Month: January 2025

Atrophic scars, such as ice pick, boxcar, and rolling scars, are common concerns that affect confidence and skin texture. Recognising their causes and available treatments helps individuals achieve smoother, healthier skin.

This article explains atrophic scars, distinguishes them from acne marks, and explores effective ways to treat and prevent them using both clinical and at-home skincare approaches.

What Are Atrophic Scars?

Atrophic scars appear as indentations in the skin where tissue loss has occurred due to insufficient collagen during healing. They form after acne, surgery, or injury when the body cannot regenerate enough dermal tissue [1,2].

Unlike hypertrophic scars, which rise above the skin, atrophic scars sit below the surface, creating a shadowed appearance that can worsen with certain lighting.

Acne Marks Vs. Acne Scars

Atrophic scars differ from acne marks, also known as post-inflammatory hyperpigmentation. Acne marks are flat and discoloured but usually fade naturally over time. Scars, however, cause permanent texture changes that require active treatment.

Identifying the difference ensures the right approach, using topical brighteners for pigmentation versus structural treatments for scarring.

Types Of Atrophic Scars

Each scar type presents differently and may need distinct treatment methods:

Ice Pick Scars

Narrow and deep, these scars resemble small punctures in the skin. They often form after severe cystic acne and are among the hardest to treat.

Boxcar Scars

Broader and rectangular, boxcar scars have sharp edges and may be shallow or deep depending on collagen loss. Treatment effectiveness varies by depth.

Rolling Scars

Wavy, undulating scars result from damage below the surface and fibrous tissue pulling the skin inward. Subcision is especially effective for this type [3].

Causes Of Atrophic Scars

Atrophic scars form when inflammation or trauma disrupts collagen production. Key causes include:

• Acne Vulgaris: Chronic or cystic acne degrades collagen and damages tissue.
• Injury or Surgery: Improper healing from deeper wounds can lead to indentations.
• Chickenpox: Healed lesions may leave residual pitted scars.

Prompt acne management and proper wound care significantly reduce scarring risk.

Atrophic Scar Treatment Options

Treating atrophic scars often involves combining therapies to stimulate collagen, smooth texture, and improve tone.

Topical Treatments

Retinoid-based creams containing tretinoin or adapalene boost collagen and accelerate cell turnover. Over time, they help smooth fine depressions [7,8]. Monderma offers prescription retinoid formulations tailored to individual needs after a free online consultation.

Chemical Peels

Procedures such as CROSS (Chemical Reconstruction of Skin Scars) remove damaged surface layers and encourage new collagen growth. A 2002 study found medium-depth peels significantly improved atrophic scars in darker skin tones [4].

Microneedling

This minimally invasive treatment uses fine needles to trigger collagen production. Studies show microneedling, especially when combined with platelet-rich plasma (PRP), improves scar depth and texture [5].

Laser Therapy

Fractional CO₂ laser resurfacing promotes collagen synthesis and smooths the skin. A 2012 randomised trial confirmed marked improvement in atrophic acne scars using fractional CO₂ treatment [6].

Dermal Fillers

Injectable fillers like hyaluronic acid lift indented scars temporarily, especially boxcar and rolling types. Results are immediate but require maintenance over time.

Punch Techniques

Severe or deep scars may require surgical excision or punch grafting. These techniques replace or lift scar tissue for long-lasting correction under clinical supervision.

Summary Of Atrophic Scar Treatments

Treatment	Summary
Topical Treatments	Retinoids and vitamins stimulate collagen and renew skin.
Chemical Peels	Exfoliate surface layers and smooth uneven texture.
Microneedling	Stimulates collagen with minimal downtime.
Laser Therapy	Resurfaces skin and refines scar depth.
Dermal Fillers	Temporarily raise sunken scars for smoother skin.
Punch Techniques	Surgically remove or replace deep scars.

Table 1: Overview of treatment options for atrophic acne scars

Preventing Atrophic Scars

Preventing scars begins with early acne management and healthy healing habits.

• Treat Acne Early: Use prescription treatments promptly to avoid tissue damage.
• Avoid Picking or Squeezing: Reduces inflammation and prevents deep lesions.
• Follow Post-Surgery Care: Proper wound management aids collagen repair.

Balanced nutrition and hydration also support the body’s natural healing process [12].

Monderma’s Personalised Approach To Atrophic Scars

Monderma’s prescription skincare combines evidence-based ingredients to target scarring and pigmentation. Each formula is crafted by GPhC-registered prescribers following a free online consultation.

Preventing Scars With Early Acne Treatment

Monderma’s acne solutions, including adapalene, tretinoin, and clindamycin, reduce inflammation and bacterial growth to prevent new scars from forming.

Skincare For Mild Scars

For early or shallow atrophic scars, tretinoin or adapalene can rebuild collagen and refine texture within 12 weeks of consistent use.

Complementing In-Clinic Treatments

When used alongside professional procedures like microneedling or laser therapy, Monderma’s formulas support collagen repair and reduce post-procedure irritation with niacinamide and azelaic acid [9,10,11].

Managing Hyperpigmentation With Atrophic Scars

Hydroquinone-based Monderma blends target dark marks accompanying scarring. Combined care improves both colour and texture for a balanced complexion [9].

Affordable, Accessible Prescription Skincare

Monderma provides high-strength, prescription-only ingredients without private clinic costs. Free consultations and UK-wide delivery make advanced skincare accessible to those over 16.

Ongoing Care & Progress Tracking

Monderma’s ongoing care adjusts formulas as skin improves, ensuring long-term maintenance and continuous progress in scar reduction.

Monderma Ingredients That Help With Atrophic Scarring

Ingredient	What It Is	How It Helps Atrophic Scarring
Tretinoin	A vitamin A derivative that promotes cell turnover.	Stimulates collagen to smooth and reduce scar depth [7,8].
Adapalene	Synthetic retinoid that regulates cell renewal.	Boosts collagen to improve skin texture [7].
Azelaic Acid	Anti-inflammatory exfoliating acid.	Smooths surface and fades hyperpigmentation [10].
Niacinamide	Vitamin B3 compound supporting barrier function.	Enhances skin repair and evens tone [9].
Hydroquinone	Skin-lightening ingredient.	Reduces pigmentation accompanying atrophic scars [9].
Clindamycin	Topical antibiotic.	Prevents acne bacteria and new scar formation [11].

Table 2: Monderma ingredients that support atrophic scar improvement

Conclusion

Atrophic scars can be effectively treated with the right combination of medical treatments and personalised skincare. From retinoids and lasers to targeted formulas, patients have more options than ever to restore smoother, more even skin.

Monderma’s expert-prescribed skincare offers tailored solutions for atrophic scars, acne, and hyperpigmentation. Begin your personalised journey today with a free online consultation, and share this article to help others learn how to improve scarred skin with confidence.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Goutos I. Atrophic Scars. Goutos London, 2024.
2. Moon J, Yoon JY, Yang JH, et al. Atrophic Acne Scar: A Process from Altered Metabolism of Elastic Fibres and Collagen Fibres. Br J Dermatol. 2019.
3. Alam M, Omura N, Kaminer MS. Subcision for Acne Scarring: Technique & Outcomes. Dermatol Surg. 2005.
4. Al-Waiz M, Al-Sharqi A. Medium-Depth Chemical Peels in Acne Scars. Dermatol Surg. 2002.
5. Ismail SA, Khella NAH, Abou-Taleb DAE. Microneedling vs PRP for Atrophic Scars. Dermatol Ther. 2022.
6. Hedelund L, et al. Fractional CO₂ Laser Resurfacing for Atrophic Acne Scars. Lasers Surg Med. 2012.
7. Medical-Aesthetics.sg. Retinoids & Acne: How Vitamin A Fights Scarring. 2024.
8. Brickell Men’s Products. Retinol for Acne Scars. 2024.
9. Navarrete-Solís J, et al. Niacinamide vs Hydroquinone in Melasma. Dermatol Res Pract. 2011.
10. Marques C, et al. Mechanistic Insights into Niacinamide Functions. Antioxidants (Basel). 2024.
11. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines for Acne Management. J Am Acad Dermatol. 2016.
12. Roengritthidet K, et al. Diet & Acne Severity Study. Acta Derm Venereol. 2021.

Melasma is a common pigmentation disorder marked by brown or grey patches on the face. While harmless, its visibility often affects confidence and emotional well-being.

In this article, we explore hydroquinone’s role as the gold standard for fading dark patches and restoring an even skin tone, including how it works and safe ways to use it for brighter, clearer skin.

Causes & Triggers Of Melasma

Hormones, Sun & Genetics

Melasma often develops due to hormonal changes, such as pregnancy or contraceptive use. Between 10–50% of pregnant women experience melasma, sometimes called the mask of pregnancy [1]. Genetic predisposition also plays a strong role, especially in individuals with darker skin tones [2,7].

The Role Of Sun Exposure

Ultraviolet (UV) radiation stimulates melanocytes, increasing melanin production and worsening dark patches. Melasma tends to intensify during summer [3].

Using broad-spectrum SPF 30+ sunscreen daily is essential to prevent flare-ups and enhance treatment success [4].

