Acne is a very common skin condition affecting teenagers but also people in their 20s or 30s. In some cases, it persists all lifelong. Almost every single person will have an episode of acne at one point of their life. You can experience comedones (blackheads or whiteheads) and pus-filled spots. However, there are different clinical forms and acne doesn’t look the same in all people affected by it. It causes scarring and marks that’s why early treatment is essential. Acne tends to be localised on skin areas rich in sebaceous glands and these are face, chest, shoulders and upper back.
What causes your acne?
It is chronic inflammation of the pilosebaceous unit affecting in high percentage young adults and teenagers. However, it has become extremely common in adult females, known as hormonal acne. There are 4 factors contributing to development of acne and these are: follicular clogging, excessive oiliness, intrafollicular colonization with Proprionibacterium acnes and inflammation. Moreover, family predisposition seems to have an impact too.
Proprionibacterium acnes is a bacteria that normally lives on the skin, but in acne prone skin, it multiplicates more than it should and it triggers inflammation with red spots appearing on the skin. Acne is frequently a sign of PCOS (polycystic ovary syndrome). Also, some tablets used for other health problems or certain contraceptives can be the cause of acne with recent onset.
Do I need blood tests to diagnose acne?
Acne is a clinical diagnosis, meaning the doctor will assess your skin visually and confirm that you have acne based on the findings. We don’t recommend blood tests routinely. Nevertheless, if you associate any other signs of PCOS, the doctor will advise on further investigations. For instance, if you experience unusual hair growth on chin, irregular periods, thinning of hair, then you should mention about these during your consultation with the doctor.
How do we treat your acne?
There are solutions to treat your acne. You might think you tried everything and nothing worked, but we can come up with a plan that perfectly suits the type of acne you are dealing with. Our aim is to give back your confidence as we understand how much this condition can impact your well-being. Your doctor will advise which treatment is suitable for the type of acne you are suffering
Acne treatment falls under 5 categories:
- Topicals (cream, gel, lotions applied directly to skin)
These are acne treatments that you apply directly on your skin. They are available in different forms as gels, creams, lotions with different indication depending on the type of acne. Topicals have as key ingredients antibiotics, benzoyl peroxide, retinoids (tretinoin, isotretinoin, adapalene) or azelaic acid. They are first line treatment in mild acne.
- Oral antibiotics (given by mouth)
Oral antibiotics are a very efficient acne treatment, but should be taken for at least 3 months for best results. Most common antibiotics used are doxycycline, lymecycline, minocycline. Clindamycin and rifampicin are more potent and used if the above fail. These can be taken at the same time with topical treatments.
- Oral contraceptive pill
There are various contraceptive pills and you need to pay attention when choosing one suitable to help improving your acne because some contraceptives can worsen acne. Also, injectable contraceptives have negative impact on acne. Ask your doctor about which would suitable you have acne prone skin.
- Antiandrogens (Spironolactone tablets)
Spironolactone has effect on blocking the male hormones (testosterone) being very efficient in acne in adult female patients. It keeps acne under control and sometimes it clears it if taken on long term. Results tend to show earliest 8 weeks after initiating treatment. If you take it in the same time with a contraceptive pill, boosts the effectiveness against acne.
- Isotretinoin (Roaccutane, Accutane)
Isotretinoin treatment is highly effective with long term results. It clears skin completely in most patients. It helps with fading of the marks too. Nonetheless, you should commit in taking it for around 6 months. Pregnancy must be avoided during treatment and also for at least 4 weeks after stopping treatment. It requires blood tests monitoring and monthly pregnancy test in females.
“There is no single disease which causes more psychological trauma, more general insecurity, feelings of inferiority and greater sums of psychic suffering then does acne vulgaris“.
Sulzberger and Zaldems, 1948
- Is a common, chronic condition that persists for a long time
- Tends to affect women more and fair skinned adults
- Characterised by persistent redness on cheeks, forehead, nose and chin and pus filled spots
- Treatment should have 2 approaches: target the redness and the spots
- Brimonidine has strongest evidence for efficacy for persistent facial erythema
- Clonidine or beta-blockers may be prescribed if blushing is a significant problem
- Isotretinoin tablets proved to be effective in severe cases
- Oral antibiotics can be given long term in low dose as maintenance