Acne

What is acne?

Everyone will experience acne. Here is an example of acne on the forehead.

Acne is a very common skin disorder that most young people get in early puberty. It is caused by inflammation of the small oil glands (sebaceous glands) that surround the fine hairs on the face and chest.

The severity of acne increases and, typically, reaches its peak around the ages of 17 to 19. For most people, acne tends to go away by the time they reach their mid-20s; however, very sensitive people may continue to have the disorder until they reach their 40s.

Hormonal changes related to pregnancy or menstrual periods can also cause or contribute to acne. This is also the case with environmental irritants such as pollution, intense heat, humidity or cold.

What causes it?

During puberty, the production of male sex hormones (androgens) increases in both girls and boys, which can stimulate the sebaceous glands to produce more sebum. In some people, the sebaceous glands are extremely sensitive to androgens. These people, mostly men, get acne so severely that they need medical treatment.

The increased production of sebum makes the openings of the sebaceous glands narrower, which prevents the sebum from getting out. Meanwhile, the sebum production continues regardless.

Pimples are often caused by Propionebacterium acnes, a common bacterium on the skin that feeds on sebum. This bacterium produces waste products and fatty acids that irritate the sebaceous glands and make them inflamed.

What are the symptoms?

The first symptoms are small, tender, red spots that later turn into pimples containing degraded fatty acids. The inflammation disappears over a few days or weeks, depending on the severity.

Severe acne can cause scars which will never disappear. Acne can also cause psychological stress and be socially disabling. An early effective treatment is therefore imperative.

What can make acne worse?

• Working in a damp environment with oil, grease and other chemicals.
• Squeezing or picking at the pimples.
• Menstrual periods.
• Certain medicines and chemicals.

What can be done at home?

• Wash your face twice a day with a mild cleanser. Make sure you wash your skin whenever it becomes sweaty. Do not scrub your face as this will only make your acne worse.
• Avoid hairstyles in which the hair is constantly touching your face. Shampoo your hair regularly.
• Do not squeeze or pick at the pimples. This makes them worse and may cause scarring.
• Avoid exposing your skin to too much cold, heat and sunlight. Sunlight may improve your acne for a while, but it won't cure it. Too much exposure to sunlight can lead to burning and skin cancer.
• Use a water-based moisturiser. Greasy or oily creams and foundations block the pores and may cause pimples.
• No scientific research has shown that certain foods can cause acne, but if you notice that spots increase after you eat certain things, it makes sense to avoid them.
• Choose a sensible, varied diet, drink lots of water and exercise regularly. If you feel good, your skin will feel good too
• Consult a beautician about how your skin should be cared for.
• Mild acne can be treated with over-the-counter medications. Ask your pharmacist for advice on products. Try them for six to eight weeks to find out if they are working - it takes time to get acne under control.

When should the doctor be consulted?

• If over-the-counter medications do not work after six to eight weeks.
• If acne causes psychological distress.
• If there are big, tender pimples.
• If the acne causes scars.
• If you have dark skin and dark patches form where the pimples used to be.

What is the treatment?

Depending on the severity of your acne, your doctor may choose to treat you or refer you to a dermatologist. Acne can be treated with medications that are either applied to the skin or taken by mouth. The treatment is directed at the factors that trigger acne, which are:

• the increased production of sebum that leads to a narrowing of the sebaceous glands
• the bacteria that causes acne.

You can continue with the home-treatment described above while you are being treated medically. Remember that it takes six to eight weeks before the effect of the treatment can be seen. Treatment will typically have to continue until the patient reaches their 20s.

Local treatment (applied to the skin)

A treatment with azelaic acid (eg Skinoren cream) or benzoyl peroxide (eg Panoxyl,Acnecide) will usually be sufficient for mild to moderate acne. These medications help prevent the narrowing of the openings of the sebaceous glands and slow the growth of the acne bacterium.

Alternatively, the doctor may choose to prescribe a product that combines benzoyl peroxide with a topical antibiotic such as erythromycin (Benzamycin gel), or clindamycin (Duac once daily gel), or treat the outbreak with a topical antibiotic alone, eg clindamycin (Dalacin T), erythromycin (Eryacne gel), tetracycline (Topicycline).

The doctor may prescribe adapalene (Differin) for people with blackheads, whiteheads and mild inflammatory acne. Women should only use adapalene if they are using effective contraception, such as contraceptive pills. Pregnant women must not use adapalene. Topical tretinoin (Retin-A) and isotretinoin (Isotrex gel)have similar uses and exclusions.

Systemic treatment (taken by mouth)

Grown women with severe acne may benefit from treatment with contraceptive pills containing anti-androgens, eg Dianette.

For people with severe inflammatory acne, long-term treatment with oral antibiotics such as tetracycline or minocycline (eg Minocin), combined with one of the medications mentioned above may be helpful. Tetracycline antibiotics are not given to pregnant women; women who are breastfeeding; or children under 12 years of age.

For patients with severe cystic acne that does not improve with other medications, oral isotretinoin (Roaccutane) may be needed. It is very important that women should neither be pregnant, nor get pregnant, while taking isotretinoin.

Women must use an appropriate contraceptive method during treatment, and for a full month after the treatment stops. Isotretinoin is not suitable for people with liver or kidney disease. The medicine has several severe side effects which is why it can only be prescribed by a dermatologist, but it also has a high success rate in acne.

Removal of scars

Scars caused by acne can be removed by abrasion (dermabrasion) or laser treatment. These treatments are carried out by a dermatologist or a plastic surgeon.