Acne Treatment
What is acne and who gets it?
Acne is common and is usually treatable. You may need acne treatment for several months to clear spots. Inflamed acne needs to be treated early to prevent scarring. Once the spots are gone, you may need maintenance treatment for several years to keep the spots away.
Acne is the common cause of 'spots'. Most people with acne are aged between 12 and 25, but some older and younger people are affected. Acne usually affects the face but may also affect the back, neck, and chest. The severity can range from mild to severe. About 9 in 10 teenagers develop some degree of acne. Often it is mild. However, it is estimated that about 3 in 10 teenagers have acne bad enough to need treatment to prevent scarring. Untreated acne usually lasts about 4-5 years before settling. However, it can last for many years in some cases.
What causes acne?
Understanding normal skin
Small sebaceous glands lie just under the skin surface. These glands make the 'oil' (sebum) that keeps the skin supple and smooth. Tiny pores (holes) on the skin allows the sebum to come onto the skin surface. Hairs also grow through these pores. During the teenage years, you make much more sebum than when you were a child. As a rule, the more sebum that you make, the more greasy your skin feels, and the worse acne is likely to be.
Mild to moderate acne - blackheads, whiteheads, and small pimples.
Some pores become blocked ('plugged'). This is due to the skin at the top of the pores becoming thicker, combined with dead skin cells that are shed into the pores. This causes whiteheads and blackheads (pigmented skin).
Moderate to severe acne - larger spots and inflammation
Trapped sebum is ideal for a bacterium (germ) called P.acnes to live and multiply. However, if a large number develop in the trapped sebum, the immune system may react and cause inflammation. This causes the surrounding skin to become red, and the spots become larger and filled with pus. Each inflamed spot will heal eventually. In some cases the area of skin that was inflamed remains discoloured for several months. Also, a small pitted scar is commonly left on the skin where there was an inflamed spot. These small scars often do not fade fully and are a marker in older people that they once had inflamed acne spots.
What makes acne worse?
- The progestogen-only contraceptive pill may make acne worse.
- In women, the hormone changes around the monthly period may cause a flare-up of spots.
- Thick or greasy make-up may, possibly, make acne worse. However, most make-up does not affect acne. You can use make-up to cover some mild spots. Oil-free products are most helpful for acne prone skin types.
- Picking and squeezing the spots may cause further inflammation and scarring.
- Sweating heavily or humid conditions may make acne worse. For example, doing regular hot work in kitchens.
- Some drugs can make acne worse. For example, phenytoin which some people take for epilepsy, and steroid creams and ointments that are used for eczema. Do not stop a prescribed drug if you suspect it is making your acne worse, but tell your doctor. An alternative may be an option.
Some myths and wrongly held beliefs about acne
- Acne is not caused by poor hygiene. In fact, excessive washing may aggravate acne and make it worse.
- Diet has little or no effect on acne. For example, there is no evidence that chocolate, sweets, or fatty foods cause acne or make acne worse. Stress does not cause acne.
- Acne is not just a simple skin infection. The cause is a complex interaction of changing hormones, sebum, overgrowth of a normally harmless bacteria, inflammation, etc, (described above).
- There is no evidence to say that sunbathing or sun beds will help to clear acne.
Skin treatment for people with acne
Do not wash more often than normal. Twice a day is normal for most people. Use a mild soap and lukewarm water. (Very hot or cold water may worsen acne.) Do not scrub hard when washing acne-affected skin. Antiseptic washes are heavily advertised, but are unlikely to make any difference.
You cannot clean off blackheads. The black tip of a blackhead is actually melanin (skin pigment) and cannot be removed by cleaning or scrubbing.
Some topical acne treatments (described below) may dry the skin. If this occurs, use a fragrance-free, water-based moisturiser cream. Do not use ointments or oil-rich creams as these may clog pores.
What are the acne treatment aims and options?
Acne treatments can be 'topical' (treatment that you apply to the skin), and/or tablets. You may prefer not to treat mild acne which is not inflamed. That is, if you just have blackheads, whiteheads and mild pimples. Mild acne is common, and usually goes in time without scarring. However, inflamed acne can scar. If you develop inflammation (redness, red spots, pustules, etc) then it is best to treat the acne early to prevent scarring. Acne treatment will usually clear most spots if you use it properly. However, no acne treatment will clear your skin completely.
Topical treatments for acne
Various gels, lotions, and creams are used to treat acne. Different preparations work in different ways, mainly helping to dry the oil in the skin and kill bacteria. Oral antibiotics may be prescribed for at least 3-6 months to help kill bacteria in the skin. Women may consider changing their oral contraceptive pill brand.
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