In this post we discuss the causes of acne, the different treatment options available, and self-care tips to help clear your spots.
What is acne?
Acne is one of the most common skin conditions in the UK and can sometimes lead to scarring of the skin. It is also known as acne vulgaris. Any type of acne can cause scarring but it’s more likely to happen when severe nodules and cysts burst and damage nearby skin.
Acne can also affect your mental health. People with the condition may feel stressed and anxious and may start to withdraw socially as a result of their condition. Some people can become depressed as a result of their acne. If you think this is the case, speak to your GP for advice. As well as treatments to improve your acne, psychological therapies like CBT may help with depression and anxiety.
The condition can occur in different parts of the body. Some people suffer from back acne or chest acne, while other people experience it on their face such as forehead acne or chin acne.
Acne is caused by hair follicles in the skin becoming blocked. Glands in the skin release an oily substance called sebum to lubricate the skin. But in acne, the glands produce too much sebum. This extra sebum can then combine with dead skin cells and cause a blockage in hair follicles. This mixture of oil and dead skin can cause spots like whiteheads and blackheads.
On top of this, bacteria (like C.acnes) that usually live harmlessly on the skin can infect the blocked follicles causing acne lesions like cysts, nodules (acne nodules), pustules or papules. Cysts are the most severe spot that acne can cause, and they have a higher risk of causing acne scars than other spots.
Some factors may trigger a flare-up of spots. For example, certain medicines like lithium and steroid medicines can trigger a flare-up. Wearing constrictive or pressuring clothing, like a backpack or a headband, may also trigger a flare-up. Cosmetic products can also be a trigger, although this is less likely with modern cosmetic products because they are more rigorously tested.
Acne can sometimes be caused by hormone changes. Hormonal acne might be caused by increased testosterone during puberty and hormone changes in women, such as during pregnancy.
Various treatment options exist and these can help improve your acne and reduce the likelihood of scarring. Treatment usually depends on the severity of your acne, which is usually classed as mild, moderate, or severe. Acne medication comes in the form of creams, gels, tablets, and capsules.
Some topical treatments are available over the counter at pharmacies. This includes benzoyl peroxide (available under the name Acnecide or Acnecide Wash Gel). Benzoyl peroxide works by targeting the bacteria involved in acne spots. It can also unblock pores and reduce blockages, which may help prevent future spots.
Benzoyl peroxide can cause dry skin and burning and may not be suitable for certain types of acne such as cystic acne. It is usually used for mild to moderate acne. Another over the counter acne cream is azelaic acid.
Other topical acne treatments are only available on prescription, like Differin Gel. Differin contains a topical retinoid called adapalene. Adapalene has an anti-inflammatory effect on spots and helps to reduce irritation and soreness. It also reduces the incidence of blocked pores which, in turn, can reduce the occurrence of spots and pimples.
Epiduo Gel is a topical gel that contains a combination of adapalene and benzoyl peroxide.
There are also prescription antibiotic topical treatments. Zineryt Solution contains the antibiotic erythromycin. This helps to treat acne by reducing the growth of bacteria that can cause acne. Duac Gel contains benzoyl peroxide and the antibiotic clindamycin, which combine to reduce the bacterial growth causing the spots. This combination also helps to prevent antibiotic resistance.
Mild or moderate acne usually responds to topical treatments. Some patients may have to try different products before finding one that is effective for their acne. However, some patients may not respond to topical treatments and are prescribed oral treatments like acne tablets.
Lymecycline (brand name Tetralysal) is an oral antibiotic taken daily, usually for 2 to 3 months. This is usually prescribed if someone has tried topical treatments but their acne hasn’t improved. Another oral antibiotic tablet that is sometimes prescribed is doxycycline. Antibiotics for acne help to treat the overgrowth of bacteria that causes or exacerbates spots.
Women with acne can be prescribed a combined oral contraceptive pill. This is a hormonal treatment for acne. An example is Co-cyprindiol (brand name Dianette or Clairette). It can be prescribed if oral antibiotics have been ineffective. You may have to take it for several months before it improves your symptoms.
If other treatments have failed, or you have severe acne, your GP may refer you for specialist acne treatment in a UK clinic. Specialists can prescribe oral capsules called Isotretinoin (brand name Roaccutane).
This can be an effective treatment for severe acne that hasn’t improved with other treatments. It works in several ways, for example, by reducing sebum production, reducing bacteria on the skin, and improving the redness and swelling caused by spots. However, it can have severe side effects. See the NHS page on Isotretinoin for more information.
Some people find self-help tips can be useful for their symptoms. This includes:
- Removing make-up before going to bed.
- Use a mild cleanser, soap or body wash with lukewarm water when washing the area. Very cold or hot water can worsen acne.
- Use water-based and non-comedogenic cosmetic and hair products
- Washing more than twice a day can irritate the skin and worsen symptoms.
- Do not try to “clean out” blackheads or squeeze spots. This can make them worse and cause permanent scarring.