What is acne?
- A skin condition characterised by the presence of comedones and pustules that is usually most severe on face, neck, chest and back
- Acne usually starts at puberty and often resolves by mid-twenties but can persist longer in some cases
Causes of acne
- Increased production of oil by sebaceous glands in response to high hormone levels
- Dead skin that lines the pores cannot be removed effectively, thereby clogging up the follicles
- This build up of dead skin and oil results in the development of comedones
- The excessive oil production by sebaceous glands also provides an ideal environment in which bacteria can multiply
- Growth of bacteria can result in inflammation of tissue and formation of pustules
- Certain medicines are associated with acne such as contraceptives and steroids but unfortunately most cases are sporadic and occur for no clear reason.
Treatment of acne
- Topical treatments - including benzoyl peroxide (P med), duac and epiduo (POM) should be considered first for patients with mild to moderate acne. Whilst often effective, they can be quite harsh on the skin resulting in significant dryness, tightness and discomfort. Topical preparations vary in terms of their potency and it is important that the correct strength is chosen to provide symptomatic relief whilst minimising side effects
- Oral treatments - including erythromycin or tetracyclines should be used for at least eight weeks before treatment efficacy should be reviewed. Oral contraceptives can also be considered for women who have responded poorly to topical preparations. It can take up to four months to see benefits of this treatment option. Isotretinoin is the last oral treatment option for people with acne that have responded poorly to all other medicines. Isotretinoin can only be prescribed under the supervision of a specialist and can cause a variety of serious side effects, including depression and suicidal ideation. They are highly teratogenic and effective contraception must be used for at least four weeks before, during, and four weeks after treatment. Additionally, women taking isotretinoin must enrol on a pregnancy prevention programme to ensure that they do not become pregnant during treatment and for up to five weeks after treatment has ceased.
- Laser and light therapies
- Treat acne promptly to reduce duration and severity of comedones and pustules
- Be patient when using acne treatments - it usually takes at least eight weeks to notice significant improvements
- Routinely clean the face with mild cleansers - choice of cleanser will vary depending on skin type and products should be chosen based on a patient-by-patient basis. Exfoliating products may also help if used occasionally but patients should be aware that scrubbing the face vigorously can worsen acne and cause skin redness and discomfort
- Choose cosmetic products carefully - ideally these should be avoided but they may help with self-esteem. If required, cosmetics that are less likely to cause/exaggerate acne symptoms should be chosen (eg. non-acnegenic)
- Acne can be a distressing and embarrassing condition and is often associated with depression and anxiety. Patients who develop these feelings should be advised to seek help from their GP. Although a very common condition, the impact that acne has on a person's confidence and self-esteem should not be overlooked.