Trigger	Effect on Skin	Management Tip
Hormonal changes	Stimulate melanin production	Consult about hormonal control options
Sun exposure	Deepens pigmentation	Use SPF 30+ daily
Genetics	Increases melasma risk	Use long-term maintenance care

Table 1: Common melasma triggers and recommended management strategies

Emotional & Psychological Effects

Melasma can significantly affect confidence and quality of life. Over 50% of patients report psychological distress related to their appearance [7,8].
Addressing pigmentation not only improves skin tone but also supports mental well-being and self-assurance.

How Hydroquinone Works

Mechanism of Action

Hydroquinone inhibits tyrosinase, an enzyme essential for melanin synthesis. By reducing pigment production, it gradually lightens dark patches.

Topical strengths between 2% and 4% are widely used, with visible improvement typically seen after 4–8 weeks of consistent application [2,5].

Duration & Effectiveness

Patients often notice early lightening within 2–4 weeks, with significant improvement by 8–12 weeks [2,4,5]. Maintenance therapy, combined with sunscreen, helps preserve results.

Strength	Time to Noticeable Results	Typical Use
2%	6–8 weeks	Mild pigmentation
4%	4–6 weeks	Moderate to severe melasma

Table 2: Typical hydroquinone strengths and expected treatment results

Using Hydroquinone Safely

Overuse or incorrect application can lead to redness or irritation, especially in sensitive skin types.
To use safely:

• Apply only to affected areas.
• Use moisturiser to reduce dryness or stinging.
• Always apply SPF 30+ daily to prevent rebound pigmentation.
• Conduct a patch test before full application [3,4].

Monderma’s licensed prescribers provide clear guidance on safe use and concentrations tailored to your skin type via a free consultation.

Why Hydroquinone Is A Leading Option

Proven Results

Clinical evidence supports hydroquinone’s success. A 2013 study found 4% hydroquinone reduced melasma severity in 80% of patients within 12 weeks [5].

Fast-Acting & Accessible

It acts faster than many alternatives, offering visible improvement and confidence boosts within weeks. Monderma enhances these results through custom blends combining hydroquinone with hydrating actives like hyaluronic acid.

Hydroquinone Vs. Other Melasma Treatments

Azelaic Acid

Derived from grains, azelaic acid (20%) reduces melanin and inflammation. A 2023 study showed it effectively improved melasma while causing fewer side effects than hydroquinone [11].
Best for sensitive or reactive skin.

Chemical Peels

Glycolic or lactic acid peels exfoliate surface cells, complementing hydroquinone. Studies show up to 60% improvement in pigmentation when used together under professional guidance [6].

Treatment	Mechanism	Best For
Hydroquinone	Inhibits melanin enzyme	Fast, targeted lightening
Azelaic Acid	Reduces pigment & inflammation	Sensitive skin
Chemical Peels	Boosts cell turnover	Stubborn pigmentation

Table 3: Comparative treatments for pigmentation and their best uses

Hydroquinone Before & After Timeline

Timeline	Expected Results
2–4 Weeks	Subtle fading of dark patches
8–12 Weeks	Noticeable reduction and even tone
12+ Weeks	Maintenance phase with ongoing protection

Table 4: Hydroquinone treatment timeline and expected results

Monderma’s Personalised Skincare Solutions

Monderma offers prescription-strength skincare tailored for melasma, acne, and pigmentation concerns. Custom formulas may include hydroquinone, azelaic acid, and niacinamide, developed by GPhC-registered prescribers for both safe and effective use.

Conclusion

Hydroquinone remains the most effective treatment for melasma, offering rapid, targeted results through melanin inhibition. When paired with consistent sun protection, gentle skincare, and professional oversight, it delivers safe, lasting improvements in skin tone and confidence.

For expert-led, prescription-based care, visit Monderma’s free consultation portal to discover a treatment designed specifically for your skin’s needs.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Handel AC, Miot LDB, Miot HA. Melasma: A Clinical and Epidemiological Review. An Bras Dermatol. 2014.
2. Jo JY, Kim JE, Park YW, Lee JH. Update on Melasma Treatments. Ann Dermatol. 2024.
3. British Skin Foundation. Melasma. 2020.
4. Albzea W, Algarni AA, Alzubaidi H, et al. Azelaic Acid Versus Hydroquinone for Managing Melasma. Cureus. 2023.
5. Monteiro RC, Moura HH, Dantas DC, et al. Comparative Study of Hydroquinone and Kojic Acid Cream. J Clin Diagn Res. 2013.
6. Garg S, Sarkar R, Mysore V, et al. Chemical Peels in Melasma: Consensus Recommendations. J Cutan Aesthet Surg. 2017.
7. Majid I, Aleem S. Melasma: Update on Epidemiology, Clinical Presentation, and Scoring. J Skin Stem Cell. 2022.
8. Platsidaki E, Markantoni V, Nicolaidou E, et al. Self-Esteem, Depression, Anxiety and Quality of Life in Melasma Patients. Clin Cosmet Investig Dermatol. 2023.

Cystic acne is one of the most severe forms of acne vulgaris, developing deep beneath the skin and often leading to pain, swelling, and long-term scarring if untreated.

In this article, we discuss the causes, healing stages, and effective management strategies that can help reduce flare-ups and support long-term skin health.

What Is Cystic Acne?

Cystic acne involves large, pus-filled cysts that form deep within the skin, unlike surface-level blackheads or whiteheads. These lesions can persist for weeks or even months and often leave scars due to their depth [1].

Cystic acne affects around 9% of the global population, primarily adolescents aged 12 to 24 years [2]. It’s less common than mild acne but significantly more severe, often requiring medical attention and prescription treatments.

Causes Of Cystic Acne

Cystic acne arises when pores become blocked with excess oil, bacteria (Cutibacterium acnes), and dead skin cells. This blockage leads to inflammation, swelling, and deep cyst formation [3].

Cause	Details
Hormonal Changes	Hormonal fluctuations during puberty, menstrual cycles, or PCOS increase androgens, raising sebum levels [4].
Genetics	A family history of cystic acne raises risk due to inherited oil production and inflammatory tendencies [3].
Diet	High-glycaemic foods and dairy products may worsen acne, though evidence remains mixed [5].
Stress	Elevated cortisol can stimulate oil glands and aggravate inflammation [3].

Table 1: Common causes and contributing factors of cystic acne

Healing Stages Of Cystic Acne

Recognising the stages of cystic acne supports better treatment timing and scar prevention.

Stage	Characteristics	Management Tips
Early Stage	A red, tender lump begins forming beneath the skin.	Avoid squeezing; use gentle cleansers and apply topical antibacterial agents [1,3].
Active Stage	The cyst enlarges, becoming inflamed and painful.	Topical antibiotics or retinoids help reduce inflammation; consult a dermatologist for severe cases [4].
Healing Stage	The cyst shrinks, pain reduces, and pigmentation may appear.	Use non-comedogenic moisturisers and SPF to reduce hyperpigmentation risk [5].

Table 2: Stages of cystic acne and recommended management approaches

Effective Cystic Acne Treatments

Cystic acne often requires a combination of topical and oral treatments to control inflammation, reduce bacteria, and balance oil production.

Topical Treatments

Benzoyl Peroxide
Reduces bacteria and inflammation. Studies show a 63% lesion reduction after 12 weeks of tretinoin gel use; combining benzoyl peroxide with retinoids enhances results [6].

Salicylic Acid
Unclogs pores and exfoliates surface layers, improving mild to moderate acne [4]. Best used alongside other treatments for deeper cysts.

Topical Retinoids (Adapalene, Tretinoin)
Promote cell turnover and prevent pore blockage. Adapalene 0.1% with benzoyl peroxide 2.5% is a recommended first-line therapy for mild to moderate acne [6].

Azelaic Acid
Gentle and safe for sensitive or pregnant patients, offering antimicrobial and anti-inflammatory benefits. It also helps fade post-inflammatory hyperpigmentation [4,5].

Oral Medications

Oral Antibiotics (e.g., Doxycycline)
Reduce bacteria and inflammation. Typically prescribed for up to 3 months alongside topical treatments to avoid antibiotic resistance [5].

Combined Oral Contraceptives
Help regulate hormone levels and reduce sebum production in women with hormonal acne [2].

Isotretinoin
A potent retinoid that drastically reduces oil production and acne lesions. Reserved for severe or resistant cystic acne due to side effects and monitoring needs [3].

Lifestyle & Home Remedies

Dietary Adjustments
Reducing dairy and high-glycaemic foods may improve acne in some individuals, though responses vary [5].

Stress Management
Meditation, exercise, and mindfulness may indirectly help regulate oil production by reducing cortisol [3].

Skincare Routine
Use gentle, non-comedogenic cleansers and moisturisers. Avoid harsh scrubs or alcohol-based toners that can worsen irritation [5].

Treating Acne Scars

Cystic acne can cause scarring, especially if cysts are picked or squeezed. Dermatological procedures can improve texture and tone.

