Q. Can you describe the characteristics of the various types of acne?
A. Acne is caused by two changes in the skin. The first is a change of growth of skin cells in the skin pore which leads to a partial blockage. The pore is what allows oil to drain from the oil glands and tiny hair follicles onto the surface of the skin. As the blockages get bigger you can see them as open pores, blackheads and white heads - these are the non-inflamed spots of acne.
With total blockage of the pore, oil cannot escape so builds-up under the skin, becomes inflamed and infected leading to red spots, pussy spots and if the spots are deep, to nodules and cysts. These are the inflammatory lesions of acne. The deeper nodules and cysts are painful and can take several weeks to settle down.
Q. Can you describe a typical stepped care approach to acne - in other words who should get what and when?
A. We tailor the treatment of acne to the individual. If you have mainly blackheads and white heads we would use a vitamin A derivative gel or cream to change the way the skin cells grow and get rid of the blockages. Salicylic acid gels and washes can help with this but they are slower. As all acne spots start with the blocked pore, the vitamin A derivative creams and gels should be part of the treatment of everyone with acne.
If you have a few inflamed spots, a cream containing benzoyl peroxide cream may settle them down. If this does not or if you have a lot of spots, your GP can prescribe an antibiotic lotion or cream. In patients who have fairly bad acne or do not respond to the antibiotic lotions and creams, antibiotic tablets are used. These need to be taken for a minimum of 6 months. In the worst forms of acne or in patients who do not respond to antibiotics, a form of vitamin A tablet, isotretinoin, can be prescribed by a Dermatologist.
Whatever treatment you use, always follow the instructions carefully and always assess your progress. If the treatment has not given a 50% improvement in 2 months it is unlikely to work and you should be changing treatment.
Q. Acne is most often associated with teenagers but I've seen many cases that carry on for much longer - what is the typical age range and when can most sufferers expect to see an improvement?
A. Acne is most common in adolescents with a peak incidence at 12 for girls and 14 for boys. Up to 80% of adolescents will suffer from some form of acne. In 70%, the acne settles after 4 to 5 years but this leaves 30% who progress into adult life with acne. The incidence reduces on a year by year basis but the incidence of acne at the age of 40 years is 5% of women and 1% of men. Acne can also start for the first time later in life and it is not uncommon for someone who has never had problems with their skin to develop acne in the mid 20s, 30s or even 40s.
Q. Are there any significant side effects associated with taking long term antibiotics?
A. No. In the vast majority of patients, long term antibiotics are very safe and well tolerated and when they are stopped, the body has no memory of the antibiotic after 7 days. Some antibiotics can have side effects, but these tend to be acute and occur early in treatment - headaches, stomach upsets, skin rashes. Very rarely, antibiotics can cause unusual disorders after prolonged use. Minocycline has been reported to be associated with a form of arthritis and liver abnormalities but this is very rare and resolves when the drug is stopped.
Long term antibiotics have no effect on your immune system, do not make you more susceptible to infections and do not affect fertility.
Q. Can scarring be prevented with the right treatment? And what can be done to help people who are already scarred?
A. The aim of treatment of acne is to prevent scarring, and as long as treatment is started early enough, this is achievable. You must seek help and treatment for your acne as soon as it starts!
If you have got scars, you will never have perfect skin, but a variety of plastic surgical techniques can help the appearance and reduce the impact of the scars. The method will depend on the type of scarring but may include straight surgery, dermabrasion - where the top layer of skin is scraped off and the skin then allowed to heal - laser re-surfacing - where the top layer of the skin is removed by lasers which leads to less trauma to the skin -, skin peels and collagen injections. If you want advice about scar correction, always get your GP to recommend a plastic surgeon.
Q. When should someone with acne be referred to a specialist?
A. Most patents with acne should be treated by the GP. People should be referred to a specialist if:
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They have very severe acne with a high risk of scarring
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If the diagnosis is in doubt
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If they have not responded to at least two courses of different antibiotics for their acne
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If their acne is profoundly affecting their mental health or severely reducing the quality of their life.
Q. Is there any science behind the use of zinc supplements in acne - if so who should take what?
A. Zinc has an effect on certain bacteria and is important in skin healing. How it works on acne is not fully understood but zinc tablets were commonly used before the use of antibiotics become popular. Zinc tablets tend to affect the stomach which limits their use. Zinc used as a lotion with an antibiotic, reputedly kill bacteria that have become resistant to the antibiotic.
Q. Do you use any alternative approaches? If so which ones, and if not, why not?
A. No. I have not found a form of alternative medicine that has a beneficial effect on acne.
Q. Are there any exciting developments in the pipeline?
A. Work in my laboratory is looking at the molecular events that lead to the development of acne. Initial results suggests that acne is caused by activation of the immune system by bacteria in the skin. New treatments based on a sound knowledge of the cause should be on line in the next few years.
We are indebted to the Acne Support Group for their help in compiling this section.
