Acne

What is acne?

Acne is a common skin condition that causes spots on the face, neck, back or chest. These spots can be whiteheads, blackheads or inflamed, pus-filled pimples.

Adult acne, also called hormonal acne, is acne that continues past the age of around 18 to 20 or starts when someone is in their early twenties.

Acne vulgaris generally affects teenagers and continues for 3 to 5 years although it can sometimes carry on for longer.

Some people have a mild form of acne, with only occasional spots or outbreaks, while others have more severe acne, with large areas of the face and body affected. Acne is more common in women than in men.

Acne can make someone feel unhappy about their appearance, develop poor self-esteem and not want to be around other people.

However, there are some effective treatments for acne. You should speak with your pharmacist or GP if you have acne and it is bothering you.

What are the symptoms of acne?

The symptoms of acne include:

• whiteheads — small white spots under the surface of the skin
• blackheads — small, blocked pores with a black ‘plug’
• pimples — inflamed red spots which can have yellow pus in the middle
• nodules — large red bumps under the skin which can be painful

These symptoms are most commonly seen on the face, but acne can also affect the back, chest, shoulders or neck.

Severe acne can cause scarring — for example, when there is deep or severe inflammation of nodules.

Occasional spots or pimples are not considered to be acne.

What causes acne?

Acne is caused by bacteria that can grow inside the pores of the skin when they become blocked. These bacteria can produce substances that damage the skin, leading to a build-up of dead skin cells and bacteria, which can then form a pimple or nodule in the skin.

When androgen hormones cause too much oil to be produced in pores in the face, neck, chest and shoulders, the pores can become blocked. Androgen levels increase both in boys and girls during puberty. This is why many teenagers have acne while younger children do not. Also, girls reach puberty earlier than boys and so may develop acne at a younger age than boys.

Acne is only caused by a hormone imbalance in a very small minority of people. There are, however, some health conditions, such as polycystic ovarian syndrome (PCOS). Stress can also lead to an increase in hormones, making someone more prone to developing acne.

People whose close family members have had acne are more likely to develop the condition too.

Some people find their acne seems to become worse when they eat certain foods, but acne is not generally caused by the foods you eat. If you are very overweight and you have acne, it is likely to be more severe and harder to treat.

How do I prevent acne?

If you have acne, there are ways to help prevent new spots appearing, and to help prevent acne scars from forming. If you have acne, there are ways to help prevent new spots from appearing and scars from forming.

The following will help prevent spots from becoming inflamed or causing scars:

• wash your face twice a day with mild soap-free wash, warm water and a soft face cloth
• use sun protection, such as a wide brimmed hat and sunscreen to protect your skin whenever you are in the sun
• remove your makeup before you go to bed
• shampoo your hair regularly, especially if it is oily and rests on your skin
• have a well-balanced, healthy diet and exercise regularly

Things to avoid include:

• oil-based makeup or greasy sunscreen
• washing your face too often, or using harsh soaps
• using face scrubs, toners or cleansers
• tight clothing over areas where you have acne
• squeezing or picking spots or pimples
• smoking

Acne most commonly affects people aged between 15 and 24 years, and many people will notice fewer and less severe spots once they get to their mid-twenties. Some people, however, do not grow out of acne and they will need ongoing treatment.

Acne also affects people whose skin is naturally more oily. While you cannot change your age or skin type, it can be helpful to know there are ways to manage your acne and look after your skin.

How can acne be treated?

Your pharmacist can recommend a gentle, soap-free face wash, which you can use with warm water twice a day. Be careful not to wash your skin too often since this may aggravate acne. If your skin still feels oily after washing it, your pharmacist can recommend an over-the-counter acne wash or cleanser.

If your acne is moderate or severe, your doctor can prescribe medicines, which may come in tablet form or as a cream.

It is important to remember that treating acne takes time — often 1 to 2 months — and that you don’t stop treatment just because you don’t see your acne getting better right away. If the acne doesn’t improve after your first treatment, you can return to your pharmacist or doctor and ask if there is another treatment you can try.

Treatments that don’t need a prescription

If you have mild acne, your pharmacist can help you choose an acne wash or cleanser, a lotion or cream with ingredients such as benzoyl peroxide, azelaic acid or glycolic acid that can treat the condition. Use these products right across the area where there is acne, not just on the individual spots. For example, if you have acne on your neck, you should wash your whole neck with the product. If these treatments make your skin feel irritated or dry, try using them less often.

Other treatments can help with mild acne, such as light microdermabrasion, chemical peels and light diathermy. They may need to be repeated regularly and are not suitable for people with severe acne.

Treatments that need a prescription from your doctor

For more severe acne, or when other treatments haven’t worked, your doctor may recommend a medicine to apply that you apply to your skin. This could be together with or instead of the creams and lotions available from the pharmacy.

Your doctor may prescribe antibiotic creams to reduce the infection and inflammation in pimples or nodules, or retinoids to help remove the whiteheads and blackheads. Both of these can make your skin feel irritated or dry as a side effect. If severe skin irritation occurs, stop using these products and see your doctor.

If your acne does not improve after using these creams, your doctor may recommend oral medicines (ones that are taken by mouth). These include:

• antibiotics such as doxycycline or minocycline to treat the bacteria
• anti-androgen medicines such as spironolactone or cyproterone, which blocks the hormone testosterone so less oil is produced in your pores
• contraceptive pills that contain oestrogen and progestogen to help control acne, and which are appropriate for some women
• oral isotretinoin which can help treat severe acne

Some natural products, such as tea tree oil, colloidal oatmeal, green tea extract, alpha hydroxy acid (fruit acid) and azelaic acid, can also help acne. However, they can also irritate your skin or interfere with other medicines you might be taking. Discuss natural acne treatments with your doctor or pharmacist before using them.

When should I see my doctor?

You should see your doctor if your acne is not improving after using the treatment recommended by your pharmacist, or if your acne is severe and causing you concern. Untreated acne can leave you with skin scars, so it is important not to leave it too late before treating it.

Your GP may refer you to a dermatologist (a skin specialist) if your acne is severe and they can help you decide which treatment is best for you.