Acne (adapted from British Association of Dermatologist leaflet at www.BAD.org.uk)


Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and varies in severity from a few spots on the face, neck, back and chest, which most adolescents will have at some time, to a more significant problem that may cause scarring and impact on self-confidence. For the majority it tends to resolve by the late teens or early twenties, but it can persist for longer in some people.


Acne can develop for the first time in people in their late twenties or even the thirties. It occasionally occurs in young children as blackheads and/or pustules on the cheeks or nose.


Acne is caused by multiple factors, the sebaceous (oil-producing) glands being particularly sensitive to normal blood levels of a hormone called testosterone, which is present in both men and women., excess oil production, dead skin cells lining the pores are not shed properly and clog up the follicles. These two effects result in a build up of oil, producing blackheads (where a darkened plug of oil is visible) and whiteheads.


The acne bacterium (known as Propionibacterium acne's) lives on everyone’s skin, usually causing no problems, but in those prone to acne, the build-up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots.


Acne can run in families, but most cases are sporadic and occur for unknown reasons.

At present there is no ‘cure’ for acne, although the available treatments can be very effective in preventing the formation of new spots and scarring.


Acne treatments fall into the following categories:


Acne

Topical treatments


These are usually the first choice for those with mild to moderate acne. They should be applied to the entire affected area of the skin (for example all of the face) and not just to individual spots, usually every night or twice daily. Consult your doctor if they cause irritation of the skin; reducing the frequency of application may be required, at least temporarily, to help overcome this problem.


There are a variety of active anti-acne agents, such as benzoyl peroxide, antibiotics (erythromycin, tetracycline and clindamycin), retinoids (Retin A and adapalene), azelaic acid and nicotinamide.

Oral antibiotic treatment


Your doctor may recommend a course of antibiotic tablets, usually erythromycin or a type of tetracycline, which should be taken in combination with suitable topical treatment.

Usually these take a few months to work and need to be taken for 6-12 months.


Oral contraceptive treatments


Some types of oral contraceptive pills help females who have acne.


The most effective contain a hormone blocker (for example, cyproterone) which reduces the amount of oil the skin produces.

Isotretinoin


This powerful and effective treatment has the potential to cause a number of serious side effects and can be prescribed only by a dermatologist usually in an NHS setting. Isotretinoin can harm an unborn child.


Women will be asked to enrol in a pregnancy prevention programme and need to have a negative pregnancy test prior to starting treatment. Pregnancy tests will be repeated every month during treatment and five weeks after completing the course of treatment. Effective contraception must be used whilst on treatment, and for four weeks afterwards.


There are concerns that isotretinoin may cause depression and suicidal feelings. Details about any personal and family history of mental illness should be discussed with your own doctor and dermatologist prior to considering treatment with isotretinoin.


Most courses of isotretinoin last for four months during which time the skin may become red and dry. Often, acne becomes a little worse before improvement occurs.


It should be emphasised that many thousands of people have benefited from treatment with isotretinoin without serious side effects.


Other treatments


There have been developments in the use of light and laser therapy for inflammatory acne but these forms of treatment have yet to be fully evaluated and are generally ineffective in the treatment of severe inflammatory acne.


Laser resurfacing of facial skin to reduce post-acne scarring is an established technique requiring the skills of an experienced laser surgeon.

What can I do?


Acne scarring


Some mild acne can get better with alteration of your skin care regime, using a topical prescription cream, after oral antibiotics or after Roaccutane.


We would advise that most of the active ‘spots’/acne is dealt with before tackling the scarring. Scarring can be changes in the skin colour or skin texture with indentations or pits.


Hyper-pigmentation after acne is extremely common especially in skin of colour and can be improved with some cosmeceuticals, some prescription topical treatments. It can also be improved with chemical peels and certain lasers. Your trained professional can talk you through the risk and benefits of these procedures.


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