Treatment	Mechanism	Benefits	Considerations
Chemical Peels	Remove surface layers with acids like salicylic or glycolic [3].	Improves texture and hyperpigmentation.	May cause irritation; multiple sessions needed.
Laser Therapy	Stimulates collagen regeneration.	Effective for deep scars.	Higher cost; requires specialist.
Microneedling	Promotes collagen to smooth skin texture [3].	Minimally invasive, effective for rolling scars.	Several sessions required.
Home Treatments	Silicone sheets and vitamin C serums may fade scars [5].	Accessible and non-invasive.	Gradual results.

Table 3: Treatment options for improving acne scars

Monderma’s Personalised Skincare Solutions

Monderma provides prescription-strength skincare tailored to acne, pigmentation, and rosacea. Custom formulations may include:

• Adapalene or Tretinoin for cell turnover.
• Azelaic Acid or Clindamycin to reduce bacteria and inflammation.
• Niacinamide to strengthen the skin barrier and soothe irritation.

Each prescription is reviewed by GPhC-registered prescribers to ensure safety and effectiveness. Through a free consultation, Monderma designs bespoke regimens that align with dermatological guidelines.

When To See A Dermatologist

Seek professional advice if:

• Acne is painful, cystic, or leaves scarring.
• Over-the-counter treatments fail after several months.
• Breakouts cause emotional distress or self-esteem issues.

NICE recommends referral for nodulocystic acne unresponsive to two 4–6-month treatment courses or causing severe distress [5]. Dermatologists can prescribe isotretinoin or advanced therapies when appropriate.

Conclusion

Cystic acne requires a comprehensive approach that combines medical treatments, skincare, and lifestyle management. Understanding its causes and healing stages helps control flare-ups, reduce scarring, and improve skin health.

For evidence-based, tailored skincare, Monderma offers free consultations to create personalised regimens that target cystic acne safely and effectively. Share this article to help others manage acne confidently and find solutions backed by clinical expertise.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. StatPearls. Acne Vulgaris. NCBI Bookshelf. Updated 2023.
2. Eichenfield DZ, Sprague J, Eichenfield LF. Management of Acne Vulgaris: A Review. JAMA. 2021;326(20):2055–2067.
3. Zaenglein AL, et al. Guidelines of Care for the Management of Acne Vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.
4. Reynolds RV, et al. Guidelines of Care for the Management of Acne Vulgaris. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30.
5. National Institute for Health and Care Excellence (NICE). Acne Vulgaris: Management. NG198. 2021.
6. Chandrashekhar BS, et al. Tretinoin Nanogel 0.025% Versus Conventional Gel 0.025% in Acne Treatment. Indian J Dermatol. 2015;60(5):520.

Rosacea is a chronic inflammatory skin condition marked by facial redness, visible blood vessels, and sometimes pustules. It is often mistaken for acne but has distinct triggers and mechanisms involving inflammation and vascular changes.

In this article, we explore how prescription face creams can significantly reduce symptoms, restoring skin comfort and confidence when used under medical guidance.

Common Symptoms Of Rosacea

Symptom	Description
Persistent redness	A hallmark sign, worsened by sun exposure.
Swelling	Inflammation leads to visible puffiness and sensitivity.
Red bumps or pustules	Inflammatory lesions resembling acne.
Visible blood vessels	Fine telangiectasia visible on the skin.
Eye irritation	Ocular rosacea causes dryness and redness.

Table 1: Common symptoms and features of rosacea

Prescription Face Creams & Inflammatory Lesions

Prescription face creams are central to rosacea management, targeting inflammation, bacterial growth, and Demodex mite overgrowth. Dermatologists prescribe these creams for long-term use, with visible improvement often seen within weeks [1].

Ivermectin For Rosacea

How Ivermectin Works

Ivermectin is a widely prescribed topical treatment for papulopustular rosacea. It reduces inflammation and eliminates Demodex mites, which are frequently linked to flare-ups [3]. Clinical results show that redness and pustules improve from week 3, with significant progress by week 16 [2].

Ivermectin also calms irritation and restores the skin barrier, making it an effective and well-tolerated option. Side effects such as mild burning or dryness are uncommon.

Other Prescription Face Creams

Metronidazole

Metronidazole cream or gel is a trusted option for reducing inflammation and facial redness. Applied once or twice daily, it is well-suited for long-term maintenance with minimal side effects.

Azelaic Acid

Azelaic acid clears pores and reduces swelling while targeting the oxidative stress that contributes to flare-ups. Studies show visible improvements in inflammatory lesions within 12–15 weeks of treatment [4]. It is suitable for sensitive skin and mild rosacea cases.

Niacinamide

Niacinamide (vitamin B3) is not a prescription-only ingredient but is often combined with medical creams for its anti-inflammatory and barrier-strengthening effects. It supports recovery, reduces redness, and improves moisture balance [5].

Ingredient	Primary Action	Effect on Rosacea
Ivermectin	Anti-inflammatory, reduces Demodex mites	Calms redness and pustules
Metronidazole	Antimicrobial and anti-inflammatory	Reduces swelling and redness
Azelaic Acid	Clears pores, reduces oxidative stress	Improves texture and prevents flare-ups
Niacinamide	Strengthens barrier, reduces redness	Enhances hydration and skin resilience

Table 2: Key active ingredients and their effects on rosacea

Monderma’s Personalised Prescription Face Creams

Monderma provides prescription-strength, dermatologist-supervised formulas that combine ivermectin, azelaic acid, and niacinamide. After a free online consultation, prescribers adjust strengths to suit individual skin sensitivity and symptom severity.

This tailored approach ensures balanced efficacy and tolerability. Results may be noticed within the first week, with greater improvement over several weeks as inflammation decreases and redness fades.

Combining Treatments For Enhanced Results

Combining topical treatments with procedural therapies can improve skin texture and reduce visible vessels. Laser therapy complements prescription face creams by addressing redness and telangiectasia directly.

Laser Treatment For Rosacea

Laser therapy uses focused light to constrict dilated blood vessels, reducing visible redness and improving tone. The NHS highlights that results can last for several months following a short series of treatments, depending on the individual [6]. Temporary redness or mild swelling may occur but typically resolves quickly.

Managing Rosacea With A Skincare Routine

Supporting prescription treatments with a consistent skincare routine helps maintain results and reduce flare-ups:

• Avoid triggers such as alcohol, spicy foods, and excessive sun exposure.
• Use gentle, fragrance-free cleansers and moisturisers.
• Apply SPF 30 or higher daily to prevent flare-ups.
• Stay hydrated and incorporate anti-inflammatory foods like omega-3-rich fish.

These daily habits strengthen skin resilience and complement medical therapies.

Conclusion

Prescription face creams such as ivermectin, metronidazole, and azelaic acid remain effective treatments for managing rosacea. When combined with niacinamide, laser therapy, and consistent skincare, they significantly reduce redness, pustules, and inflammation.

Monderma’s personalised formulas offer an accessible and evidence-based solution for those seeking expert care without long waiting times. Explore a free consultation today and take the first step toward calmer, healthier skin.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. National Institute for Health and Care Excellence (NICE). Rosacea. NICE Clinical Knowledge Summaries, 2023.
2. Taieb A, et al. Superiority of Ivermectin 1% Cream Over Metronidazole 0.75% Cream in Treating Rosacea. JAMA Dermatol. 2015;151(11):1212–1218.
3. Forton F, Seys B. Density of Demodex Folliculorum in Rosacea: A Case-Control Study. Br J Dermatol. 1993;128(6):650–659.
4. Liu RH, et al. Azelaic Acid in the Treatment of Papulopustular Rosacea: A Systematic Review. Arch Dermatol. 2006;142(8):1047–1052.
5. Marques C, et al. Mechanistic Insights into the Multiple Functions of Niacinamide. Int J Mol Sci. 2024;25(7):3140.
6. NHS. Laser Treatment for Rosacea. NHS Bristol Laser Centre, 2025.

Fibrous papules are small, harmless skin growths that often develop on the nose or nearby facial areas. While medically benign, many people seek treatment for cosmetic reasons.

This article explains what fibrous papules are, how to distinguish them from other skin conditions, and explores safe, evidence-based treatments and aftercare options for optimal results.

What Are Fibrous Papules

Fibrous papules are firm, dome-shaped bumps made up of collagen, fibrous tissue, and blood vessels [1,9]. They typically measure 2–4 mm and vary from pink to skin-toned.

These lesions, often solitary, are a type of angiofibroma most commonly found on the nose. They are non-cancerous, painless, and do not spread or cause complications [1,9].

Causes Of Fibrous Papules

The cause of fibrous papules remains uncertain. They are believed to result from local overgrowth of fibrous tissue in the dermis, possibly involving dendritic cells [9]. Most cases occur randomly in adults without lifestyle triggers [1].

In rare instances, multiple papules can be associated with genetic conditions such as tuberous sclerosis or multiple endocrine neoplasia type 1 [2]. However, solitary lesions are far more common and unrelated to hereditary factors [1].

Fibrous Papule Vs. Basal Cell Carcinoma

Accurate differentiation between fibrous papules and basal cell carcinoma (BCC) is essential. Fibrous papules are smooth, firm, and stable in size, while BCC may bleed, crust, or enlarge over time [1,5].

