Acne

Acne is caused by a combination of factors. Sebaceous (oil-producing) glands are tiny glands found near the surface of the skin and are affected by our hormones. In acne, the glands are particularly sensitive, even when these hormones are at normal levels.

This causes the glands to produce too much oil (sebum). At the same time, the lining of the pores (the small holes in the skin’s surface) becomes thickened and dead skin cells build up and block the pores. The mixture of the oil and dead skin cells plugging the pores produces blackheads and whiteheads.

Harmless bacteria that live on everyone’s skin, usually cause no problems. However, in acne, the build-up of oil creates an ideal environment for the bacteria to multiply and cause inflammation. This leads to the formation of red, swollen or pus-filled spots. (papules, pustules, nodules or cysts).

Sometimes acne can be caused or made worse by excess hormones. This may occur in women in a condition called polycystic ovary syndrome (PCOS). PCOS is a hormonal imbalance that causes irregular periods, unusual hair growth and hair thinning.

Acne can also be due to certain hormonal contraceptive preparations or high-dose steroids. Some tablets taken by bodybuilders contain hormones (anabolic steroids) that can trigger acne.

Occasionally, other types of medications can make acne worse. If you develop acne or it suddenly gets worse, it would be worth discussing this with your healthcare professional.

Oily skin care products, greasy moisturisers and hair products, or contact with oily substances at work, can also cause or worsen acne. Skin picking can also make acne worse and cause scarring.

There is not enough evidence to support specific diets for treating acne. However, a healthy, well-balanced diet is advisable. For further information, see https://www.nhs.uk/live-well/eat-well/food-guidelines-and-food-labels/the-eatwell-guide/

Is acne hereditary?

Acne can run in families, but many people with acne do not have affected people in their family. It is likely that a combination of genetic, hormonal and lifestyle factors (such as stress, skincare products, smoking, etc.) act in combination to cause most acne.

Acne is a mixture of the following: oily skin, blackheads, whiteheads, red spots and pus-filled pimples. Occasionally, larger, deeper bumps (known as nodules) or cysts (which resemble boils) may develop. Affected skin may feel hot, painful and be tender to touch.

Acne can leave scars or marks on the skin, particularly in the presence of nodules and cysts. These may be raised and lumpy (known as hypertrophic or keloid scars) or indented (known as pitted or atrophic scars). Acne can also leave discolouration which may be red, hyperpigmented (darker than your usual skin colour) or hypopigmented (lighter than your normal skin colour).

Not all spots are acne, so if there is something unusual about the rash it is advisable to consult your healthcare professional.

One important aspect of being affected by acne that is not discussed often is its impact on mental health. Acne can significantly affect an individual’s psychological well-being. This may lead to low self-esteem, lack of confidence, negative body image (appearance-related concerns), anxiety and depression. Severe acne has been associated with suicidal behaviour. It is important to recognise the impact acne may have on how you feel. If required, speak with your healthcare professional about available support.

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A healthcare professional can diagnose acne during a skin examination. They do not usually need to run any diagnostic tests as it is easily recognised by the type of spots and by their distribution on the face, neck, chest or back.

Can acne be cured?

At present, there is no ‘cure’ for acne. Treatments can be very effective, preventing the formation of new spots and reducing scarring.

How can acne be treated?

The first step is to use skincare products suitable for blemish-prone skin. These may be labelled as ‘non-comedogenic’ or ‘oil-free’.

Active topical treatments (those applied directly to the skin) can be bought over the counter without a prescription. These include benzoyl peroxide, azelaic acid and nicotinamide. You should speak to your pharmacist for advice about these. Most treatments take 2 to 4 months to produce their full effect.

If you have acne but have had no success with over-the-counter products, then it is advisable to visit your healthcare professional.

Acne treatments fall into the following categories:

• Topical treatments, i.e. those that are applied directly to the skin
• Oral antibiotics, i.e. tablets taken by mouth
• Oral contraceptive pills
• Isotretinoin capsules
• Spironolactone tablets
• Other treatments

• Try not to pick or squeeze your spots as this usually aggravates them and may cause scarring and infection.
• If your self-confidence has been affected by acne or if you are feeling distressed, it is important to reach out to others for support. This includes friends, family members and support groups. You may also be able to access a counsellor through school, university or work.
• Let your healthcare professional know if being affected by acne is making you have low moods, feel depressed or anxious. They will be able to speak with you about how you are feeling and help you to form a treatment plan. This may involve help from other specialists, such as psychologists or psychiatrists, if necessary.
• However, you are affected by acne, it is important to take action to control it as soon as it appears. This helps to avoid permanent scarring. If acne is mild, it is worth trying over-the-counter preparations in the first instance. Ingredients such as salicylic acid or benzoyl peroxide can be helpful. A pharmacist will be able to advise you.
• Expect to use your treatments for at least 12 weeks before you see much improvement. Make sure that you understand how to use them correctly, so you get the maximum benefit.
• Some topical treatments may dry or irritate the skin when you start using them. If your face goes red and is irritated by a lotion or cream, stop treatment for a few days. Try using the treatment less often and then building up gradually.
• Make-up may help your confidence. Choose products that are labelled ‘non-comedogenic’ (should not cause blackheads or whiteheads) or non-acnegenic (should not cause acne).
• Cleanse your skin and remove make-up with a gentle cleanser and water, or an oil-free soap substitute. Scrubbing too hard can irritate the skin and make acne worse. Remember blackheads are not due to poor washing.