Teen acne - in the spot-light!

Teenage acne is common - very common, in fact! About 95% of people aged 11 to 30 are affected by acne to some extent. It usually starts during puberty and can range in severity from a few spots on the face, neck, back and chest, which most teenagers will have at some time, to a more severe problem that may cause scarring and reduce self-confidence. Indeed, multiple studies have demonstrated a clear link between severe acne and psychological conditions such as depression, anxiety and suicidal behaviour.

Even if you, or the teen in your life is not plagued by severe symptoms, being a teenager is surely challenging enough without dealing with acne. That's why the doctors at Winchester GP are wholly supportive of taking acne seriously, and taking proactive steps to minimise its impact on health and happiness.

Do I have acne?

The typical appearance of acne is a mixture of oily skin, blackheads, whiteheads, red spots and pus-filled pimples. Occasionally, larger, deeper bumps or cysts may develop. Unsurprisingly, this level of inflammation makes the skin sore.

Acne can be a scarring condition. The scars may be raised and lumpy (known as hypertrophic or keloid scars) or indented (known as pitted or atrophic scars). Acne can also leave discolouration which may be red, hyperpigmented (darker than your usual skin colour) or hypopigmented (lighter than your normal skin colour).

Remember, however, that not all spots are acne, so if you are in any doubt, do consult your doctor.

What causes acne?

The onset of acne at puberty is probably clue enough that it is hormone related. The oil-producing sebaceous glands in the skin can be overly sensitive to the hormonal stimuli of puberty, producing excess oil. At the same time, the lining of the pores becomes thickened and dead skin cells are not shed properly.

This build up of dead skin cells and excess oil ultimately blocks the pores, producing blackheads and whiteheads.

The story doesn't end there though. A specific acne bacteria, known as Cutibacterium acnes, which usually lives harmlessly on the skin, is more apt to multiply on oilier skin. This bacterial growth leads to the formation of red, swollen or pus-filled spots.

What can I do to help myself?

There are many steps that you can take at home to help with your acne. Some patience is required though, as it takes at least 4 weeks for your skin to regenerate, meaning that you might not see the benefit of any changes you make for a few months. Acne is a condition that is managed rather than 'cured', so the following tips can help both whether used alone, or as part of a multi-pronged plan devised with your healthcare practitioner.

1) Go easy You may be feeling impatient and, frankly, frustrated with your skin - but please resist the temptation to scrub and 'disinfect' it. Frequent washing with harsh products and/or extremely hot or cold water can actually make acne worse. Limit your washing to twice per day, and use mild soap or cleanser and lukewarm water. Products by Cerave and Cetaphil coming highly recommended.

2) No picking! Attempts at 'extraction' done at home almost invariably worsen things and can cause permanent scarring.

3) Audit your skin and cosmetic products - making sure they are 'non-comedogenic' (won't block your pores). Use as little as you can get away with to feel confident, and remember to remove scrupulously before bed.

4) Keep exercising - for the benefits to your mood and self-esteem. Shower as soon as possible once you finish exercising as sweat can irritate your acne.

5) Wash your hair regularly and try to avoid letting your hair fall across your face.

6) Check your medications Sometimes acne can be caused by medication given for other health conditions or by certain contraceptive injections or pills. Some tablets taken by body-builders contain hormones that can trigger acne too. If in doubt check the patient information leaflet or consult your doctor.

7) Consider dietary factors Diets high in refined sugary foods (High GI) have been shown to aggravate acne, so switching to a low GI diet may lead to fewer spots (and is a healthier way to eat in any case!) Some other food groups such as milk and dairy products may be linked to acne in some people but the studies on this are not as detailed yet. As a general rule, we would strongly recommend consulting a dietician or doctor before cutting out entire food groups. Teen eating habits can tend to the erratic at the best of times, so we want to make sure that any changes don't cause more problems.

