Acne - the lowdown

This week, one of the questions posed to me by our Facebook followers on our Patient talk series was about latest treatments for acne. Hardly surprising, given how many of us suffer from it - and not just in our teenage years.

What's your spot?

There are several 'grades' of acne, and the types of spots seen vary with severity. You can get all types of spots at any stage, but some kinds are more common in severe acne.

In mild acne, spots are mostly due to sebum (the greasy fluid your skin produces) getting trapped inside your skin pores. They include:

  • Whiteheads - small firm bumps that don't produce liquid when you squeeze them
  • Blackheads - small bumps with a black centre from skin pigment, NOT dirt.

In moderate acne, these may be joined by:

  • Pustules - larger pus-filled spots caused by a combination of germs multiplying and your body's immune system reacting to this
  • Papules - red, sometimes tender bumps, due to inflammation.

In severe acne inflammation goes deeper under your skin, so it can lead to scarring. Spots seen here include:

  • Nodules - hard, often painful lumps
  • Cysts - large lumps filled with pus, which look like boils and are often painful.

How do I know what treatment is best?

There are several aims of treatment:

  • Unblocking clogged pores, which cause pimples, blackheads and whiteheads
  • Getting rid of the germ, Propionibacterium acnes, which lives in these blocked pores
  • Reducing inflammation caused by your immune system, which can lead to larger, painful red spots and lumps, and sometimes scarring
  • In women, hormone changes can make acne worse.

If you find your acne flares up around your period, a hormone option might be worth considering at an early stage. If you have multiple blackheads and whiteheads but no pustules, topical antibiotics are unlikely to work. For severe acne, a treatment that works in all the first three ways may well be needed.

Weighing up the treatment options

The best treatment for you depends on how severe your acne is and what you're prepared to put up with in terms of side effects - some really effective topical treatments (ones you put on your skin), like:

  • Retinoid creams or azelaic acid, which are good for unblocking pores
  • Benzoyl peroxide, a good all-rounder which works on germs, inflammation and blocked pores.

These can cause red, inflamed skin, at least in the short term. You'll often find that using the lowest strength cream, applying it less often (eg ,once rather than twice a day to begin with) and washing it off after an hour or so may reduce short-term side effects. The side effects should settle within a few weeks.

Although there are no forms of contraceptive pill that are routinely given just for acne, Dianette can be given for severe acne. Its effect seems to be related to its 'anti-androgen' effect - it counteracts the male androgen hormones that some women make more of than others.

Isotretinoin taken in tablet form dramatically reduces the amount of sebum your skin produces. It can improve even severe acne within weeks. But it's not without risks. These include:

  • Drying out of your mucous membranes, leading to dry cracked skin, nostrils and lips
  • Inflammation of eyelids and the surface of the eye
  • Occasional damage to kidneys, pancreas and liver
  • They can cause severe abnormalities in your baby if you take them during pregnancy, so you must always use effective contraception
  • In rare cases, they've been linked with severe depression and even suicide.

For these reasons, they're reserved for severe cases where there's a real risk of scarring and other treatments haven't helped.

How can I help myself?

Lots of people say their treatment hasn't worked, but it's often because they've been put off by short term side effects or have given up too soon. You need to use your treatment regularly for several weeks, and sometimes for months, to have the best effect.

Perhaps not surprisingly, there are dozens of myths about acne and how you can sort it out. Most of them are just that - myths. My top tips are:

  • Don't give up - use any treatment for at least 6 weeks before changing (use a reminder on your phone to make sure you take it regularly)
  • Don't wash too much - skin with acne is sensitive and excess washing can make matters worse (1-2 times a day is plenty)
  • Don't squeeze! No matter how tempting, squeezing spots increases the risk of scarring
  • Keep it natural. Heavy, oil based (waterproof) make-up can plug pores more. Stick to water-based products and remove as soon as you're out of the public eye
  • Don't sweat it. Hot, humid atmospheres can make acne worse. Keep cool with loose, breathable fabrics
  • No fringe benefits. A heavy fringe or a permanent baseball cap may cover spots, but they can increase heat and humidity and make forehead acne worse
  • Toothpaste is for teeth! Many youngsters swear by toothpaste applied to a spot to dry it out. Trouble is, toothpaste contains ingredients that can irritate the skin too
  • Do I change my diet? The evidence that changing your diet can improve your skin is much sketchier than you might think. But a healthy diet, leaded with fruit and veg and low in junk food, is a good idea for your general health, so I'd certainly recommend it.

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.