Dermoscopy can help distinguish them. Fibrous papules show a uniform pink or white background with fine blood vessels, whereas BCC often exhibits pearly or pigmented features. When uncertain, dermatologists may perform a biopsy for confirmation [1].

When To Consult A Dermatologist

Although fibrous papules are benign, changes such as rapid growth, bleeding, or altered colour require professional evaluation. The NHS recommends seeking medical assessment for any changing or persistent skin lesion [5]. Early review ensures correct diagnosis and peace of mind.

Treatment Options For Fibrous Papules

Dermatological treatments for fibrous papules are usually chosen for cosmetic improvement. The best method depends on the lesion’s size, location, and skin type [1,3].

Excision

A dermatologist can remove the papule under local anaesthesia using a fine scalpel. Excision provides immediate, permanent removal with minimal scarring when performed carefully [1,3].

Cryotherapy

Cryotherapy freezes the lesion using liquid nitrogen until it detaches naturally. While safe, it is less commonly used for facial papules due to the risk of irritation or temporary pigmentation, especially in darker skin [3].

Laser Treatment

Laser therapy uses focused light to vaporise the papule with precision. Pulsed dye and CO₂ lasers are frequently used and can achieve smooth results with minimal downtime [3,4].

Electrocautery

This treatment applies controlled electrical heat to remove the papule and seal small blood vessels, reducing bleeding and supporting rapid recovery [3].

Treatment Option	Summary
Excision	Surgical removal under local anaesthesia, highly effective with minimal scarring.
Cryotherapy	Freezes lesion with liquid nitrogen, less common for facial use.
Laser Treatment	Uses pulsed dye or CO₂ laser for precise, quick recovery.
Electrocautery	Removes lesion using heat, ideal for small papules with minimal downtime.

Each approach can be effective when performed by a qualified dermatologist. Excision and laser treatment are most common for facial areas because they offer precision and predictable cosmetic outcomes.

Post-Treatment Care

After fibrous papule removal, correct aftercare supports healing and prevents pigmentation or scarring. Dermatologists generally recommend the following:

• Gently cleanse the area with mild soap and water.
• Apply an antibacterial ointment as advised.
• Protect from sun exposure using SPF 30 or higher.
• Follow all aftercare guidance from your healthcare provider.

Sun protection is especially important to reduce post-treatment pigmentation, particularly on facial skin [1].

Monderma’s Role In Post-Excision Care

After excision, personalised skincare can support recovery. Monderma’s prescription skincare, created by GPhC-registered prescribers, combines hydrating and restorative actives in a vegan base with hyaluronic acid and peptides.

Depending on skin type, formulations may include:

• Azelaic acid (3–20%) to reduce melanin synthesis and prevent post-inflammatory pigmentation [6].
• Niacinamide (2–4%) to strengthen the skin barrier and reduce redness [7].
• Tretinoin (0.025–0.1%) to enhance gentle skin renewal and improve texture [8].

A 2024 study showed that 15% azelaic acid gel effectively treated post-inflammatory hyperpigmentation [6]. Niacinamide aids recovery by supporting the barrier function, while tretinoin promotes regeneration and smoother results over time.

Monderma offers a free online consultation for UK residents aged 16 and above. Each formulation is reviewed by a prescriber to ensure safety and suitability during the recovery process.

Conclusion

Fibrous papules, most often seen on the nose, are harmless lesions typically removed for cosmetic reasons. Understanding their characteristics and available treatments such as excision, cryotherapy, laser therapy, or electrocautery allows informed decisions about care.

Consulting a dermatologist can ensure accurate diagnosis and optimal results. Following treatment, Monderma’s personalised skincare can support healing, helping to maintain smooth and even skin tone with minimal scarring or pigmentation.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Oakley A. Fibrous Papule of the Nose. DermNet. Published October 26, 2023.
2. Pack S, Turner ML, Zhuang Z, et al. Cutaneous Tumors in Patients with Multiple Endocrine Neoplasia Type 1. J Clin Endocrinol Metab. 1998;83(3):1007–1011.
3. Typology. Fibrous Papule: How to Eliminate It? Published October 23, 2024.
4. Boixeda P, Sanchez-Miralles E, Azana JM, et al. Laser Treatment of Angiofibromas. J Dermatol Surg Oncol. 1994;20(12):808–812.
5. NHS. Skin Cancer (Non-Melanoma). NHS Inform UK. Updated October 2024.
6. Shucheng H, Zhou X, Du D, et al. Effects of 15% Azelaic Acid Gel in the Management of Post-Inflammatory Hyperpigmentation. Dermatol Ther (Heidelb). 2024;14(5):1293–1314.
7. WBCL. Barrier Repair Reinvented: How Liposomal Niacinamide Calms and Strengthens Sensitive Skin. Published June 12, 2025.
8. Govender K. The Use of Tretinoin Cream in the Management of Scars. Published March 12, 2025.
9. Damman J, Biswas A. Fibrous Papule: A Histopathologic Review. J Cutan Pathol. 2018;45(11):803–810.

Hyperpigmentation affects people across all skin tones, often presenting as melasma, sunspots, or post-inflammatory marks. These dark patches can make skin appear uneven and dull. Evidence-based skincare ingredients help to fade discolouration safely and effectively when used consistently.

This article reviews proven ingredients for hyperpigmentation and how tailored formulations, such as Monderma’s prescription blends, may support a more even skin tone.

Understanding Hyperpigmentation

What Causes Hyperpigmentation

Hyperpigmentation occurs when excess melanin, responsible for skin colour, is produced by melanocytes. Triggers include sun exposure, hormonal fluctuations, and inflammation from acne or injury. According to the NHS, UV radiation stimulates melanin production, worsening sun-induced pigmentation [1]. StatPearls reports that hormonal melasma affects up to 50% of pregnant women [2].

Identifying The Type Of Pigmentation

Different forms of hyperpigmentation require tailored care:

• Melasma: Hormonal pigmentation often on cheeks or forehead.
• Sunspots: Caused by long-term UV exposure.
• Post-Inflammatory Hyperpigmentation (PIH): Dark marks following acne or irritation.

Understanding the cause helps match the right skincare ingredients for optimal results.

Key Ingredients In Hyperpigmentation Creams

Vitamin C

Vitamin C (ascorbic acid) inhibits tyrosinase, reducing melanin formation and promoting brightness. A 2013 study confirmed that regular vitamin C use visibly lightens dark patches [3]. It also supports photoprotection when combined with sunscreen.

Tretinoin

Tretinoin accelerates skin cell turnover, helping shed pigmented cells. JAMA Dermatology found that 0.05% tretinoin can reduce melasma severity by about 40% after 24 weeks [4]. Because tretinoin may cause mild irritation initially, gradual use is recommended.

Niacinamide

Niacinamide (vitamin B3) reduces melanin transfer and supports the skin barrier. Clinical studies show that 4% niacinamide can decrease dark patches by up to 30% in eight weeks [5]. It is suitable for sensitive skin and enhances tolerance to other active ingredients.

Azelaic Acid

Azelaic acid, derived from grains, helps reduce pigmentation and inflammation. NICE notes that a 20% strength may be effective for hyperpigmentation management [6]. It is gentle and can be used on sensitive or acne-prone skin.

Alpha Arbutin

Alpha arbutin inhibits melanin production without significant irritation [7]. It is suitable for daily use and can complement other brightening agents.

Kojic Acid

Kojic acid suppresses tyrosinase activity, lightening dark spots. Studies confirm its effectiveness in improving uneven tone when used consistently [8].

Adapalene

Adapalene, a synthetic retinoid, promotes cell renewal and helps fade post-inflammatory pigmentation. StatPearls reports 0.1% adapalene reduces PIH within 12 weeks [2].

Hydroquinone

Hydroquinone remains one of the most potent topical depigmenting agents. Studies in JAMA Dermatology show 4% hydroquinone can lighten melasma in eight weeks [4]. Because of its strength, medical supervision is advised for safe use.

How Monderma’s Custom Formula Supports Hyperpigmentation Care

Monderma provides individually compounded hyperpigmentation creams containing clinically supported actives such as tretinoin, azelaic acid, adapalene, and hydroquinone.

Consultations are free and reviewed by registered healthcare professionals to ensure safety and suitability. This aligns with NICE guidance recommending individualised treatment plans [6]. Combining ingredients can improve outcomes compared with single agents [9].

Key Ingredients In Monderma Formulations

Ingredient	What It Is	How It May Help
Adapalene	Synthetic retinoid	Boosts turnover & evens tone [2].
Azelaic Acid	Naturally derived acid	Reduces pigmentation & inflammation [6].
Hydroquinone	Lightening agent	Lowers melanin for stubborn patches [4].
Niacinamide	Vitamin B3	Limits pigment transfer & soothes [5].
Tretinoin	Vitamin A derivative	Speeds renewal & fades uneven tone [4].

Table 1: Key ingredients in Monderma formulations

Sunscreen For Hyperpigmentation: Essential Protection

Daily sun protection is crucial for preventing and managing pigmentation. The NHS recommends using a broad-spectrum SPF 30 or higher [1]. For individuals prone to hyperpigmentation, SPF 50 offers additional protection. Sunscreen helps prevent recurrence and maximises the effects of topical treatments.

