Acne

Acne is a skin problem that usually starts in your teens. Your skin becomes greasy, skin pores become blocked and you develop whiteheads, blackheads, pimples or cysts. Acne usually gets better with time, though may take some years to resolve. A few people, however, may have problems into their 30s and 40s, and those with severe acne may be left with some scars (early treatment may help prevent this).

Key points

  1. Acne is very common in teenagers (80–90% develop some acne).
  2. Acne is related to hormonal changes and is not contagious.
  3. Acne may improve with creams and other treatments applied to the skin which you can buy from your pharmacy.
  4. Acne treatments may take several weeks or months to work.
  5. If you have persistent or severe acne, you should see your doctor. There are other treatments that can help and sometimes referral to a skin specialist (dermatologist) is needed.

Causesundefined

During teenage years, young men and women often have a slight hormonal imbalance in favour of the male hormone testosterone.

Testosterone makes the glands in hair follicles on your face, back or neck produce too much oil (sebum), which then gets clogged in the pores. Bacteria grow in the trapped oil and break it down to produce fatty substances that irritate your skin. This gives you whiteheads, blackheads, pimples or deep cysts.

  • Acne is common in teenagers because of the normal hormonal changes occurring at that age.
  • There may be a hereditary factor making it more common in some families.
  • In some girls, testosterone levels may be too high, so if your acne is severe this possibility may need to be investigated by your doctor.
  • If girls/young women have other symptoms as well as acne, such as excessive body/facial hair (called hirsutism) and irregular periods, they may have polycystic ovarian syndrome.
  • Acne can be made worse by some drugs, such as steroids and anti-epilepsy pills, and some birth control (contraceptive) pills.
  • Women may find acne gets worse around the time of their period.

Types of acne

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Whiteheads are round, white blemishes that form when hair follicles become blocked by a plug of sebum and dead skin cells. Blackheads are round, dark blemishes that form when the sebum and skin cell plug reaches the skin’s surface and the air.

 

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Pimples are red, swollen bumps that form when the plugged follicle walls break near the skin’s surface. Deep cysts are red, pus-filled pimples. They form when plugged follicle walls break deep within the skin.

Treatment

Treatments that are applied to the skin (topical treatments) are usually recommended at first. Some of these are available from the pharmacy without a prescription. If your acne is severe, it's best to talk with a doctor first who may prescribe a medicine for you or refer you to a skin specialist (dermatologist).

Mild acne

Topical treatments include:

  • Acne face washes/cleansers can be used to reduce the greasiness of the skin. These products may include an antiseptic or antibacterial agent, or mild salicylic acid.
  • Benzoyl peroxide (cream, lotion, gel), gets rid of some of the bacteria on the skin and makes the top layer of skin peel off, unblocking the pores. It can help if you have a lot of blackheads but may irritate your skin. If so, use a lower strength or every second night.
  • Antibiotic liquids or lotions can help stop infection if you have pus-filled spots. They do not help blackheads or whiteheads. Dab it on once or twice a day over your whole face, not just on the spots. The liquid can be very drying.
  • Retinoid gels or creams (eg, Tretinoin or Differin), which are mainly for blackheads, make the skin dry and peel. They can be very irritating so only spread a small amount very thinly on your face, no more than once a day. They may make your acne worse at first, but it should improve after a few weeks. Take care in the sun – you may burn more easily, and you should not use them if you are pregnant or there is any likelihood of becoming pregnant.
  • Azelaic acid cream, (eg, Skinoren, Acnederm) which is put on twice a day. If it irritates your skin, use less or use only once a day.

Treatments take time to work

Acne treatments don't do much for existing pimples – their job is to help prevent the next round. Therefore, treatments can take some weeks or months to show an improvement in the acne.

Try any new cream or lotion on a small area first, in case of irritation. Then apply to face, shoulders and back (if affected) rather than just the individual spots (follow specific product directions).

  • Stop using lotion/cream if severe irritation develops, and talk to your doctor or pharmacist.
  • If one product doesn’t help, there will be another product or type of treatment you can try. Ask your pharmacist/doctor for advice.

Severe acne

See your doctor if your acne doesn’t get better after using topical treatments or makes you feel down (depressed). Early treatment for severe acne may help prevent scarring.

Treatments may include:

  • Oral antibiotics may need to be taken for three months or more, depending on how bad your acne is. Many antibiotics used for acne cannot be taken in pregnancy (or if you may become pregnant while taking) or given to children under 12 years old.
  • Oral retinoids (eg, isotretinoin) may be prescribed by your doctor, though you may need to be referred to a skin specialist (dermatologist). There is a range of possible side effects with these medicines, some of which can be serious, so their use has to be monitored carefully. They are not suitable for women who are pregnant and women must not become pregnant during this treatment or for one month after treatment (because of a high risk of causing damage to your baby). Your doctor or dermatologist will discuss these medicines further with you.
  • Hormone treatments may be an option if you have a hormonal imbalance.
  • Other treatments like blue-light or other light-based systems may be suggested by your skin specialist.

Self care

Lifestyle measures to help acne include:

  • gentle regular cleaning: avoid excessive scrubbing of the acne/skin
  • leaving acne alone: removing blackheads is not recommended. You should also try not to pick or squeeze pimples – it can make the swelling (inflammation) worse and cause scarring
  • avoid high humidity, eg, saunas
  • avoid using oily moisturisers/make-up
  • be careful with sun exposure – some treatments make your skin more prone to burning.

A low-GI diet may be beneficial

There may not be agreement among experts about the effect of diet on acne and it has been thought that no special diets are required. However, some studies show a reduction in acne in people who follow a low-GI (low Glycaemic Index) diet.

A low-GI diet:

  • includes foods such as fresh fruit and vegetables, wholegrains, lean meats and seafood 
  • excludes, or keeps to a minimum, processed foods (such as biscuits, cakes, chips, pastries, sweets).

Making changes to the way you eat may not help everyone with acne. Talk to your doctor or dietitian for further advice.  

Learn more

Acne All about acne (AUS), 2014
Live well with acne and common myths explained NHS Choices (UK), 2014

Credits: Health Navigator. Images from 123rf.com. Last reviewed: 17 Feb 2015