Acne is a skin condition that develops in the pores around the hair follicles and oil producing glands. It is characterised by pimples, blackheads and white heads that appear on the face, neck, chest, back and shoulders. It is most common in the 14 - 19 year age group although people in their 20s or 30s also may have acne. Females tend to get acne at an earlier age although males tend to have more severe acne. It can appear at menopause for women or, for both sexes, if you start taking certain medicines.
What causes acne?
Acne is caused by an increased level of specific hormones (androgens) usually during puberty. Because of higher hormone levels, the sebaceous glands in the hair follicles start to produce excessive sebum (oil). Normally sebum helps to move dead skin cells out of hair follicles and also spreads over the skin to lubricate it and protect it. When too much sebum is produced, and the cells lining the follicles clump together, the resultant mass (or plug) blocks the opening of the hair follicles. This blockage will lead to mild forms of acne causing white heads or blackheads (see the diagrams below).
Some people believe that certain foods, such as chocolate, cause acne. However there is no evidence that foods actually cause acne.
What makes acne worse?
- Working with oils or greases, and jobs that make you very sweaty and hot.
- Some medicines and contraceptive pills (ask your Life pharmacist)
- Hormones, especially in a woman just before her period.
- Scratching, squeezing or picking your pimples.
- Clothing that rubs on your skin.
- Excessive sweating.
- Heavy, greasy, foundation and moisturising make-up.
Acne can be controlled. You should cleanse your skin twice daily to control excess oil. Skin cleansers, and medicated washes containing antiseptic agents, are useful in de-greasing the skin and reducing bacteria on the skin’s surface.
Blackheads and whiteheads
- Acne affects the hair follicle - a small sac in the skin that holds the hair root. In a normal hair follicle the old cells lining the sac fall away and are carried to the skin surface by sebum oil.
- In Acne the oil and old cells form a plug that blocks the follicle and as more oil is produced it builds up behind the plug. The plug under the surface of the skin is called a white head.
- When the plug of old cells and oil reaches the skin surface it turns black (due to melanin) and is called a blackhead.
The right treatment can reduce the risk that your skin will be damaged or scarred from acne. Treatment products work by removing follicular plugs and opening blocked pores, and by removing excess grease and bacteria - the factors that lead to the development of pimples.
A variety of topical products (applied to the skin) such as creams, lotions and washes, and oral medicines (medicines taken by mouth), are available to treat acne. Different products work in different ways - talk to your doctor or LIFE pharmacist about the best acne treatment for your skin.
These include cleansing agents that help remove excessive sebum and bacteria from the skin’s surface.
Benzyl peroxide: this will help to shed excess skin cells and decrease the skin’s oiliness. Its antibacterial properties help to reduce the amount of bacteria on the skin.
Sulphur/Resorcinol: these will also help to shed excess skin cells and help to reduce the inflammation and bacteria that cause acne.
Clindamycin and erythromycin: these are antibiotic liquids that are applied to the skin to decrease bacteria and sebum (oil) on the skin. They are Prescription Medicines. Your doctor will help you decide if these medicines are suitable for you.
Retinoid-type topical agents: chemically related to Vitamin A, retinoids unplug follicle openings and help un-clump cells. They are available only on prescription and must not be used in pregnancy.
If using more than one type of topical preparation, apply them at different times so as not to affect each one’s action.
Oral acne treatments are prescription medicines and include:
Oral antibiotics: these work by decreasing the number of bacteria on your skin so that there is less inflammation.
Hormonal contraceptive pills: in females these will help to regulate the production of excessive hormones that lead to acne and greasy skin.
Isotretinoin: this is used to treat severe acne that does not respond to other treatments. It can be used as first line treatment to prevent scarring due to severe acne. Like the topical retinoids, isotretinoin is a chemical relative of Vitamin A and reduces the formation of sebum by the sebaceous glands. Less sebum means fewer skin bacteria and less inflammation in the hair follicles. lsotretinoin generally is not used at the same time as topical anti acne preparations.
Treatment time scale
Acne treatment may take from two to six months to work. Don’t stop using the medicines within this time. If your acne does not improve after six months, talk to your doctor or LIFE pharmacist. Also discuss with your LIFE pharmacist if you get side effects from or irritations to, acne medicines. Some products dry-out the skin during initial stages but the skin usually adjusts.
- Cleanse your face and other acne areas in the morning and at night with a mild cleanser, or an antiseptic wash specifically for acne.
- Use a water-based moisturiser (avoid using any oil-based preparations and make up on your face).
- Apply treatment all over the area - not just on individual spots.
- Keep hair clean - wash it often.
- Keep hair off your face, especially your forehead.
- Wear loose-fitting clothing, especially if you have acne on your back or chest.
- Eat a balanced diet; drink plenty of water and exercise regularly to keep a healthy body.
- Stay out of the sun, or use a water-based sunscreen, if you are taking oral medicines to treat your acne.
- Rub your face dry - pat it gently when drying it.
- Touch your eyes and lips when applying any topical treatments - they can sting.
- Squeeze or pop pimples - this may damage the skin and cause scarring.
When to see your doctor
You should see your doctor if:
- You have acne on your chest and/or back.
- You have large red pimples that may or may not contain pus, or large lumps (cysts). These should be treated by a doctor to prevent scarring.
- Your acne does not improve with medicines you have tried already.