Acne

Causes of acne

Acne pimples happen when hair follicles (the tiny holes in your skin that hairs grow out of) get blocked by dead skin cells, and the skin produces too much natural oil (sebum). The sebum and skin cells form a plug and the pore may then get infected by bacteria, often Cutibacterium acnes, which causes inflammation. The spots then go red and swollen and may collect pus.

What are the symptoms of acne ?

The physical symptoms of acne include a range of different spots and comedones, some sore and some not. It usually affects the face and neck, but acne can also appear on the upper arms, shoulders and back.

Acne has a psychological impact

Because acne affects appearance it can have an impact on self-esteem and wellbeing. If it is affecting your daily activities – for example, it might make you not want to have fun with your friends – then speak to your GP. Acne can make some people more susceptible to depression, so it’s important to get it treated.

Acne is really common. According to the Canadian Dermatology Association, it affects nearly 20 per cent of the population. It is the commonest skin disorder that doctors see.

Acne can cause scarring

Even mild acne can result in scarring, so you need to treat it, particularly if it is severe and long-lasting.

Acne can be a sign of something more serious

Acne that starts suddenly in adult woman should be investigated by a GP as it may be a symptom of a hormonal imbalance.

How is acne diagnosed?

Acne has visible symptoms, and is diagnosed by examining the skin. Acne is classified according to severity:

• mild acne: few lesions close to the skin surface
• moderate acne: larger and more extensive comedones and inflamed red spots
• severe acne: many acne spots and deeper nodules and cysts with inflammation covering much of the face, back and chest

What should I do if I have acne ?

If you think you might have mild acne , try the tips outlined in the management of acne section first. There are many over-the-counter skin care products that you can try. Patience and persistence are key with acne management, and remember that in some cases the treatment will make your acne worse before it gets better.

When should I see a doctor about my acne?

See a GP about your acne if:

• you have moderate to severe acne
• your acne is having a big negative impact on your daily life
• you’ve tried self-help acne treatment for a couple of months, and it has not worked

A GP or dermatologist can prescribe more powerful creams and even pills to treat your acne. They may recommend a course of antibiotics to improve your skin bacteria. They can also help you work out a face and back washing regime that will give your skin the best chance of recovering. As with non-prescription treatments, it can take a while for your acne prescription meds to work – but if you are in any doubt about how your acne treatment regime is going, speak to your prescribing doctor or get advice from your pharmacist.

Management of acne

There are plenty of treatment and management options for acne . They range from skin washes to creams to lifestyle and diet changes to prescribed pills and skin preparations. It can take a few months to see success with an acne-management regime, so be patient and persistent.

Skin care for acne

Finding the right skincare regime will help keep your acne at bay. The Canadian Dermatology Association recommends washing the affected area twice daily with a cleanser formulated for acne. Scrubbing and vigorous washing can irritate the skin, so be gentle in your daily cleansing routine. Also avoid picking or squeezing spots: it increases the risk of more bacteria invading your skin.

What aggravates acne?

Acne often flares up where skin is irritated. These are some examples of things that aggravate acne.

• Makeup can aggravate acne, so try taking a break from it, or changing to oil-free or non-comedogenic products.
• Sun exposure and indoor tanning can irritate your skin and cause a breakout of acne. So sunscreen is important if you have acne. Look for sunscreen products that are non-comedogenic and non-acnegenic.
• Pillowcases that are not washed often enough can deposit oil and dirt on your skin. Another culprit is makeup brushes and applicators: clean them with antimicrobials where possible, or renew them frequently. Some experts also blame mobile phones for acne flares, so if you get an outbreak where you rest your phone on your cheek, give your device a daily antibacterial clean.
• Anything that rubs or irritates your skin can make acne worse. For example, straps on safety helmets, or a hat that is badly fitted, or a bag strap across your back.
• Stress may make acne flare up, but it does not cause it.

Diet and acne

Some people find that certain foods make their acne flare up. If this sounds like you, cut that food out of your diet if it is safe for you to do so. The Canadian Dermatology Association says reducing intake of dairy and eating more low GI foods make help acne symptoms in some cases.

Drug interactions and acne

Some medications, such as corticosteroids, can make acne worse. Although the oral contraceptive pill is sometimes used to treat acne, the progesterone-only pill and the contraceptive implant have been observed to worsen acne.

If you have any concerns or worries about your meds for other conditions causing acne or making your spots worse, speak with your doctor and pharmacist. They can help you manage your health regime in a way that reduces the impact on your skin.

Drugs and medications used to treat acne

Not all cases of acne need drug therapy. But there is a range of different treatment options if your doctor agrees that medication is the best option for your acne . And if one acne treatment doesn’t work, your doctor will help you to try another. Treating acne is a slow process and it can take months before you see a result.

Ask your GP how long it will take before you start seeing improvements in your acne. Also ask how long the course of meds is likely to be. Keep in touch with your GP and if your pharmacist offers you a medicines review, take the opportunity to check-in and get expert advice.

