Acne

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Acne vulgaris is a skin disease that causes spots or pimples to develop on the skin. The types of spots can include blackheads, whiteheads, pus-filled pustules and cysts. The sufferer will usually find these spots develop primarily on the face, neck, chest, and back. Acne is a common skin complaint and will affect most of us at some point in our lives, usually during puberty.

Acne occurs when your skin begins to produce too much sebum. Sebum is an oily substance produced naturally in the skin that stops it from drying out. When too much sebum is produced, the excess mixes with dead skin cells and forms a plug. This plug blocks the tiny hair follicles found on the skin. These plugged follicles can produce blackheads or whiteheads, depending on whether the follicle is open or closed. Open follicles will create blackheads, and closed follicles will produce whiteheads. If these plugged follicles mix with naturally present bacteria, the contaminated follicle can become infected. This will cause papules, pustules, nodules or cysts to form.

Acne is usually triggered by changes in the body’s hormone levels. This is why acne is very prevalent amongst pubescent teenagers (around 80%), as the hormonal levels are in a constant state of flux. These hormonal fluctuations can result in the over-production of sebum, which is the main cause of acne. Other factors that can alter hormone levels and lead to acne include menstruation, pregnancy and periods of stress. It is also thought that acne runs in families, therefore if one or both of your parents suffered from acne then you are more likely to also experience it.

Acne is not caused by having a poor diet, being dirty or having poor hygiene, or sexual activity.

The primary symptoms of acne are spots and oily skin. Acne, for almost everyone, will occur on the face and neck, with half of those sufferers presenting with acne on the back. It is estimated that only 15% of acne sufferers will experience symptoms on the chest. There are six main types of acne spots:

• Blackheads: The black or sometimes yellowish appearance of blackheads isn’t due to dirt but rather a pigmentation produced by the blocked hair follicle. They will present as small bumps on the skin
• Whiteheads: Are very similar to blackheads, however, they are firmer and will not empty when squeezed
• Papules: These are red bumps that can feel sore or tender to touch
• Pustules: These are similar to papules. However, they will have a white centre due to a build-up of puss
• Nodules: These are large, hard and sometimes painful lumps that develop beneath the skin’s surface
• Cysts resemble boils and are large pus-filled protrusions. This is the most severe spot caused by cystic acne and carries the greatest risk of permanent scarring.

Most cases of acne can be managed without the need to consult a doctor. As the symptoms of acne are generally easy to self-diagnose and are normally uncomplicated, treating acne yourself is a favourable option.

It is important to remember that even milder cases of acne can lead to emotional distress. If you are experiencing emotional distress from your acne or you’re finding treatment ineffective, then it is recommended to consult a GP. Should your acne present with cysts and/or deep nodules, it is also advised to consult a doctor, as these types of spots can potentially lead to permanent scarring if not managed correctly.

If you decide to see your doctor about acne, they will be able to perform a diagnosis through a simple visual examination. They will inspect the face, chest and back to identify the different types of spots present. From this examination, the doctor will be able to judge how severe your acne is. Identifying the severity of acne is important for determining the most appropriate treatment. The severity of acne can be classified thusly:

• Mild acne – Grade 1: mostly blackheads and whiteheads, perhaps with a few pustules and papules.
• Moderate acne – Grade 2: multiple pustules and papules, which will be confined mostly to the face.
• Moderate to severe acne – Grade 3: high numbers of pustules and papules affecting the face, back and chest. Grade 3 acne will also include the presence of inflamed nodules.
• Severe acne – Grade 4: high numbers of pustules and nodules that are both large and painful.

If you’re a woman and suddenly experience the development of acne as an adult, you should see your doctor. They may wish to perform an ultrasound or blood test, especially if other symptoms that suggest a hormonal imbalance are present. These symptoms may include irregular or lighter periods or an increase in the growth of body hair. All these symptoms could point towards polycystic ovary syndrome (PCOS), which is the most common cause of hormonal imbalance in women.

