Dr Emma Wedgeworth
Acne affects more than 640 million people worldwide and this incidence is increasing. Although it typically begins around the time of puberty, it can affect all ages.
Acne is an inflammatory disorder of the skin’s oil producing (sebaceous) glands. It predominantly affects face, back or chest, presenting as red spots (papules or nodules), yellow heads (pustules), cysts or blocked pores (comedones).
Common causes of acne
Acne results from an interaction between genetics and environmental factors (exposomes). There is a significant genetic contribution, with estimates of heritability between 50-80%.
External influences include nutrition, medication and lifestyle. Increasingly westernised diets, high glycaemic index foods (such as refined grains and sugary food) and high dairy intakes have all been linked with acne.
Hormonal abnormalities such as polycystic ovaries may underlie some cases. Acne cosmetica is the term for acne associated with skincare, as certain cosmetic ingredients are pore blocking (comedogenic).
Acne is often perceived as a mild skin condition or a rite of passage in teenagers. However, it can have a significant impact on psychological wellbeing.
Finding a suitable treatment
Acne is a treatable condition, although there is frequently considerable delay to definitive treatment, resulting in scarring and long-term psychological impacts.
Simple cleansing and over the counter ingredients such as salicylic acid and benzyl peroxide can be helpful, alongside avoidance of pore blocking ingredients such as coconut oil or cocoa butter. A low glycaemic index diet may be helpful, however, very restrictive diets are not advised.
The first line of treatment involves vitamin A based creams (retinoids). Topical retinoids are effective, but acne may take up to three months to show improvement. Slow introduction and gentle skincare can help manage skin irritation. Other medicated creams include benzyl peroxide, topical antibiotics and azelaic acid.
Oral treatments for severe cases
In more severe acne, tablets may be required. There are three classes of tablets which can be used:
- Antibiotics. These rebalance the microbiome and reduce inflammation and are usually used for a minimum of three months.
- Hormonal treatments – combined oral contraceptive pills and anti-androgens. These are useful treatments in women who experience premenstrual flares.
- Oral isotretinoin (roaccutane) is indicated for severe acne. However, it has a number of potential side effects.
Acne is often perceived as a mild skin condition or a rite of passage in teenagers. However, it can have a significant impact on psychological wellbeing. Depression, anxiety and suicidal thoughts are all more common in acne sufferers.
In addition, acne is linked with social isolation, low self-esteem and poor body image. It is a manageable condition and effective treatment should be instituted as soon as possible to reduce the risk of scarring and the psychological burden.