Choosing The Right Hyperpigmentation Products

Match Your Skin Type

Oily skin may respond well to niacinamide or adapalene. Sensitive skin may prefer azelaic acid or lower retinoid concentrations.

Test New Products

A 24-hour patch test helps identify possible reactions. Discontinue use if redness or irritation develops.

Seek Professional Guidance

Consulting a licensed prescriber or dermatologist ensures appropriate ingredient selection. Monderma’s healthcare team follows clinical guidance from sources such as UpToDate and NICE [6][7].

Enhancing Your Routine With Retinol For Hyperpigmentation

Retinol, a gentler derivative of vitamin A, offers a milder option for those unable to tolerate tretinoin. Regular use promotes smoother texture and reduced discolouration. Combining retinol or tretinoin with daily SPF enhances overall results and reduces risk of irritation.

Conclusion

Hyperpigmentation can be improved through evidence-based skincare ingredients such as tretinoin, hydroquinone, niacinamide, azelaic acid, and vitamin C. Combining these actives under professional supervision supports more even tone and healthier-looking skin. Consistent use of SPF 50 sunscreen is essential to prevent recurrence.

Those seeking tailored formulations can complete your free Monderma consultation to receive prescription-strength options guided by healthcare professionals.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. NHS. Sunscreen and sun safety. NHS, accessed 11 July 2025.
2. Postinflammatory Hyperpigmentation. StatPearls, updated 2023.
3. Telang, P.S. Vitamin C in dermatology. Indian Dermatology Online Journal, 2013; 4(2):143–146.
4. Kang, W.H. et al. Intermittent therapy for melasma in Asian patients with combined topical agents. J Dermatol. 1998;25(9):587–596.
5. Hakozaki, T. et al. The effect of niacinamide on reducing cutaneous pigmentation. Br J Dermatol. 2002;147(1):20–31.
6. Scenario: Management of acne vulgaris in primary care. NICE Clinical Knowledge Summaries, 2019.
7. Hyperpigmentation disorders: Treatment and management. UpToDate, 2024.
8. Lim, J.T. Treatment of Melasma Using Kojic Acid in a Gel Containing Hydroquinone and Glycolic Acid. Dermatol Surg. 1999;25(4):282–284.
9. Bandyopadhyay, D. Topical treatment of melasma. Indian J Dermatol. 2009;54(4):303–309.

Papules are small, raised bumps that appear in many common skin conditions. Though they can look concerning, most are harmless. These tiny lesions can vary in colour and texture, appearing anywhere on the body. Understanding what causes papules helps determine if they are temporary irritations or signs of something requiring medical attention.

This article explores papules, how they form, conditions that cause them, and the differences between papules, moles, and warts.

What Are Papules

Papules are small, solid skin bumps under 1 cm in diameter [1,2]. They contain no pus or fluid, unlike pustules or vesicles [3]. Papules can appear as red, brown, purple, or flesh-toned, and may have a smooth or rough surface [3].

Recognising their appearance helps distinguish them from other skin lesions and supports early identification of potential causes.

How Papules Form

Papules develop from irritation or inflammation that causes localised swelling of the skin [4]. This occurs when the immune system reacts to internal or external triggers such as infections, allergies, or chronic skin conditions [5].

Common Triggers Include

• Blocked pores or bacterial infection
• Skin irritation from harsh skincare products
• Sun exposure or environmental pollutants
• Hormonal changes or high stress levels [6]

Identifying these triggers supports prevention and helps guide gentle, evidence-based care.

Common Skin Conditions & Papules

Papules are common in several dermatological conditions. Each condition presents differently and may require specific management approaches.

Skin Condition	Characteristics	Common Locations	Management Strategies
Acne	Inflamed bumps caused by clogged pores that may progress to pustules or nodules [7].	Face, back, shoulders	Topical benzoyl peroxide or retinoids; skincare adjustments; lifestyle changes [8].
Eczema	Dry, itchy skin with red papules during flare-ups [9].	Elbows, knees, face	Use emollients, mild corticosteroids, and avoid triggers [10].
Psoriasis	Red, scaly papules merging into plaques due to immune activation [11].	Elbows, knees, scalp	Apply topical agents, phototherapy, or prescribed systemic treatments [12].
Lichen Planus	Purple, itchy, flat-topped papules that may appear in clusters [13].	Wrists, ankles, mouth	Topical corticosteroids, antihistamines, or light therapy [14].

Table 1: Common skin conditions associated with papules and their management

Differentiating Papules From Other Skin Lesions

Papules can resemble other lesions such as moles, warts, or nodules. Recognising their differences helps guide accurate assessment and care.

Lesion Type	Characteristics	Cause	Treatment
Moles	Pigmented, stable skin growths that can change with time; sudden changes may require review [15].	Melanocytes	Regular monitoring or excision if clinically necessary [16].
Warts	Rough, raised bumps with a cauliflower-like surface; spread through HPV [17].	Viral infection	Topical wart treatments or cryotherapy under supervision [18].
Nodules	Larger, deeper, solid lumps beneath the skin’s surface [19].	Varies by condition	Dermatologist assessment; sometimes medication or surgery [20].

Table 2: Differences between papules and other common skin lesions

When To Seek Medical Advice

Most papules heal naturally, but medical advice may be needed if:

• They rapidly change in size, shape, or colour [16].
• They become painful, itchy, or inflamed [5].
• Other symptoms such as fever or fatigue appear [4].

Early professional assessment can help rule out infection or more serious conditions [21].

Treatment Options

Treatment depends on the underlying cause. Dermatologists or healthcare professionals can recommend suitable care.

Topical Treatments

Mild acne-related papules may respond to benzoyl peroxide or salicylic acid [8]. Prescription retinoids such as tretinoin may help reduce blocked pores and inflammation [22].

Moisturisers & Creams

For eczema or psoriasis, emollients and mild corticosteroids reduce dryness and irritation [10,12]. Azelaic acid can be used to help manage inflammation and redness associated with rosacea [23].

Medical Procedures

Stubborn lesions like warts may require dermatological treatments such as cryotherapy or laser therapy, performed safely by qualified professionals [18].

Monderma’s Role In Personalised Skincare

Monderma provides prescription skincare designed for acne, rosacea, hyperpigmentation, and other skin concerns. After a free online consultation, healthcare professionals formulate treatments using evidence-based ingredients such as azelaic acid, niacinamide, or tretinoin.

This personalised approach supports safe, effective management tailored to individual skin types. Learn more through Monderma’s free online consultation.

Conclusion

Papules are small, raised lesions that often result from inflammation or common skin conditions such as acne, eczema, or psoriasis. Most are harmless, but persistent or changing papules should be reviewed by a healthcare professional.

With professional support and tailored skincare, managing papules becomes more straightforward. Explore Monderma’s free consultation service to discover personalised options for clearer, balanced skin.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Nast A, et al. Papule. In: ScienceDirect Topics. 2016.
2. Habif TP. Clinical Dermatology. 6th ed. Elsevier; 2015.
3. Marks JG, Miller JJ. Lookingbill and Marks’ Principles of Dermatology. 5th ed. Elsevier; 2013.
4. Bolognia JL, et al. Dermatology. 4th ed. Elsevier; 2017.
5. Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine. 8th ed. McGraw-Hill; 2012.
6. Draelos ZD. Cosmetic Dermatology: Products and Procedures. Wiley-Blackwell; 2015.
7. Zaenglein AL, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.
8. NICE. Acne vulgaris: management. 2021.
9. Eichenfield LF, et al. Guidelines of care for atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-351.
10. NICE. Atopic eczema in under 12s: diagnosis and management. 2007.
11. Menter A, et al. Guidelines of care for psoriasis and psoriatic arthritis. J Am Acad Dermatol. 2008;58(5):826-850.
12. NICE. Psoriasis: assessment and management. 2012.
13. Le Cleach L, Chosidow O. Lichen planus. N Engl J Med. 2012;366(8):723-732.
14. American Academy of Dermatology. Lichen planus: Diagnosis and treatment. 2025.
15. Bolognia JL, et al. Melanocytic nevi and neoplasms. In: Dermatology. 4th ed. Elsevier; 2017.
16. UpToDate. Melanoma: Clinical features and diagnosis. 2023.
17. Sterling JC, et al. British Association of Dermatologists’ guidelines for the management of cutaneous warts. Br J Dermatol. 2014;171(4):696-712.
18. Sabry AO, Patel BC. Papillomas: A Multisystem Overview of HPV-Associated and HPV-Independent Lesions. StatPearls. 2023.
19. DermNet NZ. Terminology in dermatology. 2025.
20. American Academy of Dermatology. Find skin cancer: How to perform a skin self-exam. 2023.
21. NHS. Itchy Skin. 2023.
22. Leyden JJ, Stein-Gold L, Weiss J. Why topical retinoids are mainstay therapy for acne. Dermatol Ther (Heidelb). 2017;7(3):293–304.
23. Thiboutot D, et al. Standard management options for rosacea. J Am Acad Dermatol. 2020;82(6):1501-1510.