If your acne is moderate to severe or widespread, then it may be deemed necessary to treat using prescription acne treatments, including:

• Topical retinoids (Differin, Isotrex)
• Oral antibiotics (Tetralysal/lymecycline, Oxytetracycline)
• Topical antibiotics (Dalacin-T, Zineryt, Zindaclin)
• Keratolytics (Acnecide)
• Azelaic acid (Skinoren)
• Combination acne treatments (Duac Gel, Epiduo, Isotrexin, Treclin)

Topical retinoids work by reducing the amount of sebum produced while preventing dead skin cells from clogging up the hair follicles. An example of a topical retinoid is Adapalene, which is also known as Differin Cream 0.1%.

Oral antibiotics are usually used in combination with a topical cream treatment. They are usually reserved for more moderate to severe bouts of acne. In the majority of cases, the preferred choice is a class of antibiotic called Tetracyclines. An example of a tetracycline antibiotic is Tetralysal 300 Capsules, containing lymecycline. Tetracyclines, such as Tetralysal 300, work by killing the bacteria that cause acne.

Azelaic acid is usually used as an alternative treatment to benzoyl peroxide or a prescription retinoid cream if these have proved ineffective. It works in a similar way to benzoyl peroxide by increasing the turnover of skin cells, killing bacteria and eliminating the dead skin cells that can plug the hair follicles. An example of an Azelaic acid preparation is Skinoren 20% Cream.

You can also see a list of specifically over-the-counter acne treatments here.

All acne treatments need to be used regularly for a number of months to build up an effect and successfully treat acne.

Mild acne can be successfully managed without a prescription using topical acne medications available from pharmacies. These will usually include the ingredient Benzoyl Peroxide. Benzoyl Peroxide works by helping to prevent dead skin cells from clogging up the hair follicles. It also eliminates the bacteria responsible for causing infection to these plugged follicles. Benzoyl peroxide can be found in products like Acnecide Gel (benzoyl peroxide 5%) and is usually applied to the affected areas 20 minutes after washing with a mild soap or a gentle cleanser. But make sure it doesn't come into contact with hair or clothes as it can bleach your hair and coloured fabrics.

Anyone who has ever had acne dreads breakouts, and for good reason, too, because sometimes it takes weeks to clear up, not to mention the risk of scarring. Even if you've found an effective treatment for your acne, it is still important to take measures to prevent recurrence - with a few simple precautions, you may be able to fend off breakouts.

Acne can be very hard to prevent. Some inducing factors, such as puberty, can’t be helped. However, there are ways to reduce your risk of developing acne and for improving your symptoms if it’s unavoidable. These include:

• Wash using a mild soap or cleanser. Avoid using very hot or very cold water, as this can make acne worse. Avoid scrubbing harshly or using abrasive washcloths, as this can irritate the skin. Use a very soft cloth, rinse well with warm water, and pat dry using a clean towel.
• Don’t wash the affected area more than twice a day. Washing too frequently can irritate the skin and make the acne worse.
• Avoid touching your face. This can spread bacteria from the hands to the face.
• Avoid the temptation to pick at or squeeze your spots. This can lead to permanent scarring.
• Ensure hair is regularly washed and try not to let it fall across the face.
• Avoid using oils, fragrances, gels or pomades on your hair. If any of these products get onto your face, they can block pores and cause acne.
• Avoid using excessive amounts of cosmetics and makeup. Try to only use products labelled as ‘non-comedogenic’. Non-comedogenic products are water-based and are less likely to clog up the pores on your skin.
• Always remove makeup before going to bed.
• If your skin is dry and flaky, try using a fragrance-free water-based emollient.

For more details on how to prevent acne, see below:

Keep your hands off the face

Our hands may look very clean, but they carry all kinds of germs. They are constantly gathering dust and grime as we touch different surfaces, including our hair. They secrete quite a bit of sweat, too. Touching a clean mirror with your fingers should demonstrate it all too well. Unconsciously rubbing or scratching the skin may cause abrasions or even break a zit, which in turn will set off a reaction that may culminate in a full-blown breakout. Avoid touching the face except to gently wash it occasionally.

