Acne Treatments

Acne is a common skin condition affecting up to 95% of adolescents to some extent, with the condition being more prevalent in 12-24 years old’s. 20-35% develop moderate to severe acne. Acne is mostly found on the face, back and chest. Acne is caused by blockage and inflammation of the hair follicle, hair shaft and sebaceous gland. Sebaceous glands produce sebum, an oily substance that helps lubricate the hair and skin and prevents drying. In acne, the glands produce too much sebum, which mixes with dead skin cells and blocks the follicle.

There are six main types of spots:

1. Blackheads: small black or yellowish bumps. Their black because the inner lining of the hair follicle produces colour.
2. Whiteheads: Similar appearance to blackheads but are closed, firmer and will not empty if squeezed.

The natural bacterial flora on the skin can contaminate and infect the plugged follicles causing:

3. Papules: Tender or sore small red bumps (<5mm in diameter)
4. Pustules: Similar to papules but have a white inner core caused by a build up of pus. (<5mm in diameter)
5. Nodules: Painful large head lumps (>5mm in diameter)
6. Cysts: most severe spot cause by acne. They are large pus filled lumps similar to boils and can cause permanent scaring. (>5mm in diameter)

Acne is a long-term disease that can persists for years normally clearing after adolescence. There will be occasions where acne is under control and then suddenly flare up. During flare ups you may notice more spots progressing to inflamed papules or pustules. Studies have suggested factors/triggers that may contribute to the development of acne:

• Hormones: Teenage acne is thought to be triggered by puberty. The sebaceous glands produce more sebum when there are high concentrations of testosterone. Women are more likely to have adult acne than men. This may be due to changes in hormone levels at certain times like periods, pregnancy or polycystic ovaries syndrome.
• Genetic factors: There is studies showing a higher chance of developing acne especially if both parents had acne.
• Cosmetic products: These can block pores. We recommend looking out for non-comedogenic products.
• Medication: Steroid medicines, lithium and some drugs used to treat epilepsy. We do not recommend you stop taking the medicines but in fact see your GP if you are concerned.
• Smoking: Can contribute to acne in older people.
• Diet: Eating foods with a high glycemic index such as carbohydrates can trigger acne. Foods high in carbohydrates include jacket potatoes, bread, beans, fizzy drinks, and fried foods.

Acne treatment depends on how severe it is. Positive effects can take 6-8 weeks to become noticeable. For mild to moderate acne you will usually be started on a combination of topical treatments, or antibiotic tablets combined with topical treatments. Prescription medicines include:

Topical retinoids: Indicated for mild to moderate acne. Examples include differin (adapalene) and isotrex. These are medications derived from vitamin A formulated as a cream, lotion, foam, emulsion or gel. They work by exfoliating the skin by removing dead skin cells which helps prevent them building up within hair follicles. Retinoids also help reduce inflammation, pain and irritation by preventing build up of skin cells and inflammatory responses.

Benzoyl Peroxide: These work as antiseptics to reduce the number of bacteria on the skin. It is also anti-inflammatory and reduces spots by removing dead skin cells. They come in gels and creams. Examples include Acnecide. They are readily available over the count and from The Family Chemist.

Topical antibiotics: These helps kill the bacteria that can infect blocked hair follicles. They are available as a lotion or gel. A 6-8 week course is usually recommended. Any longer and the bacteria may become resistant which could make the acne worse and cause additional infections. Examples include: Dalacin T or Zineryt.

Azelaic Acid: These are used as an alternative to benozyl peroxide or topical retinoids if not tolerated. Azelaic acid works by getting rid of dead skin and killing bacetria. Examples include Skinoren.

Combination products: Zineryt: contains a antibiotic (erythromycin) and a healing agent (Zinc) which helps repair damage to the skin from acne.

Epiduo: Benzoyl peroxide and adapalene (topical retinoid). Epiduo helps to kill bacteria and exfloite the skin by removing dead skin cells, dirt and oil.

Duac Gel: Clindamycin and Benzoyl peroxide

Tretin Gel: Tretinoin (topical retinoid) and Clindamycin (antibiotic)

Antibiotic tablets: Antibiotic tablets are used in combination with a topical treatment to treat more severe acne. Tetracyclines (a class of antibiotics) are the preferred choice of treatment. Example includes lymecycline tablets. One capsule is taken per day and studies suggest lymecycline can reduce acne severity by over 4 in 10 people.

Combined oral contraceptives for women: If you suffer from flares during the time of your period COC may be beneficial. Some combined oral contraceptives are anti androgens which help reduce sebum productions. Low sebum production reduces risk of blocked pores and therefore lower incidence of acne.

Other specialist treatments include oral isotretinoins, photodynamic therapy, drainage or extractions and peels. These are only available from dermatologists or your skin specialists.

Myth: Toothpaste can dry up individual spots.NO. Toothpastes carry antibacterial properties however they also contain substances that can irritate and damage your skin. Using toothpaste in this manner is not recommended.