Acne

Acne is a very common skin condition characterised by comedones (blackheads and whiteheads)

Acne

Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and varies in severity from a few spots on the face, back and chest, which most adolescents will have at some time, to a more serious problem that may be embarrassing, sap self-confidence and cause scarring. For the majority it tends to resolve by the late teens or early twenties but can persist for longer in some people. Acne can develop for the first time in people in their late twenties or even the thirties. It occasionally occurs in young children.

What causes acne?

The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of a hormone called testosterone, which is present in both men and women. This causes the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles. These two effects result in a build-up of oil producing blackheads (where a darkened plug of oil is visible) and whiteheads.The acne bacterium (known as Propionibacterium acnes) lives on everyone’s skin, usually causing no problems, but, in those prone to acne, the build up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots.

Is acne hereditary?

Acne can run in families, but this does not necessarily mean that if your parents had acne you will get it too.

What does acne look like and what does it feel like?

The typical appearance of acne is a mixture of the following: an oily skin, blackheads and whiteheads, red spots and yellow pus-filled pimples, and scars. Occasionally, large, tender spots or cysts may develop which can either eventually burst and discharge their contents or may heal up without bursting.

How is acne diagnosed?

Acne is easily recognised by the appearance of the spots and by their distribution on the face, neck, chest or back. However there are several varieties of acne and your doctor will be able to tell you which type you have after examining your skin. The most common type is “acne vulgaris”.

Can acne be cured?

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

How can acne be treated?

If you have acne but have had no success with over-the –counter products then it is probably time for you to visit your doctor. In general, most treatments take two to four months to produce their maximum effect.

Acne treatments fall into the following categories:

·         Those that are applied directly to the skin (topical treatments)

·         Oral antibiotics (tablets taken by mouth).

·         Oral contraceptive pills (O.C.P.)

·         Isotretinoin capsules

·         Other treatments

Topical treatments

These are usually the first choice for those with mild to moderate acne. They should be applied to the entire affected area of the skin and not just to individual spots. Sometimes they can cause irritation of the skin, but reducing the frequency of application, at least temporarily, can help to overcome this problem. There is a variety of active anti-acne agents such as benzoyl peroxide, antibiotics (erythromycin, tetracycline and clindamycin), retinoids (such as tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide.

Oral antibiotic treatment

Your doctor may recommend a course of antibiotic tablets that should be taken in combination with suitable topical treatment. Antibiotics need to be taken for a minimum of two months, and are usually continued until there is no further improvement. Some should not be taken at the same time as food, so read the instructions carefully.

Oral contraceptive treatments

Some types of oral contraceptive pills help women who have acne. The most effective contain a hormone blocker (for example cyproterone), which reduces the amount of oil the skin produces. It usually takes three to four months for the benefits to show.

Isotretinoin

This powerful treatment has the potential to cause a number of serious side effects and can be prescribed only by a dermatologist.  Isotretinoin can harm an unborn child. Women will be asked to enrol in a pregnancy prevention programme and need to have a negative pregnancy test prior to starting treatment. Pregnancy tests will be repeated every month during treatment and five weeks after completing the course of treatment. Effective contraception must be used whilst on treatment, and for four weeks afterwards.There are concerns that isotretinoin may cause depression and suicidal feelings. Details about any personal and family history of mental illness should be discussed with your own doctor and dermatologist prior to considering treatment with isotretinoin.Most courses of isotretinoin last for four months during which time the skin may become red and dry. Often, acne becomes a little worse before improvement occurs.It should be emphasised that many thousands of people have benefited from treatment with isotretinoin without serious side effects.

Other treatments

There have been developments in the use of light and laser therapy for inflammatory acne but these forms of treatment are yet to be fully evaluated. Laser resurfacing of facial skin to reduce scarring is an established technique requiring the skills of an experienced laser surgeon.

Web: www.skincarephysicians.com/acnenet/