Wash your face frequently

Keeping the skin free of germs and dirt will reduce the chances of acne breakouts. You don’t have to use soap or other cleansing products every time. Deep cleaning once a day may be beneficial, but always apply a neutral moisturiser afterwards, as dry skin triggers excessive production of skin oils.

Follow a healthy diet

We are what we eat. Greasy and spicy food is thought to promote breakouts. Food allergies, however mild they may be, are also potential triggers. Dairy products, nuts, chocolate and soda are some of the common allergenic foods. So are alcohol and certain additives in fast foods. Eating plenty of fruits and vegetables will ensure healthy skin.

Stay hydrated

Drinking plenty of fluids is thought to reduce the risk of acne considerably. Besides flushing out toxins from the body, water can keep the skin moisturised from the inside.

Keep a tab on the products you use

Reduce your exposure to potential allergens by choosing everyday cleaning products like soaps, shampoos and detergents carefully. Note adverse reactions whenever you try a new product and check out the ingredients. Avoid other products that contain them.

Cut down on cosmetics use

These well-known culprits can trigger acne in several ways. They clog up the skin pores and literally suffocate the skin, creating an ideal environment for bacterial growth. Cosmetic products typically contain a number of chemicals, any of which can cause an allergic reaction. The very act of applying makeup can irritate sensitive skin.

If you find it hard to completely abstain from cosmetics, stick to specific products that you have personally found to be the least offensive. Leave the make-up on for the minimum amount of time. Never go to sleep with it. Avoid vigorous rubbing while applying and removing makeup.

Avoid stress

Most people experience breakouts during periods of stress. The hormonal changes could be the reason. Stress is part of life, but it is essential to keep the mind and body healthy through regular exercise and relaxation techniques. Get good sleep, too.

Sleep in clean beds

Since we spend one-third of our day in bed, sweat, dead skin cells, and dandruff accumulate in our bedding. They can irritate the skin and cause acne. Change pillowcases and bed covers every week.

Anyone who has ever had acne dreads breakouts, and for good reason, too, because sometimes it takes weeks to clear up, not to mention the risk of scarring. An overnight cure does not exist. Even if you've found an effective treatment of acne, it is still important to take measures to prevent recurrence - with a few simple precautions, you may be able to fend off breakouts.

Acne can be very hard to prevent, and it’s best to keep a diary of your breakouts to help you get to the bottom of what is causing them. This may help you track if your acne is caused by a hormonal imbalance due to ovulation or periods for women. Some inducing factors, such as puberty, can’t be helped. However, there are ways to reduce your risk of developing acne and for improving your symptoms if it’s unavoidable. These include:

• Wash using a mild soap or cleanser. Avoid using very hot or very cold water, as this can make acne worse. Avoid scrubbing harshly or using abrasive washcloths, as this can irritate the skin. Use a very soft cloth, rinse well with warm water, and pat dry using a clean towel.
• Don’t wash the affected area more than twice a day. Washing too frequently can irritate it and make the acne worse.
• Avoid touching your face and jawline at all costs. This can spread bacteria from the hands to the face.
• Avoid the temptation to pick at or squeeze a blemish. This can lead to permanent scarring.
• Ensure hair is regularly washed and try not to let it fall across the face.
• Avoid using oils, fragrances, gels or pomades on your hair. If any of these products gets onto your face, they can block pores and cause acne.
• Some herbal treatments with natural antibacterial properties, such as tea tree oil, may be useful home treatments of acne.
• Avoid using excessive amounts of cosmetics and makeup. Try to only use products labelled as ‘non-comedogenic’. Non-comedogenic products are water-based and are less likely to clog-up the pores on your skin.
• Always remove makeup before going to bed.
• If your skin is dry and flaky, try using a fragrance-free water-based emollient.

For more details on how to prevent acne, see the 'Alternatives' tab.