Addressing Acne​

How adult acne should be managed according to one of the UK’s leading consultant dermatologists

Acne Young Female

Acne is a dermatology condition that affects many women and men of all ages (yes even adults!). It’s a condition that can cause severe self-esteem and confidence issues, yet many adults suffer in silence and don’t seek professional help.

To learn more about managing acne, we spoke to one of the UK’s leading consultation dermatologists Dr Susan Mayou, who practises at the Cadogan Clinic. She specialises in acne, eczema, mole monitoring and skin cancer and also has a special interest in paediatric and cosmetic dermatology.

Dr Susan Mayou
Dr Susan Mayou

What is acne?

Acne is one of the most common skin conditions, affecting up to 90% of people at some time in their lives. Whilst it is most commonly seen in adolescents and young adults between the ages of 11 and the mid-20s, more cases of late onset acne are being noted in adults from the age of 25.

The appearance of acne can include oily skin, blackheads, whiteheads, red spots, pus-filled pimples (pustules), cysts (resembling boils) and nodules (deep bumps), as well as causing the skin to feel hot or tender to touch.

Acne most commonly presents on the face, back, neck, chest and shoulders, which are the locations of the highest concentration of sebaceous glands, but they can appear almost anywhere on the body. It can also affect both men and women, and people of all skin colours!

What causes acne?

Acne can be caused by fluctuating hormones in the body such as the menstrual cycle, pregnancy or some birth control pills. Medication for other health conditions can also exacerbate acne, as well as there being a genetic predisposition.

Stress is a recognised trigger of inflammatory skin conditions such as eczema, psoriasis and acne. Diet may also have a causal or exacerbating role for acne in some people; high glycaemic index diets (high in sugar, white rice, white bread and potatoes) have been shown to increase acne. Studies are also being undertaken on the role that dairy products may play in aggravating the condition.

Acne is formed by inflammation of oil-producing (sebaceous) glands in the skin due to the influence of the hormone testosterone, in much lower levels in women than men.

Testosterone also causes the cells which line the follicles of the sebaceous glands to become stickier and the ducts to clog up. This triggers whiteheads (when the follicular opening is closed) and blackheads/comedones (when the follicular opening is open). Interestingly, the black colour of a blackhead is caused by melanin pigmentation, not dirt!

Bacteria on the skin’s surface, (called Propionibacterium acne), are normally able to move in and out of the sebaceous glands, but become trapped inside by the follicular plug. This bacteria act on the increased oil in the sebaceous glands, breaking it down to a form which inflames the area and results in papules (red bumps) or pustules (with yellow heads) causing the typical appearance of acne spots.

Types of Acne Pimples diagram

What acne treatment options are available?

There are many treatments available for acne and it is important to consult a qualified practitioner such as a dermatologist to discuss which one is the most suitable option for you.

Acne requires a management strategy. Everybody is different, has different requirements and will respond differently to treatments or treatment combinations. There is no ‘one size fits all’ but dermatologists are experts in treating acne and have a vast understanding of the medication options, so are best able to tailor-make the most beneficial regime for your requirements.

Types of acne treatments I would recommend to my patients include: topical formulations, oral treatments, isotretinoin and contraceptives. Nothing oral should be taken when pregnant; even many topical treatments are best avoided.

Topical treatments: these are applied directly onto the entire affected area of the skin and are generally the first prescribed by a doctor to help treat mild superficial acne. Topical treatments use ingredients such as benzoyl peroxide, retinoids (tretinoin, isotretinoin and adapalene), azelaic acid, niacinamide and antibiotics. It is important to follow the advice of your doctor in terms of frequency of application as some topical treatments may require a phased introduction.

Oral treatments: a course of long-term low-dose antibiotics such as Lymecycline, a once daily tetracycline, may be prescribed for at least six months. Antibiotics are a safer option if a woman is thinking of conceiving, though should be stopped if they are actively trying to conceive. They make take six weeks to show their benefits, but thereafter there should be a 20% improvement at two months, 30% at three months and so on.

Isotretinoin/Roaccutane: is an oral treatment taken for four to six months and starts working within 10 days of treatment. It can be very effective for severe acne or scarring acne, acne which has failed to respond to an appropriate course of antibiotics and adult acne. It is imperative that women do not become pregnant whilst taking it as it is very damaging to the unborn baby. It can also have adverse mental effects on those who have a preceding concern such as depression, manic depression, suicidal tendency, anorexia or anxiety.

Contraceptives: for women with acne, many respond well to the oral contraceptive pill, which helps to reduce oil production. The ‘skin-friendly’ Yasmin or Cilest pills are a good way forward, particularly for women wanting contraception, but definitely not a viable option for those thinking of conceiving. Some pills are unfriendly to skin, so it is important to get the right one.

Spironolactone: is another option for teenagers and women with hormonal acne who cannot take a skin-friendly pill or isotretinoin. Spironolactone is a diuretic (water tablet) can be used by specialists off-label to treat hormonal acne, which acts similar to the drospirenone in the skin friendly pill Yasmin.

What skincare regime should you use to manage acne?

In addition to oral and topical treatments, it’s important to maintain a good skincare regime to support the management strategy. This will be dependent on the skin type and, again, it’s important to discuss this with a dermatologist for optimum advice.

Cleansing the skin to remove makeup, dirt and bacteria is very important and should be done twice daily in the morning and evening – be mindful to remove cleansers properly, particularly if containing drying ingredients such as alcohol and sodium lauryl sulphate which will potentially irritate the skin left on.

For oily skin, it’s important to use products designed specifically for oily skin and avoid products containing oil.

You won’t need to moisturise, unless you have spotty and dry skin. I would recommend patients use non-comedogenic products, which are those formulated to not cause clogged pores.

If your skin is prone to blackheads, use exfoliators to help reduce these. Ingredients that are good for exfoliating the skin include salicylic acid or alpha hydroxy acids. For those with inflammatory acne, don’t exfoliate the skin as this will likely exacerbate the condition.

What in-clinic treatments are available?

There are various in-clinic treatments such as those using light and laser therapies to help treat acne, which have varying levels of success. Your practitioner will be able to recommend the in-clinic treatments that will benefit you most after a thorough medical consultation.

How can you avoid acne scars?

As tempting as it can be, it’s important not to squeeze or pick spots because this can cause infection, inflammation and increase the healing time, as well as leading to acne scarring.

However, even if you don’t pick your spots, sometimes acne, especially if left untreated, will lead to scarring. There are many clinical treatments which can help treat acne scarring including microneedling, laser therapies and skin peels. It’s important to see a skilled and trained practitioner such as a dermatologist to discuss your concerns and treatment options before undertaking any clinical treatments.

When should you consult a professional?

Acne has the ability to affect mood, self-esteem and also deplete confidence so it’s important to understand how your acne might be affecting you. If acne, acne scarring, or any other dermatological or cosmetic issue is affecting your quality of life in any way, it’s time to seek help from a professional who will adopt the best treatment strategy tailored to individual needs.

You can also learn more about acne through the British Association of Dermatologists.

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