Acne

What is acne?

Acne is a common skin condition that happens when hair follicles (tiny holes) under the skin become blocked by excess sebum (oil) and dead skin cells. It causes oily skin, spots (pimples), blackheads and whiteheads. Sometimes it can make the skin feel hot or it can be painful to touch.

Acne can affect everyone, but it’s most common in teenagers and young adults. It often starts during puberty between the ages of 10 and 13 and tends to worsen for people with oily skin.

What causes acne

Acne develops when the tiny glands near the surface of your skin (called sebaceous glands) make too much oil (sebum). The sebum mixes with dead skin cells, forming a plug. This blocks the hair follicles under your skin, causing them to bulge, creating whiteheads. If the blocked follicle is open to the skin, blackheads, which look like tiny black dots, form. Bacteria living on your skin can infect the plugged follicles, causing spots, lumps and other blemishes to appear.

A range of things can trigger acne, including:

• Puberty – Changing hormone levels can lead to excess oil (sebum) and a thickening of the inner lining of the hair follicles, which blocks the pores

• Genes – Acne tends to run in families. If your parents had it, then it’s likely you’ll also get acne

• Menstruation and pregnancy – In women, hormonal changes during the menstrual cycle and pregnancy can lead to acne breakouts

• Certain medications, like steroids and medicines that treat depression, bipolar disorder and epilepsy, can trigger acne

• Stress – This doesn’t cause acne, but stress and anxiety can make it worse

• Smoking

• Areas of pressure or friction - Like wearing a headband, having a tight collar or carrying a backpack

Acne symptoms

Acne usually affects the face, forehead, back, shoulders and chest. The symptoms vary depending on how severe your acne is and may include:

• Blackheads

• Whiteheads

• Papules - Small red, tender bumps in the skin

• Pustules - Small red bumps with a white tip in the middle containing pus inside

• Nodules - Large, hard, painful bumps under the surface of the skin

• Cysts - Large, painful, pus-filled lumps that look similar to boils. This is the most severe type of spot caused by acne and is often called cystic acne.

How to get rid of acne

You may be able to treat acne yourself at home, but it depends on how severe it is. If you only have a few blackheads, whiteheads and spots, you could try some of these self-care tips. These natural forms of dead skin cell removal are worth trying before any stronger treatment.

• Don’t wash the affected areas too much – Ffrequent washing can irritate your skin and make your symptoms worse

• Use a mild soap or skin cleanser and try not to use very hot or icy water

• Try using a mild exfoliant or a natural sponge to remove dead skin cells on your body or face - this helps prevent them building up and clogging hair follicles

• Avoid the temptation to squeeze your spots – Tthis can make them worse and may cause permanent acne scars

• Don’t wear too much makeup or cosmetics – Tthese can clog your pores and aggravate your acne

• Make sure you completely remove your makeup before you go to bed - this will also help to prevent dead skin cells building up

• After exercising, shower as soon as you can – sweat can irritate your acne

Ask the pharmacist for advice if you’ve got mild acne. There are lots of treatments like lotions, creams and gels that you can buy over-the-counter. But if you have severe acne, it may need to be treated with stronger medication prescribed by a doctor.

When to see a GP

• If your acne is not responding to products bought over the counter containing benzoyl peroxide

• You’ve developed painful nodules or cysts

• Your acne is leaving scars on your skin

• Your acne is causing you psychological distress (like anxiety or depression)

The GP can also refer you to a skin specialist (called a dermatologist) if your acne is severe or you’re getting complications.

Acne treatment

Topical acne treatments (like creams and gels you apply to affected areas) containing the ingredient benzoyl peroxide are effective in most cases of mild acne. These products can be bought at the chemist.

