Skin imbalance is rarely a single visible event. In acne-prone skin, what appears on the surface as breakouts, post-inflammatory hyperpigmentation, open pores or early textural change often reflects a deeper biological pattern: excess sebaceous activity, inflammatory signalling, microbiome disruption and slower tissue recovery.
In this case supervised by Dr Vania Hiratsuka Dalmedo, the concern was not only active acne, but the cumulative effect of repeated flares on skin structure. When inflammation persists, lesions may recur, pigmentation can linger, and early scarring may begin to alter the quality of the tissue itself.
The objective was therefore to interrupt the inflammatory cycle before further dermal alteration occurred, while supporting the skin’s capacity to regulate, repair and stabilise.
The clinical picture
At baseline, the skin presented with active acne, post-inflammatory hyperpigmentation, visible pores, early scarring and excess sebum production. These signs suggested a skin environment under sustained inflammatory pressure, where repeated flares were disrupting both barrier function and tissue repair.
This type of imbalance can be influenced by multiple factors, including hormonal shifts, stress, occlusion and dietary patterns. In acne, the pilosebaceous unit is affected by excess sebum, altered follicular keratinisation, microbial imbalance and immune-inflammatory activity. The skin microbiome is increasingly recognised as part of this process, particularly through changes in microbial diversity and Cutibacterium acnes behaviour.
A four-week, in-and-out protocol
The protocol ran from T0 baseline to T4, week 4, under the supervision of Dr Vania Hiratsuka Dalmedo. It combined daily oral intake of The Skin Biotic with twice-daily use of The Gentle Cleanser and The Active Cream.
The strategy focused on three priorities:
1. Modulating inflammation from within
The Skin Biotic was used to support the gut-skin axis, helping to rebalance microbial diversity and regulate systemic inflammatory signalling.
2. Preserving the skin surface without aggression
The Gentle Cleanser supported daily cleansing while maintaining surface microbiome equilibrium and limiting additional irritation.
3. Supporting barrier lipids and dermal repair
The Active Cream reinforced barrier structure, supported lipid balance and contributed to a more stable skin environment.
Why consistency mattered
Acne-prone skin often requires controlled modulation rather than episodic intervention. When the skin is treated only when visible lesions appear, the underlying cycle may continue: inflammation triggers lesions, lesions leave pigmentation, pigmentation lingers, and the tissue remains vulnerable to further disruption.
In this case, the aim was to reduce recurrence by improving the conditions that allow the skin to recover. Over four weeks, breakout frequency decreased, pigmentation began to soften and the overall texture appeared more refined.
Expert insight
'This patient presented with active acne, post-inflammatory hyperpigmentation and early scarring, driven by sebaceous overactivity and sustained inflammatory signalling. What concerned me was not only the presence of acne lesions, but the cumulative structural impact of repeated flares. The skin was trapped in a cycle of inflammation without adequate regeneration.
Our objective was to interrupt that progression before further dermal alteration occurred. We implemented AWvi’s inside-out strategy to regulate inflammatory pathways, rebalance the microbiome and support tissue repair.
Consistency was essential, as acne requires controlled modulation rather than episodic intervention. Across four weeks, the evolution was progressive and measurable. Breakout frequency decreased, pigmentation began to soften and overall texture appeared more refined.
This case confirms that when acne is addressed at both inflammatory and structural levels, stability can be restored in a durable and physiologically coherent way.'
Dr Vania Hiratsuka Dalmedo, MSc
Dentist and Aesthetic Medicine Practitioner
Clinical Senior Lecturer
Dr Vania Hiratsuka Dalmedo is a London-based aesthetic medicine practitioner and clinical academic. Queen Mary University of London lists her as Clinical Senior Lecturer in the Aesthetic Medicine postgraduate programme, and notes her academic role in clinical teaching and external engagement.
A biology-led approach to acne-prone skin
This case illustrates a central principle of AWvi’s approach: visible skin imbalance often reflects a wider biological system under pressure. In acne-prone skin, the objective is not simply to dry, suppress or cover visible lesions. It is to support regulation across the microbiome, inflammatory pathways, sebaceous activity and barrier function.
When these systems begin to stabilise, the skin becomes less reactive, better able to repair and more predictable over time.
Sources:
Dr Vania Hiratsuka Dalmedo, Queen Mary University of London profile
Acne and the Cutaneous Microbiome: A Systematic Review of Mechanisms and Implications for Treatments
The Role of the Skin Microbiome in Acne: Challenges and Future Therapeutic Opportunities
Skin Barrier Dysfunction in Acne Vulgaris: Pathogenesis and Therapeutic Approaches
Post-inflammatory Hyperpigmentation: A Systematic Review of Treatment Outcomes
The Pathogenesis and Management of Acne-Induced Post-inflammatory Hyperpigmentation
