

Vitamin A is able to help normalise cell turnover and reduce the amount of sebum our skin produces, which helps to minimise blocked pores and blemishes. Retinaldehyde (found in Crystal Retinal) is ideal for blemish-prone skin as it is directly antibacterial, able to eliminate blemish-causing C. acnes bacteria.

Recommended product: Crystal Retinal, layer on top of any other serums, in the evening

Then add in your blemish-specific actives:

SALICYLIC ACID

A beta hydroxy acid (BHA), salicylic acid is able to soften and dissolve keratin, a protein that blocks pores by causing skin cells to stick together. Salicylic acid is an oil soluble exfoliating acid, meaning it can penetrate deep into pores to break down clogged skin cells and sebum to clear blockages. This helps to diminish formed blemishes and prevents their appearance in the future. Salicylic acid is also able to help minimise inflammation to reduce the appearance of red, sore blemishes.

Recommended product: Blemish Control Pads, use on clean skin as the first step in your skincare routine, up to twice a day

NIACINAMIDE

Otherwise known as vitamin B3, niacinamide is one of the most potent anti-inflammatories in skincare. Ideal for minimising the appearance of blemishes, it can help reduce the skin’s inflammatory response to calm red and sore imperfections. Niacinamide is multi-functional as it can also help promote the skin’s natural barrier, as well as blocking the process to melanin formation to minimise the chances of post-inflammatory hyperpigmentation.

Recommended: Clarity Peptides, can be layered on top of Blemish Control Pads, or underneath Crystal Retinal, up to twice a day

A healthy skin barrier is key in helping to minimise future blemishes. Blemish-prone skin is sensitive skin; avoid attacking your skin with harsh products. Use gentle cleansers designed for blemish-prone skin, and don’t be afraid to moisturise.

Those dealing with more persistent blemishes may benefit from a course of professional peel treatments as well as consultation with a skin specialist to enhance their journey to clear skin. See Medik8 Professional Treatments overview for more information and to find your local clinic.

Top tips for preventing blemishes

In addition to the blemish-prone skin care regime mentioned above, we’d recommend to…

- Avoid touching your face

- Keep anything which does touch your face clean; pillowcases and phones are a big contributor

- Avoid picking or popping spots. If you have to pop a spot, only do it when it has a white head and use clean fingers with very gentle pressure. If the spot doesn’t pop by the second try, leave it be. You are likely to cause more inflammation which could lead to post-blemish dark marks.

- Changes to diet can help to mitigate blemishes in some people. You may wish to consult a dietician. Certain types of dairy and high sugar foods are often associated with higher chances of blemish-prone skin.

Dealing with post-blemish skin & post-inflammatory hyperpigmentation

A key concern that is associated with blemishes is the uneven tone and/or redness that can remain even after skin has recovered from a blemish. This can either be in the form of a dark mark or a red mark, depending on your skin, referred to as post-inflammatory hyperpigmentation (PIH) or post-inflammatory erythema (PIE).

PIH is caused by the skin producing too much melanin after being inflamed and leads to skin darkening in the area where the blemish was. PIH is more common in deeper skin types, in which melanin-making cells tend to be more active.

PIE is more common in lighter skin types, and is a result of damaged capillaries from the area of inflammation around a blemish.

The more inflammation, the more significant the PIH and PIE can be. They can take months or years to resolve on their own, and can worsen with sun exposure or with additional inflammation.

The key steps to preventing PIH & PIE is to prevent inflammation as much as possible; treat blemishes gently, do not squeeze them and always wear sunscreen.

PIH and PIE will often clear on their own after some time, but you can speed this up by using skincare products such as Crystal Retinal which speeds up the rate at which skin cells refresh themselves, bringing fresh skin cells to the surface and shedding hyperpigmented cells.

Acne-scarring is a different type of post-blemish concern, where the scar is usually raised or indented, and the same colour as your skin. These are usually permanent and need a professional skin resurfacing treatment to minimise their appearance on the skin.