If your acne is moderate or severe, or the medicine the pharmacist recommended hasn’t worked, you may need stronger medication prescribed by the doctor. Prescription medicines that treat acne include:

• Topical retinoids – These come as creams, gels and lotions. They work by removing the dead skin cells on the surface of the skin, which prevents them from blocking hair follicles. Examples of topical retinoids are tretinoin and adapalene. You usually apply them once a day before you go to bed. Topical retinol increases your skin’s sensitivity to the sun, so it’s essential to avoid too much sunlight

• Azelaic acid – This is often used as an alternative to topical retinoids if they irritate your skin. Available as a cream or gel, azelaic acid works by getting rid of dead skin cells and killing bacteria. It’s usually applied twice a day and usually takes about a month before you’ll see an improvement in your acne

• Topical antibiotics – These help kill the bacteria on your skin and are available as a lotion or gel. You need to apply them once or twice a day, and the doctor will usually recommend a 6-8 week course

• Antibiotics – Given in tablet form (oral antibiotics), these are often prescribed to be used with a topical treatment to treat more severe acne. It usually takes about 6 weeks to see an improvement in your skin, and the doctor may prescribe them for 4-6 months. They can make your skin sensitive to sunlight and can also make the oral contraceptive pill less effective. If you’re on the pill, you’ll need to use an alternative method of contraception (like condoms) while taking antibiotics

• Combined oral contraceptive pill – If you’re female, the doctor may recommend you start taking the pill, which can be very effective against acne, especially if your acne flares up when you get your period

• Co-cyprindiol – This is a hormonal treatment that helps to reduce sebum (oil). It’s often prescribed for severe acne that doesn’t get better with antibiotics. It can take 2-6 months before you notice your acne improves

• Isotretinoin – This is a severe acne treatment that can only be prescribed by a specialist doctor. It comes in capsules and can help reduce sebum levels, prevent follicles from becoming blocked, decreases bacteria on the skin, and reduce redness and swelling around spots. It has a wide range of side effects, so you’ll need to be carefully monitored

Benzoyl peroxide

This topical treatment is used as an antiseptic (in the form of cream or gel) to reduce the amount of bacteria and dead skin cells on your face or the affected area of skin. The anti-inflammatory treatment also helps to minimise the amount of blackheads and whiteheads. A doctor or pharmacist can give you more guidance on how to apply benzoyl peroxide acne treatment, but it’s usually advised to use it once or twice a day, 20 minutes after washing the affected skin.

As benzoyl peroxide is very strong, it should be applied sparingly to avoid irritating your skin. Using benzoyl peroxide can make your skin more sensitive to sunlight too, so it’s best to stay out of the sun and ultraviolet (UV) light, like sunbeds.

Benzoyl peroxide spot treatment can have a bleaching effect, so avoid getting it on your hair or clothes.

Other common side effects of using benzoyl peroxide for acne, include:

• dry and tight skin

• a burning, itching or stinging sensation

• some redness and peeling of the skin

The side effects of benzoyl peroxide are mostly mild and will pass once the treatment for acne has finished.

Doctors usually advise to take a 6-week course of treatment to clear the affected skin, depending on the severity of the acne.

Some people may need a repeated course of treatment at a later stage to prevent the acne coming back.

Acne complications

Acne scars are a complication that sometimes happens. All spots can cause scars but if you’ve got more severe spots, like nodules or cystic acne (cysts), you’re more likely to get scars when they burst and damage the skin.

You can also develop acne scarring if you squeeze or pick your spots.
Treatment for acne scars is not generally available on the NHS because it’s considered cosmetic surgery. But sometimes, if it’s causing a lot of psychological distress, like anxiety or depression, an exception may be made, so it’s worth asking a doctor.

There are lots of private clinics that offer treatment for acne scars. Options may include:

• Dermabrasion – Involves removing the top layer of your skin using lasers or a special wire brush

• Laser treatment – There are 2 types. Ablative laser treatment uses lasers to remove a small patch of skin around the scar so that new, smoother skin develops. Non-ablative laser treatment uses lasers to stimulate the growth of collagen (a protein found in the skin), which helps to repair some of the damage caused by scarring and helps to improve the appearance of your skin

• Punch techniques – These are used to treat different types of acne scars and involves surgically removing the scars and either sealing the wound, lifting the skin, so the scar area is less noticeable, or plugging the wound by taking skin from somewhere else (usually behind your ear)

• Subcision – A surgical procedure to treat scars with sloping edges (called rolling scars). It involves removing the upper layer of skin and allowing blood to collect underneath. The blood clot that forms allows new skin tissue to develop that pushes up the rolling scar, so it’s level with the rest of the surface of the skin