Skin ageing starts earlier than most expect, often in the mid-20s, and gradually progresses over time. While the process is natural, environmental and lifestyle factors can accelerate visible signs. Understanding these causes helps guide the best anti-ageing skincare choices, from daily sunscreen to prescription creams.

This guide explains what causes skin ageing, how to recognise its signs, and which evidence-based solutions may help improve texture, firmness, and tone.

How And Why We Experience Ageing Skin

Ageing skin results from a combination of intrinsic and extrinsic factors. Intrinsic ageing refers to natural biological changes that begin in the mid-20s, when collagen and elastin production decline by about 1% each year [1]. Extrinsic ageing comes from external influences such as sunlight, pollution, and free radicals.

A large JAMA Dermatology study found that UV exposure accounted for around 80% of visible facial ageing in participants [2]. Over time, the skin becomes thinner, less elastic, and slower to regenerate. Hormonal changes and lifestyle habits also contribute, while lighter skin tones tend to show wrinkles earlier and darker tones more often develop uneven pigmentation [4,8].

Subtypes Of Ageing Skin

Subtype	Description	Common Areas
Intrinsic Ageing	Natural, biologically driven changes	Whole body
Extrinsic Ageing	UV-induced or environmental ageing	Face, neck, arms, legs

Table 1: Subtypes of ageing skin and commonly affected areas

Intrinsic ageing occurs in everyone, but genetics influence its pace. Extrinsic ageing varies more widely and is largely preventable. Sun-exposed areas typically show deeper wrinkles and more discolouration than protected skin [2,6].

What Causes Ageing Skin

The main driver of visible ageing is collagen loss. From the mid-20s, collagen and elastin production slow, reducing firmness and hydration [3]. Hormonal shifts, especially decreased oestrogen, further impact skin strength and moisture [8].

UV radiation, free radicals, smoking, and high-sugar diets accelerate this decline. Studies show that ultraviolet light alone causes up to 80% of premature skin ageing [2,9]. Lifestyle factors like smoking also stiffen collagen fibres and reduce elasticity [10].

How To Spot Premature Ageing

Early signs of ageing often appear around the late 20s, progressing with each decade.

Age	Signs	Typical Features
25–30	Early	Fine lines, mild collagen loss
40s	Moderate	Wrinkles, reduced elasticity
70+	Advanced	Fragile, thin skin with deep folds

Table 2: Age-related signs and typical features of premature ageing

By assessing photos or video, Monderma’s healthcare professionals can evaluate areas such as the face and neck, determining severity and providing tailored guidance.

Evidence-Based Treatments For Ageing Skin

Clinical research supports the use of topical retinoids, antioxidants, and sunscreen for maintaining youthful skin [12]. For mild cases, over-the-counter products may help. In more advanced cases, prescription-strength formulations offer greater impact.

Monderma’s personalised anti-ageing cream contains tretinoin, a well-studied retinoid shown to increase collagen and smooth fine lines. The treatment can be integrated easily into an existing routine to target wrinkles, uneven tone, and photoaged skin.

Monderma’s Personalised Custom Formula For Fighting Ageing Skin

Ingredient	Strength	Description	Effect On Ageing Skin
Adapalene	0.1–0.3%	Third-generation retinoid derived from vitamin A	Boosts cell turnover and smooths fine lines
Azelaic Acid	3–20%	Anti-inflammatory compound derived from yeast	Reduces pigmentation and refines texture
Hydroquinone	2–4%	Skin-lightening agent targeting melanin	Fades age spots and evens tone
Niacinamide	2–4%	Vitamin B3 with antioxidant action	Strengthens barrier and supports elasticity
Tretinoin	0.1–1%	Prescription retinoid	Increases collagen, reducing wrinkles and firmness loss [11,16]

Table 3: Key active ingredients in Monderma’s custom anti-ageing formula

Common Complications

Without treatment, fine lines deepen and skin thins, making it prone to dryness and slower healing [14]. Sun damage can also cause persistent hyperpigmentation, which becomes harder to treat with age [15]. Fragile blood vessels may increase the risk of redness or rosacea flare-ups.

Practical Tips For Preventing Skin Ageing

• Use a broad-spectrum SPF 30 or higher every day, even in winter [13,17].
• Apply a retinoid or antioxidant serum at night to promote renewal [16].
• Eat a diet rich in whole foods, fruits, and vegetables.
• Limit alcohol, sugar, and smoking.
• Exercise regularly and aim for sufficient sleep.

Consistent, gentle care helps maintain firmness and hydration, while sun protection remains the single most effective anti-ageing measure.

Conclusion

Ageing skin reflects both natural biology and environmental exposure. While no treatment can stop the process, evidence-based skincare and lifestyle choices can slow it significantly.

Monderma’s personalised formulations combine prescription retinoids and antioxidants to help improve firmness, texture, and tone. Begin with a free online consultation to explore a tailored anti-ageing routine designed for your skin.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Shuster S, Black MM, McVitie E. The influence of age and sex on skin thickness, skin collagen and density. Br J Dermatol. 1975;93(6):639-643.
2. Flament F et al. Effect of the sun on visible clinical signs of aging in Caucasian skin. Clin Cosmet Investig Dermatol. 2013;6:221-232.
3. Makrantonaki E et al. Identification of Biomarkers of Human Skin Ageing. PLOS One. 2012;7(11):e50393.
4. Vashi NA et al. Aging Differences in Ethnic Skin. J Clin Aesthet Dermatol. 2016;9(1):31-38.
5. Farage MA et al. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci. 2008;30(2):87-95.
6. Jeremian R et al. Skin photoageing following sun exposure. Br J Dermatol. 2024;190(4):590-592.
7. Ganceviciene R et al. Skin anti-aging strategies. Dermatoendocrinol. 2012;4(3):308-319.
8. Thornton MJ. Estrogens and aging skin. Dermatoendocrinol. 2013;5(2):264-270.
9. Rabe JH et al. Photoaging: mechanisms and repair. J Am Acad Dermatol. 2006;55(1):1-19.
10. Choi JY et al. Agents Targeting Advanced Glycation End-Products for Skin Anti-Aging. Antioxidants (Basel). 2025;14(4):498.
11. Kligman AM et al. Topical tretinoin for photoaged skin. J Am Acad Dermatol. 1986;15(4 Pt 2):836-859.
12. Ganceviciene R et al. Skin anti-aging strategies. Dermatoendocrinol. 2012;4(3):308-319.
13. Young AR et al. Ultraviolet radiation and the skin: Photobiology and sunscreen photoprotection. J Am Acad Dermatol. 2017;76(5S):S100-S109.
14. Ashcroft GS et al. Aging and wound healing response in a murine model. J Invest Dermatol. 1997;108(4):430-437.
15. Vashi NA, Kundu RV. Facial hyperpigmentation: causes and treatment. Br J Dermatol. 2013;169(Suppl 3):41–56.
16. Mukherjee S et al. Retinoids in the treatment of skin aging. Clin Interv Aging. 2006;1(4):327-348.
17. Randhawa M et al. Daily Use of Broad-Spectrum Sunscreen Improves Photoaging. Dermatol Surg. 2016;42(12):1354-1361.

Rosacea is a chronic inflammatory skin condition affecting around 1.65% of people in the UK [1,9] and over 5% globally [4]. It commonly appears after age 30 and presents with facial redness, visible blood vessels, irritation, and sometimes acne-like bumps [2].

This guide explores rosacea symptoms, triggers, and treatments including dermatologist-supervised skincare to help manage flare-ups safely and effectively.

Understanding The Types Of Rosacea

Rosacea has four recognised subtypes, often overlapping and evolving over time [10].

Subtype	Description & Effects	Prevalence	Common Areas
Erythematotelangiectatic	Redness, visible vessels, and burning	57% [3]	Nose, cheeks, chin
Papulopustular	Redness with acne-like bumps (no blackheads)	43% [3]	Forehead, cheeks, chin
Phymatous	Thickened, bumpy skin (often on the nose)	7% [3]	Nose, ears
Ocular	Eye dryness, burning, and irritation	11% [3]	Eyes, eyelids

Table 1: Common rosacea subtypes and prevalence

Subtypes can co-exist or shift over time, requiring professional evaluation for tailored care.

Common Triggers Of Rosacea

Flare-ups are highly individual, but several common triggers frequently worsen redness and irritation [5,6].

Trigger	Effect On Skin	Prevalence	Management Tip
Sun Exposure	UV rays dilate blood vessels and damage skin barrier	81% [6]	Apply SPF 30+ mineral sunscreen daily [7]
Stress	Releases inflammatory neuropeptides	79% [6]	Use mindfulness or relaxation exercises [5]
Extreme Weather	Heat or wind aggravates flushing	75% hot / 46% cold [6]	Layer clothing & protect face outdoors
Alcohol	Expands blood vessels, increasing redness	52% [6]	Limit red wine and strong spirits [5]
Exercise	Raises body temperature and facial flushing	56% [6]	Cool skin, hydrate, apply SPF if outdoors
Spicy Food	Capsaicin widens vessels and triggers burning	45% [6]	Choose mild flavours [5]
Hot Drinks	Heat triggers flushing	36% [1]	Try iced versions
Harsh Skincare	Fragrance or alcohol increases sensitivity	41% [6]	Use gentle, fragrance-free cleansers [5]

Table 2: Common rosacea triggers and management strategies

Tracking triggers with a healthcare professional helps refine personalised management plans.

