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.
The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of a hormone called testosterone, which is present in both men and women. This causes the glands to produce an excess of oil. At the same time, the 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 acnes) 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.
The typical appearance of acne is a mixture of the following: oily skin, blackheads and whiteheads, red spots, yellow pus-filled pimples, and scars. Occasionally, large tender spots or cysts may develop that can eventually burst and discharge their contents or may heal up without bursting. The affected skin may feel hot, painful and be tender to touch. Not all spots are acne, so if there is something unusual about the rash it may be advisable to consult your doctor.
Acne is easily recognised by the appearance of the spots and by their distribution on the face, neck, chest or back. However, there are several varieties of acne and your doctor will be able to tell you which type you have after examining your skin. The most common type is ‘acne vulgaris’.
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.
If you have acne but have had no success with over-the-counter products then it is probably time for you to visit your doctor. In general, most treatments take two to four months to produce their maximum effect.
Acne treatments fall into the following categories:
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 (such as tretinoin, isotretinoin and adapalene), azelaic acid.
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.
Antibiotics need to be taken for a minimum of two months, and are usually continued until there is no further improvement, for at least 6 months. Some should not be taken at the same time as food, so read the instructions carefully.
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. It usually takes at least three to four months for the benefits to show. Although they may not be taken for this reason, the pills also help to prevent conception. As they prevent ovulation, they may be less suitable in young teenage girls where ovulation is not well established.
This powerful and effective treatment has the potential to cause a number of serious side effects and is prescribed in the main only by a dermatologist. 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.
An information leaflet provided by Dr O Connor and Dr Gibson to their patients on Roaccutane can be downloaded by clicking on this link
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.