A B C D E F G H I J K L M N O P R S T U V W

COMMON ACNE - ACNE VULGARIS - TEENAGE SKIN

What is Common Acne ?

Acne vulgaris is an inflammatory skin condition, which particularly affects the face, back, and chest. It is commonest in young adolescents, but may persist into late adult life. It may appear for the first time in the 20s. The skin is usually excessively greasy and may have comedones (blackheads), small pimples, large pustules (pus spots) or painful swollen cysts.

How does Common Acne occur ?

The oil-producing glands that are associated with the tiny hairs which cover the face and body are the site of the primary changes seen in acne vulgaris. These oil glands become active at puberty when the male hormone called testosterone acts on them. That is why acne occurs after puberty. The male hormone is a normal part of the blood of women as well as men, but is present in smaller amounts. People with acne usually have normal hormone levels in the blood. Some women with severe acne may, however, have increased male hormone levels. The acne may then be part of a problem affecting the ovaries (polycystic ovary syndrome). In acne, the response of the skin in men and women is increased. In patients with acne, the oil glands produce too much oil. The cells in the pores of the skin where the hair and oil come out to the surface become abnormally sticky and block the pore. The trapped oil becomes infected, and this leads to pustules (pus spots) and pimple formation.

Why does Common Acne occur ?

Evidence suggests that acne may run in families. A number of factors are thought to exacerbate acne. In women acne often becomes worse before a period. This is probably related to the change in hormone levels at this time. Women on some types of contraceptive pill can develop acne, or notice it worsening if it was previously present. Your GP or family planning clinic doctor can advise which pill to avoid. Other medicines, such as steroids and anti-epilepsy drugs, can make acne worse. In most patients, diet is irrelevant. In a small number however, chocolate and fried food may make it worse. This is rare. Normal cosmetics have no effect on acne, but oily make-up, particularly the ethnic Indian make-up, can cause blackheads. Acne is often made worse in hot, humid atmospheres such as kitchens. People who work with oil often have worse acne, particularly where there is oil contact with the skin. There is no relationship between acne and any form of sexual activity.

Treatment Involved for Common Acne

Treatment will depend on how bad the acne is, and whether pustules or blackheads are the bigger problem. Treatment may need to be given over a period of months or years before it can be withdrawn without the acne recurring. Mild acne can be treated with creams or lotions, but more severe acne will require drug treatment. Most creams contain a preparation called benzoyl peroxide, which reduces the infection in the skin and causes the top layers of the skin to rub off, which unblocks the pores. These are safe but may cause skin irritation in some people. They are useful in combination with tablets in more severe acne.

Antibiotic lotions are very useful in mild and moderate acne with pustules. These have the advantage of causing little skin irritation and avoiding any potential side effects of antibiotics given in tablet form. Antiobiotic lotions can be used by themselves or with tablets in more severe cases. Tretinoin (cream, lotion, and gel) preparations and Isotrex gel and Differin gel are based on a synthetic vitamin A and are very effective in blackhead predominant acne. They may cause irritation and excessive drying of the skin, which can limit their usefulness but when used correctly they are usually well tolerated. They work by making the cells in the follicle less sticky and therefore reducing the blockage. They are therefore an important part of the treatment of all patients with acne and should be used with topical or oral antibiotics.

In moderate to severe acne, antibiotic tablets will be needed. These will be given for a period of 6 months or more, depending on the response. The usual antibiotics are tetracyclines, but other antibiotics can be used. It is important not to stop the tablets suddenly, as the acne will flare up. They must be reduced slowly, depending on the state of the acne. Tetracyclines must not be taken during pregnancy as they can affect the foetus. If women are on the contraceptive pill, extra precautions are needed for the first 3 weeks that they are taking the antibiotic as the antibiotic will make the pill unsafe for this period.

The older tetracyclines are affected by food in the stomach and must be taken on an empty stomach and without eating for one hour. The newer tetracyclines such as minocycline and doxycycline are not affected by food in the stomach, which makes them easier to take. Hormone treatment is sometimes helpful. In women with a serious acne problem, the doctor may arrange to measure hormone levels. If abnormal levels are found, hormone treatment may be indicated. In women, a medication (cyproterone acetate) that counteracts the male hormone testosterone can be used, usually in combination with the female hormone oestrogen. Some types of oral contraceptive pill can also benefit acne. Others contain a male type component, and these can make the acne actually worse. Isotretinoin tablets can be prescribed either in severe acne, or when it is not responding to long-term antibiotic treatment. It is usually prescribed only by a hospital consultant.

During Treatment for Common Acne

Many of the creams used in acne may irritate and dry the skin, but simple moisturizers may help to prevent this. Benzoyl peroxide can bleach hair and clothing. Antibiotic tablets may interfere with the contraceptive pill and make it less effective for the first 3 weeks. The tetracyclines can also cause a build-up of fluid around the brain, leading to severe headache. This is more likely to occur with the newer types, such as minocycline, but is still very rare. If you develop severe headache on these drugs, let your doctor know immediately. The symptoms normally settle very quickly once you stop the drug.

Antibiotics are otherwise safe with only rare long-term side effects. Any drug can cause unexpected or rare side effects and if you develop any symptoms that you cannot attribute to another cause, you should seek advice from your GP. As a general rule, the antibiotics should not be taken by pregnant or breast-feeding women. In women treated with cyproterone acetate tablets, there may be a flare-up of the acne in the first weeks of treatment. Isotretinoin causes dryness of the skin, chapping of the lips, and can change some of the chemicals in the blood. The drug can make you very sensitive to the sun. This drug can also cause abnormalities in developing babies. If you are on the drug, you must not allow yourself to get pregnant until at least one month after discontinuing it.

Depression has also be recorded in patients taking Isotretinoin. The side effects are very variable from one person to another so that most patients have fairly mild side effects but some patients may suffer severe side effects. Long term side effects after Isotretinoin occur in up to 10% of patients but are generally mild. Isotretinoin can only be given to you under hospital supervision.

After Treatment for Common Acne

Acne is a scarring condition that may leave either pits or thick scars in the skin. Prevention of these long-term effects is the aim of treatment. Early treatment is therefore essential. Once the scars have developed, plastic surgery techniques can improve the patient's appearance, but unfortunately the end result is never perfect. Acne may recur after any form of treatment and further courses of treatment may be necessary.

If Common Acne is Left Untreated

Acne eventually gets better, even without treatment. It can persist into late adult life. Without treatment, most mild acne patients will improve with no problems. The more severe cases will be left with permanent scars.