Acne

Acne is a common condition that affects most people at some time in the lives. Most people are affected between the age of 12 and 25.

Acne is a skin condition that causes
• blackheads (comedones)
• whiteheads
• greasy skin
• scars

Acne can affect the face, back, neck, chest and arms and the severity of the condition varies.

Causes
• Extra grease formation of the skin caused by over-activity of the sebaceous glands of the skin.
• High level of male hormones that men and women produce through adolescence. Women with Polycystic Ovarian Syndrome are prone to acne: see Women’s Health link.
• The water retention that some women suffer before their periods
• Normal bacteria (propionibacterium) on the skin that get into the sebaceous glands causing the infective phase of the spots.
• In more severe acne cysts develop beneath the skins surface, these cysts can rupture, spreading the infection into the nearby skin tissue. This can result in scarring.
• Some contraceptive pills may make acne worse. This is due to the progesterone content of the pill. Some contraceptive pills improve acne.
• Some medicines aggravate acne e.g. medicines for epilepsy, steroids and some topical steroid creams.

Skin care and Acne
• There is no evidence that acne is related to poor hygiene and that lack of washing is associated with acne or that frequent washing improves the condition
• Too vigorous cleansing or scrubbing can aggravate the inflammatory phase of acne.
• In general there is no evidence that diet affects sebum production,
• Picking and squeezing spots may cause further inflammation and scarring.
• We suggest that you should clean your acne skin areas twice daily at most using warm water and fingers (avoiding rough cloths and other scrubbing materials). Abrasives may cause an increase in acne.
• Moisturisers may be useful for people with dry skin or irritation due to topical medication e.g. Dermol 500
• You should try and select products that do not block the pores and in general lotions and oil-based products are less good than gel based products. Foundations containing silicone derivatives (cyclomethicones or dimethicone) and loose powder may be better than pressed powder.
• Anti-bacterial soaps, which contain agents such as Chlorhexine and Triclosan do not help the acne and can be irritating. The exception is Benzoyl Peroxide wash (which is available over the counter at the chemist), which does suppress the bacteria. This can cause redness and peeling to start with. This tends to settle down if you reduce the number of times you use it.

TREATMENTS

It is important to realise that treatments for acne take time to be effective. There are a range of treatment options depending on the severity.

1. Topical treatments
• Azealic acid (Skinoren ) is an alternative to benzoyl peroxide and may not make your skin as sore
• Topical retenoids e.g. Adapalene are medicines based on vitamin A. They work by encouraging the outer layer of the skin to rub off
• A topical antibiotic lotion. These need to be used for at least 6 months


2. Oral treatments
• Oral Antibiotics such as tetracyclines or erythromycin. These should be taken daily for 3 months but it may take longer for the effect to be seen. Benzoyl peroxide wash needs to be used as well to stop black head formation.
• Some types of oral contraceptives e.g. Dianette
• Isotretinoin e.g. Roaccutane, is a medicine that works by drying up oily secretions. It tends to be prescribed to people with severe acne that have proved resistant to other treatment. There are a number of serious side effects and it needs to be taken under the supervision of a dermatologist. You will also need monthly blood tests and women pregnancy tests whilst on it. The length of treatment is usually for about three months

All the Student Practices are very experienced in advising on and treating acne.

www.bad.org.uk


Source: Acne Support Group
British Association of Dermatologists
Journal of the American Academy of Dermatology July 2003
Bupa Health Information