8) Consider other hormonal imbalances While acne has a strong hormonal element, most sufferers will have normal hormone levels if tested. The most common exception to this rule would be in females with polycystic ovarian syndrome (PCOS). If you are a woman and develop irregular periods, unusual hair growth or hair loss or other changes to your body, do mention this to your doctor in case it is relevant.

9) Get early help However your acne affects you, it is important to take action to control it as soon as it appears. This helps to avoid permanent scarring and reduces embarrassment. If your self-confidence has been affected by acne or if you are feeling distressed, do seek support. This could be from friends, family members and support groups. You may also be able to access a counsellor through school, university or work.

How can your pharmacist help with acne?

Most people's first port of call for acne will be their pharmacist, and there are many over the counter preparations that you could try. We would emphasise again that 'more is not always more', so be sure to show the combination of treatments you are planning to use to the pharmacist to check they are compatible. Scrutinise the ingredients list when you buy (common active ingredients are salicylic acid or benzoyl peroxide) to ensure that you are not doubling up on products or overpaying for fancy marketing.

How can your doctor help with acne?

Please don't hesitate to consult your doctor if you are feeling down about your skin. They understand both the physical and psychological impact of the condition, and should be nothing but empathetic - and they have access to an even greater range of options to help. In general, most treatments take two to four months to produce their maximum effect.

Acne treatments can be split in to several categories:

Topical treatments, i.e. those that are applied directly to the skin
Oral antibiotics, i.e. tablets taken by mouth
Oral contraceptive pills
Isotretinoin capsules
Other treatments

Topical treatments

These are usually the first choice for those with mild to moderate acne. There are a variety of active anti-acne agents, such as benzoyl peroxide, antibiotics (e.g. erythromycin, tetracycline and clindamycin), retinoids (e.g. tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide (also known as niacinamide).

Oral antibiotic treatment

Your doctor may recommend a course of antibiotic tablets, usually erythromycin or a type of tetracycline, which is often taken in combination with a suitable topical treatment. Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement.

Oral contraceptive treatments

Some forms of the oral contraceptive pill can be helpful in females who have acne. The most effective contain a hormone blocker (e.g. cyproterone acetate) which reduces the amount of oil the skin produces. It usually takes at least three months for the benefits to show. This might be a particularly good option to consider if you need contraception anyway.

Isotretinoin (Roaccutane)

This is a treatment for severe or persistent acne and the improvements can be long-lasting in those who complete a course of treatment. It does, however, have the potential to cause a number of serious side effects and can be prescribed only under the supervision of a consultant dermatologist. That being said, it should be emphasised that once the necessary screening and precautions have been taken, isotretinoin, is a highly effective treatment that has benefitted many thousands of people.

More detailed information on isotretinoin and its side effects can be found on the BAD website.

Other treatments

There are many forms of light and laser therapy for inflammatory acne but these types of treatment have given mixed results when studied and are usually ineffective in the treatment of severe acne. Laser resurfacing of facial skin to reduce post-acne scarring is an established technique requiring the skills of an experienced laser surgeon. Laser treatment should not be done for at least one year after completing a course of isotretinoin. This treatment is only available privately.

Various other techniques may also be used to improve the appearance of acne scars. These include steroid injections, microneedling and subcision and are also not routinely available on the NHS. Skin camouflage is an inexpensive and effective method for disguising changes in the pigmentation of the skin which can sometimes remain after acne has been treated.

Psychological support is also important

Please don't hesitate to let your GP or Dermatologist know if your acne is making you feel depressed or anxious. They should absolutely take your seriously, explore with you how you are feeling and help you to form a treatment plan. This may involve input from other specialists, such as psychologists or psychiatrists, if necessary.

Where can I get more information?

Web links to detailed leaflets:
http://www.acnesupport.org.uk/
http://www.acnesupport.org.uk/emotional-support/

Acne Support provides expert, impartial information from consultant dermatologists on the treatment, causes and prevention of acne, as well as advice on how to access emotional support.

https://www.nhs.uk/conditions/acne/
http://www.pcds.org.uk/clinical-guidance/acne-vulgaris
http://www.dermnetnz.org/acne/index.html