Diagnosing Rosacea

Diagnosis is clinical and based on visible redness, vascular changes, and inflammation in the absence of blackheads. According to NHS guidance, assessment includes evaluating severity and identifying aggravating factors [7].

Monderma’s clinicians review photographs or video consultations to confirm type and recommend suitable prescription skincare.

Effective Rosacea Treatments

Evidence-Based Ingredients

Topical therapies help calm inflammation, reduce redness, and improve barrier function.

Ingredient	Strength	What It Is	How It Helps Rosacea
Azelaic Acid	3–20%	Dicarboxylic acid from grains	Calms inflammation & reduces redness [7]
Niacinamide	2–4%	Vitamin B3 derivative	Strengthens barrier & reduces sensitivity
Ivermectin	1%	Antiparasitic compound	Targets Demodex mites linked to rosacea [13]

Table 3: Common Prescription Actives For Rosacea Management

Combination formulas prescribed by a healthcare professional can address both inflammation and microbial imbalance.

Prescription Formulations

Monderma offers dermatologist-directed treatments containing medical-grade actives such as azelaic acid, niacinamide, and ivermectin. These ingredients target redness, strengthen skin resilience, and reduce mite-related irritation.

Managing Complications

Without management, rosacea can lead to persistent redness, thickened skin, or eye complications. Around 20% of advanced cases involve ocular symptoms such as dryness or discomfort [8,9,12].

Psychological impacts are also common, highlighting the importance of early, compassionate treatment and ongoing support.

Practical Skincare Tips For Rosacea

• Use gentle, fragrance-free cleansers twice daily.
• Apply prescribed rosacea cream as directed by your clinician.
• Always wear SPF 30+ mineral sunscreen, even on cloudy days [7].
• Avoid alcohol-based or exfoliating products [6,11].
• Keep a trigger diary to monitor food, weather, or stress patterns.
• Stay consistent and review progress regularly with a healthcare professional.

Conclusion

Rosacea management combines identifying triggers, using gentle skincare, and applying targeted prescription treatments. With consistent SPF use, avoidance of irritants, and professional guidance, most people achieve noticeable improvement in redness and comfort.

For expert-led rosacea care, complete a free consultation with Monderma today and share this article to help others better understand rosacea management.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. NICE. Rosacea: Prevalence. Clinical Knowledge Summaries, 2023.
2. Patient.info. Rosacea. Updated May 2023.
3. Barakji YA, et al. Assessment of Frequency of Rosacea Subtypes in Patients With Rosacea. JAMA Dermatol. 2022;158(6):678-686.
4. Gether L, Overgaard LK, Egeberg A, et al. Prevalence and risk of rosacea: a systematic review and meta-analysis. Br J Dermatol. 2018;179(2):282-289.
5. National Rosacea Society. Coping With Common Rosacea Triggers. 2018.
6. National Rosacea Society. Rosacea Triggers Survey. Accessed July 2025.
7. NHS. Rosacea. 2023.
8. DermNet NZ. Ocular Rosacea. Accessed July 2025.
9. Spoendlin J, Voegel JJ, Jick SS, Meier CR. Epidemiology of Rosacea in the U.K. Br J Dermatol. 2012;167(3):598-605.
10. Tan J, Berg M, Gallo RL, Del Rosso JQ. Applying the Phenotype Approach for Rosacea. Br J Dermatol. 2018;179(3):741-746.
11. Searle T, Ali FR, Carolides S, Al-Niaimi F. Rosacea and Diet: What Is New in 2021? J Clin Aesthet Dermatol. 2021;14(12):49-54.
12. National Rosacea Society. Ocular Rosacea Can Threaten Sight. Rosacea Review. Winter 2004.
13. NICE. Rosacea: Management. Clinical Knowledge Summaries, 2023.

Acne is one of the most common skin conditions worldwide, often starting in adolescence and sometimes continuing into adulthood. It can impact self-esteem and overall well-being, making informed treatment vital.

This guide explains acne’s causes, subtypes, and treatment options, helping individuals understand how to achieve clearer, healthier skin safely and effectively.

What Is Acne?

Acne occurs when hair follicles become blocked by oil, dead skin cells, and bacteria, leading to inflammation and spots. It affects up to 95% of people aged 11 to 30 in the UK, with most cases peaking in teenage years [1,3]. Around 10–15% of adults aged 35–44 continue to experience acne [2].

While most common on the face, acne can also appear on the back (up to 60%) and chest (around 15%) [1].

Historical Context & Understanding

Records of acne date back to ancient Egypt, around 1550 BCE, describing skin lesions resembling cystic acne [12]. By the 19th century, scientists recognised the link between hormones and oil production. Modern research now explores the combined roles of genetics, hormones, and environment in acne’s development.

Subtypes Of Acne & Their Features

Acne appears in several forms, from mild to severe. Each type requires different management strategies.

Acne Subtype	Description	Common Areas
Blackheads	Small, dark, non-inflammatory bumps	Forehead, nose, chin
Whiteheads	Small, light, non-inflammatory bumps	Forehead, nose, chin
Papules	Tender, red, inflamed bumps	Forehead, cheeks, jawline
Pustules	Red bumps with white pus tips	Forehead, cheeks, jawline
Nodules	Hard, deep-seated lumps	Cheeks, jawline
Cysts	Large, boil-like, painful lumps	Cheeks, jawline

Table 1: Common acne subtypes and locations

A healthcare professional can identify acne type accurately and suggest a suitable management plan.

What Causes Acne?

Excess sebum (oil) production combines with dead skin and bacteria, blocking follicles and causing inflammation. Hormonal changes, particularly during puberty, are a primary trigger [2].

Genetics also play a strong role. Individuals with parents who had severe acne are more likely to develop similar patterns [1]. Maintaining hydration and using non-comedogenic moisturisers can support skin balance.

Contributing Factors

Hormones, diet, stress, and environment can worsen acne.

• Diet: A 2020 JAMA Dermatology study linked high-sugar diets with increased acne risk [7].
• Lifestyle: Smoking has been associated with acne scarring, and humid climates can worsen breakouts [6].
• Medications: Certain drugs, such as corticosteroids, may temporarily aggravate acne by altering skin turnover.

Diagnosing Acne

A clinician assesses acne severity based on lesion type and count.

• Mild-to-Moderate: Up to 34 inflammatory lesions or 1–2 nodules
• Moderate-to-Severe: 35+ lesions or more than 3 nodules

Accurate diagnosis follows NICE guidelines, which recommend reviewing medical history and potential triggers [8].

Monderma’s healthcare professionals review photographs or video consultations to ensure accurate classification before treatment planning.

Conditions That Mimic Acne

Some conditions may resemble acne but require different care.

• Rosacea: Often shows redness and visible vessels; affects about 1.65 per 1000 UK adults [10].
• Folliculitis: Caused by infection or shaving irritation, producing small pustules [11].

A healthcare professional can distinguish these for proper management.

Effective Acne Treatment Options

When standard skincare is insufficient, prescription-based topical treatments can help. Monderma’s clinicians provide personalised formulations containing clinically supported ingredients.

Key Active Ingredients & Their Roles

Ingredient	Strength	What It Is	How It Helps Acne
Adapalene	0.1–0.3%	A third-generation retinoid	Prevents clogged pores & reduces breakouts
Azelaic Acid	3–20%	Natural dicarboxylic acid	Reduces bacteria & brightens dark marks
Clindamycin	1%	Topical antibiotic	Targets acne-causing bacteria
Niacinamide	2–4%	Vitamin B3 derivative	Regulates oil & calms redness
Tretinoin	0.01–0.1%	Prescription retinoid	Boosts cell turnover to unclog pores

Table 2: Active ingredients commonly used in acne treatment

All ingredients should be used under medical supervision to ensure safety and suitability.

Practical Tips For Acne-Prone Skin

• Cleanse Gently: Use mild, non-stripping cleansers twice daily.
• Apply Treatments Sparingly: Use a pea-sized amount to reduce dryness or irritation.
• Moisturise Daily: Non-comedogenic moisturisers help protect the skin barrier.
• Sun Protection: SPF 30 or higher prevents photosensitivity from active ingredients.
• Be Patient: Noticeable results often take 6–8 weeks [9].

Advanced Acne Scar Treatment Options

For persistent scars, dermatologists may recommend:

• Chemical Peels: Remove surface cells to smooth texture.
• Laser Resurfacing: Stimulates collagen to refine deep scars.

Both methods can improve acne scarring when performed under professional supervision. Individual results vary depending on scar depth and skin type.

Complications Of Untreated Acne

Without treatment, severe acne can lead to permanent atrophic scars such as ice-pick or rolling scars. Emotional and social effects are also common, highlighting the importance of early intervention.

Monderma’s Personalised Acne Care Approach

Monderma’s clinicians offer evidence-based acne treatments customised to skin type and severity. Through an online consultation, patients receive dermatologist-reviewed plans containing proven active ingredients.