Topical preparations for acne

Topical preparations – that is, creams or gel that are applied to the skin – for treating acne include:

• topical benzoyl peroxide, salicylic acid or glycolic acid
• topical azelaic acid
• topical retinoids
• topical antibiotics

These creams should be put on the entire area affected by acne. There’s no need to dab your acne cream on to each pimple.

Benzoyl peroxide, salicylic acid or glycolic acid creams are available over the counter from your pharmacist. They encourage the surface of the skin to peel off so that your skin follicles are not blocked by dead skin cells and sebum.

Topical retinoids are a prescription med that works by exfoliating – that is, removing the dead skin cells from the surface of the skin. Retinoids must not be used by people who are pregnant or planning to conceive as they can cause birth defects. When a doctor prescribes retinoids for your acne, you may be asked what contraception you use, and you may have to take a pregnancy test each month. You may also be asked to agree to take extra precautions to avoid pregnancy during the course of your retinoid treatment.

Many acne treatments cause some irritation, redness, burning and peeling of the skin. Azelaic acid is prescribed for people with acne who can’t tolerate retinoids or benzoyl peroxide.

What if my acne cream or gel is too painful to use?

If the burning and irritation caused by your topical acne treatment is unbearable, talk to your doctor or pharmacist. It may be possible to try another acne med. Or they may have some advice about tweaking your acne care regime to minimize the irritation.

Antibiotics for acne

Oral or topical antibiotics may be prescribed for severe acne. Tetracycline antibiotics target the bacteria that infects acne-prone skin, causing the redness and inflammation characteristic of an acne outbreak. Your acne doctor is likely to prescribe erythromycin if you are pregnant or breastfeeding. Antibiotic treatment for acne takes four to six weeks to start improving your acne. You may need to take antibiotics for acne for four to six months.

Hormonal therapy for acne

Your GP may prescribe a hormonal therapy for your acne. For example, sometimes the combined oral contraceptive pill is prescribed for acne even if you are not sexually active. This may take up to a year to improve your acne.

Another hormonal treatment is co-cyprindiol. It reduces the production of sebum in the skin.

Co-cyprindiol is not safe to take during pregnancy and breastfeeding. If there is a chance you could become pregnant your doctor will require you take pregnancy tests during the course of the meds. The course of co-cyprindiol is at least two to six months.

Creams and gels used to treat acne scarring

With effective prevention, you should not get acne scars. But if you do have acne scars, your dermatologist may prescribe a tretinoin cream or gel.

What precautions do I need to take with acne drugs?

Prescription drugs that treat acne need to be handled with care. Even expert patients manage their acne regime better when supported by a doctor or pharmacist. Please keep in touch with your doctor and pharmacist. Ask for advice if something doesn’t seem right, if you are struggling with side-effects or if you think you need to stop taking your meds.

Are acne drugs safe if you are trying to conceive?

Some acne drugs, creams and gels are linked to birth defects, particularly if used during the early stages of pregnancy. Doctors and pharmacists will closely question patients who can become pregnant before prescribing or dispensing isotretinoin products. Always follow the prescriber’s instructions, answer their questions honestly and comply with any pregnancy testing or contraceptive requirements.

For your own peace of mind, if you plan to get pregnant or think you might be pregnant, mention this to the doctor or dermatologist who prescribed your acne medication.

Do acne creams cause sunburn?

Sun exposure can make acne worse, so it’s a good idea to wear a non-acnegenic sunscreen when you’re out and about, and avoid using sunbeds and tanning salons while you are treating your acne. But some acne treatments, such as benzoyl peroxide, topical retinoids, azelaic acid, and tetracycline antibiotics can make you more vulnerable to sun damage and sunburn. So, while you are using these treatments, take extra care in the sun.

Acne myths and facts

Treating acne takes a long time, and there are a lot of outlandish remedies and suggestions floating around about it. We fact-checked some of them using reliable, science-based resources such as the Canadian Dermatology Association.

Toothpaste is not good for drying up spots. It can irritate the skin, making acne worse and there are more effective over-the-counter creams available for treating pimples.

Blackheads are not full of dirt. They are black because the natural skin oil has oxidized on exposure to the air.

Frequent, vigorous scrubbing is not a good way to manage acne. Over-washing your skin can irritate it, making acne worse.

Acne is not contagious. The skin condition acne is not infectious and you can’t catch it from someone else.

Tanning doesn’t help with spots. Tanning, whether indoors or outside, is not helpful as a treatment for acne. It does dry up skin lesions and oils, and the colour change of a tan will mask redness; but this effect will not last. Many people find their acne flares if they have been in the sun or on a sunbed as UV exposure irritates the skin.

Greasy food does not cause acne. Studies have found no connection between eating greasy food (or chocolate) and aggravated acne.

Picking or squeezing acne spots makes them worse. Squeezing a spot can push bacteria and sebum into the surrounding skin tissues, making infection more likely. Manipulated spots are more likely to scar too. If a comedo needs removing, this is best left to a professional dermatologist or nurse.