Acne explained

What is acne?

Acne is a broad term that basically means spots of varying severity. The technical name for different types of spots are comedones (blackheads and whiteheads) and pus-filled spots (pustules). Most teenagers get some form of acne but it is also common in adults and almost everybody suffers with blemishes now and again. Acne can also develop for the first time in your twenties and thirties.

What causes acne?

The sebaceous glands in the skin produce too much oil. This builds up and plugs pores which leads to blackheads and whiteheads. Interesting fact – blackheads are called blackheads because the dead skin on top of the blocked pore turns black from exposure to air.

The acne bacteria Cutibacterium acnes lives on everybody’s skin. However, when oil builds up it creates a perfect environment for bacteria to multiply and this in turn causes inflammation which leads to red, pus filled spots.

The amount of oil your skin produces is closely linked to hormone levels hence why acne is often more severe in teenagers. Some women suffer with a condition called polycystic ovarian syndrome (PCOS) which causes imbalances in hormonal levels and this can be associated with acne. Other signs of PCOS are irregular periods and excessive body hair.

Some medications can cause acne. For example, some women find that certain forms of contraceptive such as the progesterone only contraceptive pill (the mini pill) can make acne worse.

There is emerging evidence to suggest that certain diets may make some people more prone to developing spots. High glycaemic index (GI) diets may make some people more prone to acne or increase the severity of their acne (high GI diets are diets rich in sugary foods, white bread, potatoes, white rice etc).

How to get rid of acne?

Dermatologists treat acne with the following:

• Over the counter creams and prescription topicals
• Antibiotic tablets
• Oral contraceptive pills
• Isotretinoin capsules
• Oral spironolactone

Topicals for acne

Benzoyl peroxide is a common ingredient that you can get over the counter to treat acne. It reduces the number of bacteria on the skin. Prescription creams can include antibiotics such as erythromycin or clindamycin. The antibiotic is usually combined with another ingredient in the cream such as a retinoid to reduce the chance of antibiotic resistance. Prescription retinoids have been used to treat acne for several decades now and have a lot of evidence behind them. Common ones in the UK are tretinoin and adapalene. At Uncouth we can adapt the concentration of the retinoid to suit your skin. Azelaic acid is a different kind of topical treatment which is frequently used by dermatologists to treat acne in concentrations of 15% and 20% and is deemed safe to use in pregnancy.

Oral treatments for acne

Dermatologists used several oral treatments to treat more persistent acne. Some of these treatments are different types of antibiotics which have antibacterial and anti-inflammatory actions. Spironolactone is a different type of oral medication for acne – it can be used to treat hormonal acne in women (hormonal acne often manifests itself as spots around the chin and jawline. It works by blocking the action of androgens (male hormones) in the skin. If acne is severe or causing scarring, dermatologists may use a treatment called isotretinoin (brand name Roaccutane) which is an oral retinoid – a form of vitamin A. This drug is teratogenic (harmful to a foetus) therefore cannot be taken by pregnant or breastfeeding women or women who are planning a pregnancy.

Which treatment is right for me?

That totally depends on how severe your acne is, your preferences and your lifestyle. Some people are fine with something like a salicylic acid cleanser that can be bought in the shops or online. Some people may respond better to more powerful ingredients such as prescription grade ingredients and/ or oral medications.

References

British Association of Dermatologists information leaflet on ‘ACNE’