This individualised method supports both skin clarity and long-term maintenance.

Conclusion

Acne is manageable with a tailored, consistent approach. Understanding its causes and treatment options empowers individuals to reduce breakouts, fade scars, and restore confidence.

You can complete a quick, free online consultation reviewed by a GPhC-registered prescriber to see if a prescription-strength formula could be right for your skin.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. NHS. Acne. 2020.
2. Vasam M, et al. Acne vulgaris: A review of the pathophysiology, treatment, and prevention. Cureus, 2023.
3. Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474–485.
4. Del Rosso JQ. The primary role of sebum in the pathophysiology of acne. J Dermatol Treat. 2024.
5. Teder-Laving M, et al. Genome-wide meta-analysis identifies novel loci conferring susceptibility to acne. Eur J Hum Genet. 2024.
6. Capitanio B, Sinagra JL, Bordignon V, et al. Acne and smoking. Dermatology, 2009;218(2):119–124.
7. Penso L, Dréno B, et al. Association Between Adult Acne and Dietary Behaviors. JAMA Dermatol. 2020;156(8):854–862.
8. NICE. Acne vulgaris: management. NG198, 2021.
9. Callender VD, Baldwin H, Cook-Bolden FE, et al. Effects of Topical Retinoids on Acne and Post-inflammatory Hyperpigmentation in Patients with Skin of Color. Dermatol Ther (Heidelb). 2021;11(1):1–15.
10. Spoendlin J, Voegel JJ, Jick SS, Meier CR. A study on the epidemiology of rosacea in the U.K. Br J Dermatol. 2012;167(3):598–605.
11. Dermatology of Seattle. Folliculitis: Why You Might Mistake It for Acne. 2025.
12. SLMD Skincare. The (Bumpy!) History of Acne Treatments. 2024.

Hyperpigmentation occurs when certain areas of the skin darken due to excess melanin production. It is common and generally harmless, though it can create uneven skin tone.

This article explains the causes, recognised treatments, and skincare steps for managing hyperpigmentation safely.

What Causes Hyperpigmentation

Several triggers can cause hyperpigmentation. Identifying these helps guide an appropriate care approach for different skin types.

Sun Exposure

Sunlight is one of the leading causes of hyperpigmentation. UV rays increase melanin production, forming sun spots on areas such as the face and hands.

Continuous exposure can worsen uneven tone, particularly in darker skin types [1]. Using a broad-spectrum sunscreen with SPF 30 or higher helps protect against this risk [9].

Hormonal Changes

Hormonal fluctuations, including pregnancy or hormonal therapy, can trigger melasma, often called the “mask of pregnancy.” Melasma affects between 8% and 50% of pregnant women, varying by skin tone and location [2].

Broader, symmetrical patches distinguish melasma from other forms. A healthcare professional can recommend suitable management options.

Skin Injuries & Inflammation

Post-inflammatory hyperpigmentation often follows acne, eczema, or minor skin injury. It is particularly common in darker skin tones [3]. Gentle skincare and early treatment support healing and help reduce lingering marks.

Medications

Certain medicines, such as minocycline, may darken the skin as a side effect. Minocycline-related pigmentation occurs in up to 15% of long-term users [4]. If this occurs, seek medical guidance before making changes to treatment.

Genetic Factors

Genetic traits influence the activity of melanocytes and overall pigmentation risk. People with darker complexions often have higher melanin activity [5]. Awareness of family patterns supports preventive skincare planning.

Effective Treatments For Hyperpigmentation

Several treatments can help reduce the appearance of dark spots. Suitability and outcomes depend on the underlying cause, consistency, and professional oversight.

Topical Treatments

Skin creams for hyperpigmentation often include ingredients such as hydroquinone, kojic acid, or vitamin C. Studies show 4% hydroquinone can improve dark patches within 12 weeks [6].

Kojic acid, a natural melanin inhibitor, can enhance skin brightness. Introduce active ingredients gradually to reduce irritation risk.

Hyperpigmentation & Tretinoin

Tretinoin increases cell turnover, helping to fade dark marks and smooth skin texture. It is effective in melasma and post-inflammatory hyperpigmentation when used under clinical supervision [12].

As a prescription-only medicine in the UK, tretinoin should be used as directed by a qualified prescriber and always alongside daily sunscreen.

Chemical Peel For Hyperpigmentation

Chemical peels gently exfoliate the skin and improve texture. Trichloroacetic acid (TCA) peels have shown clinical benefit for uneven pigmentation [7].

Post-treatment hydration supports recovery, and a healthcare professional should carry out the procedure.

Laser Therapy

Laser therapy targets excess melanin in the skin and can help with stubborn pigmentation cases [8]. It should be performed by trained clinicians, as suitability and outcomes vary.

Treatment Type	Benefit	Timeframe	Consideration
Topical Creams	Lightens dark areas	8–12 weeks	May cause irritation
Tretinoin	Boosts skin renewal	12–24 weeks	Prescription only
Chemical Peels	Improves evenness	4–8 weeks	Professional procedure
Laser Therapy	Reduces persistent marks	6–12 weeks	Higher cost

Table 1: Common treatments and considerations

Preventing Hyperpigmentation

Preventive skincare habits protect the skin from new pigmentation and maintain a balanced tone.

Daily Sun Protection

Sunscreen for hyperpigmentation helps prevent dark spots and uneven tone. The NHS recommends broad-spectrum SPF 30, reapplied every two hours outdoors [9]. This step benefits all skin tones and is especially important for those with prior pigmentation issues [10].

Gentle Hyperpigmentation Skincare

A consistent routine using vitamin C, niacinamide, or kojic acid supports skin balance. Antioxidants in skincare and diet can help protect skin cells from oxidative stress [11]. Weekly exfoliation and adequate hydration contribute to smoother, healthier-looking skin.

Monderma’s Custom Formula For Hyperpigmentation

Monderma provides prescription-strength formulations created by UK-registered clinicians and dispensed by a GPhC-registered pharmacy. Each treatment is tailored to individual skin needs after a clinical review.

Ingredient	Strength	Description	How It Supports Even Tone
Adapalene	0.1–0.3%	Vitamin A retinoid	Promotes cell renewal & reduces new marks
Azelaic Acid	3–20%	Naturally derived acid	Helps reduce melanin activity & refine tone
Hydroquinone	2–4%	Prescription-only agent	Reduces melanin formation under supervision
Niacinamide	2–4%	Vitamin B3 derivative	Supports brightness & decreases pigment transfer
Tretinoin	0.01–0.1%	Prescription retinoid	Increases turnover & improves uneven tone

Table 2: Key ingredients and their benefits for even skin tone

Conclusion

Hyperpigmentation can often be managed through consistent skincare, professional assessment, and daily sun protection. Evidence-based ingredients such as hydroquinone, azelaic acid, and tretinoin may help improve uneven tone when clinically appropriate.

You can complete a quick, free online consultation reviewed by a GPhC-registered prescriber to see if a prescription-strength formula could be right for your skin.

Content is for informational purposes only. Monderma treatments are prescribed following consultation. Results and timeframes can vary. Use as directed by your prescriber.

Bibliography

1. Del Bino, S. et al. “Variations in skin colour and the biological consequences of ultraviolet radiation exposure.” British Journal of Dermatology, 2013, 169(s3):33-40.
2. Ogbechie-Godec, O.A. “Melasma: an Up-to-Date Comprehensive Review.” Dermatology Research and Practice, 2017.
3. Davis E.C., Callender V.D. “Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of colour.” Journal of Clinical and Aesthetic Dermatology, 2010; 3(7):20-31.
4. Eisen D., Hakim M.D. “Minocycline-induced pigmentation. Incidence, prevention and management.” Drug Safety, 1998; 18(6):431-440.
5. Bajpai, V.K., et al. “A genome-wide genetic screen uncovers novel regulators of melanogenesis.” bioRxiv, 2021.
6. Monteiro, R.C., et al. “A Comparative Study of the Efficacy of 4% Hydroquinone vs 0.75% Kojic Acid Cream in the Treatment of Melasma.” Journal of Clinical and Aesthetic Dermatology, 2012.
7. Sitohang, I.B.S., et al. “Trichloroacetic Acid Peeling for Treating Photoaging: A Systematic Review.” Journal of Cutaneous and Aesthetic Surgery, 2021.
8. Sarkar R., Gokhale N., Godse K., et al. “Lasers in Melasma: A Review with Consensus Recommendations by the Pigmentary Disorders Society (PDS), India.” Journal of Clinical and Aesthetic Dermatology, 2017; 10(1):34-45.
9. NHS. “Sunscreen and Sun Safety,” 2025.
10. Fatima, S., et al. “The Role of Sunscreen in Melasma and Postinflammatory Hyperpigmentation.” Journal of Clinical and Aesthetic Dermatology, 2020.
11. Addor, F.A.S. “Antioxidants in Dermatology.” Journal of the European Academy of Dermatology and Venereology, 2013, 27(Suppl 1):19-23.
12. Moolla S., Miller-Monthrope Y. “Dermatology: How to Manage Facial Hyperpigmentation in Skin of Colour.” Canadian Family Physician, 2022; 68(5):357-359.