Acne

Acne is a skin condition affecting most people at some point in their life, but typically teenagers get affected. The condition causes oily skin, spots and sometimes painful-to-touch skin, and is often also just known as spots, pimples, zits, blemishes, comedones and acne vulgaris.

Acne occurs when the sebaceous glands, which are attached to the hair follicles, become blocked, and therefore most commonly affects areas with oil glands and hair follicles such as the face, forehead, back and shoulders. For those affected, the skin condition can cause scarring, a lack of confidence and even anxiety. But luckily there are ways to treat acne and prevent complications of the condition.

Acne vulgaris is the medical name of what is known as common acne. Common acne is the less severe type of acne, and includes blackheads, and ‘pimples’ in the face, on the chest, shoulders and the back.

This condition is largely the result of hormonal changes, which is why it's more common after puberty or at certain points during a woman's menstrual cycle. Most people who suffer from acne tend to stop experiencing outbreaks during their 20s, but some are affected well beyond this point. Adult acne is less common and talked about, but acne also affect many adults.

Spots and other acne symptoms tend to appear most commonly in areas where sebaceous glands are present in large numbers. This is because these glands produce sebum (oils), which is a natural substance that helps moisturise and protect the skin.

However, if too much sebum is produced, it can cause skin to become greasy, resulting in pores becoming blocked and acne to form. Excess sebum production is therefore often associated with androgens, which are male hormones, as they can influence sebaceous gland activity.

Changes in androgen levels can occur as a result of puberty, pregnancy or menstruation. Cushing's syndrome and polycystic ovary syndrome can also be causes of acne, though this is more rare.

Medications can also influence hormone levels, such as oral contraceptives or topical steroid creams. Some cosmetics can have an effect on the skin as well.

Symptoms of the condition can vary, depending if you have mild acne, moderate acne or severe acne. Although there are conditions that can cause spots, acne has specific characteristics that distinguish the condition from other types of spots. They are:

• spots, bumps, pimples and nodules that present most commonly on the face, back and chest that feel sensitive when touched
• skin that is red and sometimes hot to the touch
• oily/greasy skin due to the sebaceous glands being overactive
• blackheads and/or whiteheads

However, acne can take on more than just the appearance of red spots on the skin surface. Other forms of acne include whiteheads, papules, pustules, blackheads, nodules and cysts.

Because of the range of severity in symptoms of the condition, acne is often confused with other skin conditions, such as rosacea (previously ‘acne rosacea’), contact dermatitis, keratosis pilaris, folliculitis, and even skin cancer.

Acne can be categorised into two main types; inflammatory acne and noninflammatory acne. Inflammatory acne is a more severe acne type, and can cause pitting and scarring. Milder acne types typically do not cause scarring and can be treated with topical treatments or even over-the-counter medicines, while severe acne may require the attention of a dermatologist.

Below you can see an overview of acne subtypes and how they range in severity.

Moderate acne is when you experience more widespread whiteheads and blackheads, but also with papules and pustules. If you also experience nodules and/or cysts, you are experiencing a more severe case of acne. For both moderate and severe acne you should speak to a GP or dermatologist about getting treatment.

Most commonly acne appears on your face and forehead, but it can also frequently occur on a person’s chest, upper back and shoulders. This happens as these are the areas of the skin that produces the most oil, through the sebaceous glands that are connected to your hair follicles.

You may also experience acne-like symptoms such as bumps, inflamed hair follicles and pus-filled spots in other places on your body, which may be caused by another skin condition, as many are often confused with acne.

Some other locations of your body you may experience acne-like symptoms are:

• your scalp
• your bottocks (butt)
• your intimates, especially after shaving
• other areas of your body

The condition isn’t just about the pimples and bumps it can cause. More severe types can leave long-lasting scars and physical changes to one's appearance, but it doesn’t always stop there. Picking and squeezing of spots can also cause scarring. Acne sufferers may also experience a negative effect on their mental health as a result of the condition.

Physical complications include:

• acne scars - ice pick scars, rolling scars and boxcar scars
• keloids (thick scars)
• hyperpigmentation (skin in affected areas may become darker)
• hypopigmentation (skin in affected areas may become lighter)

Psychological complications include:

• lower self-esteem and lack of confidence
• anxiety
• depression
• decreased quality of life

There are no specific ways to prevent acne, but there are some measures that can be taken to reduce the likelihood of acne breakouts. These include:

• washing the face at least twice a day, especially after exercising or partaking in activities where dirt can get into the pores
• do not over-wash as this can make the problem worse as the sebaceous glands will attempt to replace what has been removed
• try not to over-touch affected areas so as not to make the infection worse
• avoid make-up and products that can block the pores before going to bed

Be careful in the type of skincare products which are used, checking whether they are noncomedogenic or nonacnegenic, as they are less likely to clog pores. Bear in mind that over-cleanliness can antagonise sebum production on the skin and resulting in acne rather than clearing up the skin.

