Acne

About acne

Acne usually begins in the teenage years and disappears after eight to 10 years. In some cases, it can persist until the 30s and even 40s.

Acne is caused by inflammation of the hair follicles. It most commonly affects the face, back and chest. Features include blackheads, whiteheads, pimples (zits) and cysts. In severe cases, acne may lead to permanent scarring.

Cysts are lumps under the skin that have pus and other tissue in them, but do not come to a head like pimples do. They can cause scarring, blotchy, uneven skin colour and pitting.

Unfortunately, acne hits people at a time when they most want to look their best. Acne can make teenagers feel embarrassed and bad about themselves.

There are multiple treatments available for acne over the counter from pharmacies. The most effective of these contain benzyl peroxide, which is an antiseptic. It works to prevent new pimples from forming and in general, the benefits are first seen after six to eight weeks of daily use.

Your family doctor can also prescribe retinoid creams, antibiotic creams or antibiotic tablets, which also work to prevent new pimples from forming. In general, the benefits are first seen after six to eight weeks of daily use. They can be used together with benzyl peroxide creams.

If your acne is severe, causing scarring or severe distress, then you may need a referral to a dermatologist for isotretinoin treatment. After a course of isotretinoin, most people are cured of their acne.

While there are various surgical and laser treatments that can help acne scarring, the best treatment for acne scarring is prevention. Seek professional advice for acne early.

If you are concerned about skin problems or skin care, you should talk to your doctor or pharmacist for information about possible treatments.

Acne - hormones and genetics

At the start of puberty, androgen hormones are released into the body. Both boys and girls have androgens, but boys have more of them. Androgens cause the oil glands in the skin of the face, neck, back, shoulders and chest to enlarge and to produce more oil (sebum).

Bacteria that normally live on the skin surface digest the oil and by-products from this digestion irritate the skin, block the pores and produce blackheads, pimples and cysts.

Girls tend to reach puberty earlier than boys and develop acne at a younger age. Acne can become worse or ‘break out’ at certain times of a girl’s menstrual cycle, usually just before a period.

Self-help strategies for acne

Suggestions to manage acne include:

• Cleansing – using cleansers specifically developed for acne-prone skin can help. Try washing the affected areas twice per day. Don’t overdo it. Too much cleansing can cause other skin problems, such as dryness or skin irritations. Try to keep hair clean and off the face and neck, as oil from the hair can make acne worse.
• Make up – choose water-based, oil-free products where possible to avoid worsening acne by clogging the pores with oils or powder. Make up should be thoroughly removed before going to bed.
• Don’t squeeze – picking and squeezing pimples can make them worse and lead to scarring.
• Diet – there is some weak evidence that a low-GI diet may help some people with acne. Many people think that lollies or chocolate cause pimples. Research has not shown any strong link with these foods, but if you notice that eating certain foods causes pimples for you, try avoiding them.

Treatment for acne – non-prescription

Some acne treatments can be bought over the counter at pharmacies or supermarkets. These work by cleaning the skin and drying up excess oil. Mild irritation can occur with such treatments. If this happens, take a short break from treatment and restart after a few days. If the irritation is excessive, stop the medication and speak to your doctor about an alternative.

It is a good idea to talk to a pharmacist before you buy a product to find out which treatment might be the most useful for you. A cleanser for acne-prone skin may be all that is needed for mild acne. Don’t rely on advertisements or the advice of friends.

Treatment for acne – professional

If your acne is not improving with over-the-counter treatments or if you have more severe forms of acne, you will need to see your doctor. Your family doctor can assess your acne, determine if you are developing any scarring and prescribe treatments specific for your type of acne.

They may also refer you to a dermatologist for assessment and possible prescription of isotretinoin. After a course of isotretinoin, most people are cured of their acne. Isotretinoin can have side-effects that need to be carefully explained to you before commencing treatment.

Medication can lead to significant improvements in how the skin looks and can reduce the number of new pimples.

Medical treatments are topical or oral and can include:

• retinoids, which unblock pores of existing acne and prevent new blockages from developing
• antibiotics to kill bacteria and reduce inflammation
• hormonal agents, such as the contraceptive pill, to reduce the amount of androgen in the body and therefore oil secretion.

Where to get help

• Your GP (doctor)
• Pharmacist
• Dermatologist (see your doctor for a referral)
• The Australasian College of Dermatologists Tel. (02) 8765 0242