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. Multiple studies have demonstrated a clear link between severe acne and psychological conditions such as depression, anxiety and suicidal thoughts and behaviour.
Even if you, or the teen in your life, is not affected by severe symptoms, being a teenager is challenging enough without dealing with acne. That’s why the doctors at Winchester GP believe acne should be taken seriously and managed proactively to minimise its impact on health and happiness.
Do I have acne?
Acne typically appears as a mixture of oily skin, blackheads, whiteheads, red spots and pus-filled pimples. Occasionally, larger, deeper lumps or cysts may develop. This inflammation can make the skin sore and uncomfortable.
Acne can be a scarring condition. Scars may be raised and lumpy (hypertrophic or keloid scars) or indented (pitted or atrophic scars). Acne can also leave discolouration, which may be red, darker than your usual skin colour (post-inflammatory hyperpigmentation), or lighter than your normal skin colour.
Not all spots are acne, so if you are unsure, it is sensible to consult your doctor.
What causes acne?
The onset of acne during puberty reflects its strong hormonal influence. Oil-producing sebaceous glands in the skin can become overly sensitive to hormonal changes, leading to excess oil production. At the same time, dead skin cells are not shed properly, causing the pores to become blocked.
This build-up of oil and dead skin cells forms blackheads and whiteheads. The acne bacterium Cutibacterium acnes, which normally lives harmlessly on the skin, is more likely to multiply in blocked, oily pores. This can trigger inflammation and lead to red, swollen or pus-filled spots.
What can I do to help myself?
There are many steps you can take at home to help manage acne. Patience is important, as treatments usually take at least 6–8 weeks to start working and several months to reach their full effect. Acne is best thought of as a condition that can be controlled rather than cured.
No picking!!
1) Go easy
Avoid scrubbing or using harsh products in an attempt to “clean” your skin. Over-washing and extreme water temperatures can worsen acne. Wash your face no more than twice daily using a mild cleanser and lukewarm water. Gentle skincare brands such as CeraVe and Cetaphil are often well tolerated.
2) Don’t pick or squeeze spots
Picking or attempting home extractions almost always makes acne worse and increases the risk of permanent scarring.
3) Check skincare and cosmetic products
Choose products labelled “non-comedogenic” or “oil-free”, meaning they are less likely to block pores. Use the minimum amount needed and remove make-up thoroughly before bed.
4) Keep exercising
Exercise benefits both physical and mental health. Shower as soon as possible after exercising, as sweat can irritate acne-prone skin.
5) Look after your hair
Wash hair regularly and try to keep it away from the face, as hair products and oils can contribute to breakouts.
6) Review medications
Some medications, including certain hormonal contraceptives and anabolic steroids, can trigger or worsen acne. If you are unsure, check the patient information leaflet or speak to your doctor.
7) Consider dietary factors
High glycaemic index (high-sugar) foods may aggravate acne in some people, and given that a lower-GI diet, with as little processed food as possible is preferable for overall health, it makes sense to pay attention to this. Whilst dairy products often get anecdotally linked to acne, the research evidence to back this up is not particularly strong. We would advise against cutting out major food groups without first consulting a suitable qualified medical practitioner. .
8) Consider hormonal conditions
Most people with acne have normal hormone levels. That being said, an important exception is polycystic ovary syndrome (PCOS). If acne is accompanied by irregular periods, excessive hair growth, hair loss or other hormonal symptoms, this should be discussed with a doctor.
9) Get help early
Early treatment reduces the risk of scarring and emotional distress. If acne affects your confidence, mood or daily life, it is important to seek medical advice, regardless of how mild it may appear.
How can your pharmacist help with acne?
Many people first seek advice from their pharmacist. Over-the-counter treatments often contain ingredients such as benzoyl peroxide or salicylic acid. Using too many products at once can irritate the skin, so a simple routine is best. A pharmacist can help ensure products are compatible and used correctly.
How can your doctor help with acne?
Doctors understand both the physical and psychological effects of acne and can offer a wider range of treatments. Most prescription treatments take several weeks to work, with maximum benefit often seen after three to four months.
Acne treatments include:
Topical treatments
Oral antibiotics
Hormonal treatments
Isotretinoin
Other specialist treatments
Topical treatments
These are usually the first choice for mild to moderate acne. Options include benzoyl peroxide, topical retinoids (such as adapalene or tretinoin), azelaic acid and topical antibiotics. When topical antibiotics are used, they should always be combined with benzoyl peroxide or a retinoid and used for limited periods to reduce antibiotic resistance.
Oral antibiotics
Oral antibiotics such as doxycycline, lymecycline or erythromycin may be prescribed for moderate to severe acne. They are always used alongside topical treatments and are usually limited to courses of three to six months, with regular review.
Hormonal treatments
Some combined oral contraceptive pills can improve acne in females, particularly those with anti-androgenic properties. Improvement typically takes at least three months.
Isotretinoin (Roaccutane)
Isotretinoin is reserved for severe, scarring or treatment-resistant acne. It is prescribed only by consultant dermatologists and requires strict monitoring and pregnancy-prevention measures. When used appropriately, it is a highly effective treatment with long-lasting benefits.
Further information is available on the British Association of Dermatologists website.
Other treatments
Light and laser therapies have limited evidence for treating active acne and are not routinely recommended for severe cases. Procedures for acne scarring, such as laser treatment, microneedling or subcision, may be effective when performed by experienced specialists. These treatments are usually considered from around six months after completing isotretinoin, depending on specialist advice. Skin camouflage can also be a helpful and inexpensive option for persistent colour changes after acne.
Psychological support matters
Acne can have a significant impact on mental health. If acne is causing low mood, anxiety or distress, it is important to let your GP or dermatologist know. Emotional wellbeing is a recognised part of acne care, and support or referral to counselling services can be arranged if needed.
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