Acne can be treated in a number of different ways, and the choice is largely determined by the severity of the condition.

The most commonly used treatments for acne are those that are available over the counter and usually include creams, lotions, washes, soaps or gels that usually contain alpha hydroxyl acids, benzoyl peroxide, salicylic acid or sulphur. These over-the-counter acne treatments can be very effective in managing mild forms of this condition, but for more serious cases prescription medications are usually recommended.

Combined oral contraceptives

Combined oral contraception can help women improve their skin, although it might take up to a year before they have had their full effect. This type of treatment is particularly useful for women who experience acne flare-ups around their periods, as they help balance hormones.

The combined pill Dianette is specifically prescrived to treat acne in women, and is only prescribed as a contraceptive where the woman also suffers form acne.

However, the mini pill and the implant may have the opposite effect on acne.

Oral antibiotics

This treatment method is usually used in conjunction with a topical treatment for more severe cases of acne. Tetracyclines such as Oxytetracycline is most often prescribed unless the patient is pregnant or breastfeeding. For pregnant acne sufferers, or breastfeeders, are usually prescribed erythromycin instead.

You will usually experience an improvement in 6 weeks, but a full course of treatment can last 4-6 months.

Antibiotics can make hormonal contraception less effective, so another method of contraception should be used while taking oral antibiotics.

Topical acne treatments

Topical acne treatments are applied locally to the affected area of the skin. While using topical acne treatments, you should avoid sunlight exposure and wear sunscreen. It is important to always read the patient leaflet before use, as it details how to use the treatments correctly.

Topical antibiotics

Clindamycin (Duac) and erythromycin are examples of topical antibiotics commonly used to treat acne by applying the cream or gel once or twice a day to the affected skin. A treatment course is usually 6-8 weeks, and it is important to not take this treatment for too long, to avoid the risk of antibiotic resistance.

This type of treatment kills the bacteria on the skin that can otherwise infect the clogged hair follicles.

Benzoyl peroxide

Benzoyl peroxide is a treatment that works as an antiseptic. It reduces the number of bacteria on your skin, has an anti-inflammatory effect, and reduces the number of whiteheads and blackheads.

Benzoyl peroxide comes as a cream or a gel, and is applied to the affected skin after being washed, once or twice a day. A typical treatment course is 6 weeks.

Topical retinoids

Topical retinoids, such as ‘tretinoin’ and ‘adapalene’, have an exfoliating effect on the skin. This means that it removes dead skin cells from the skin’s surface, which helps prevent hair follicles (pores) from being blocked.

Topical retinoids come as a cream or a gel and are applied locally to the affected area. They are typically applied once a day, after washing your face at night time. A treatment course is typically 6 weeks long.

Azelaic acid

More often than not, this is used as an alternative when other methods are not suitable. These creams and gels help get rid of dead skin and kill bacteria. Differently to the alternatives, azelaic acid does not make the skin more sensitive to the sunlight, and a treatment course is typically a month, before you will see improvements in the skin.

It is normally applied twice a day, but once a day if the skin is very sensitive.

Acne scars are caused by more severe cases of acne when left untreated. Treatments of these scars are usually not covered by the NHS as they are regarded as cosmetic surgery. However, patients whose acne scars are affecting their mental health, exceptions have sometimes been made.

Methods of treating acne scars include:

• dermabrasion: is done by using either lasers or a type of wire brush, and removes the top layer of skin leaving the skin red and sore for several months until it heals
• ablative laser treatment: lasers are used to remove skin around the scar, which produces new skin and the area appears smooth-looking
• non-ablative laser treatment: lasers are used to stimulate collagen growth in the skin, which repairs some of the scarring damage and improves appearance of the skin
• punch excision: a method to surgically treat mild ice pick scars by removing the scar leaving the wound to heal back to a smooth area of skin
• punch elevation: used to surgically treat boxcar scars by removing the base of the scar before it’s reattached to the sides, leveled with the skin’s surface
• punch grafting: treats deep ice pick scars by removing the scar, but filling the wound with skin from a unnoticeable area of the body, such as from behind the ear
• subcision: rolling scars can be treated using this surgical treatment. The upper layer of the skin is removed from the underlying scar tissue, which allows blood to pool under this area, creating connective tissue which helps level it with the skin’s surface. Additional treatment is used after completion, such as laser or dermabrasion

For stubborn acne that has not improved with the use of over-the-counter treatments or skincare routines, prescription treatment is typically the next in line. Prescription treatment is also typically recommended for moderate and severe acne.

You can order prescription acne treatments such as the combined contraception pill Dianette, the topical antibiotic treatment Duac and the oral antibiotic Oxytetracycline, and more at euroClinix. All we ask is for you to complete a written medical consultation, and if our doctors think that we have a suitable treatment for you, you will be prescribed one.

All orders come with free next-day delivery and prescription included in the price. If your request for treatment is denied, you will be refunded any amounts reserved.