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Acne – symptoms, causes and how to treat it

Acne is a very common skin condition that occurs when dead skin cells and oil from skin clog hair follicles and pores.

It is sometimes referred to as ‘spots’ or ‘pimples’. Common sites for acne are the face, chest, shoulders and back - the sites of oil glands.

Acne can be mild or the spots can be inflamed and filled with pus.

Many teenagers get acne as they undergo hormonal changes in puberty, but it affects most people at some stage in their life.

Acne on forehead

Types of acne spots

There are 6 main types of acne spots that include:

  • Blackheads - open clogged pores where oil turns brown when exposed to air
  • Whiteheads - closed clogged pores that are firm and won’t pop
  • Papules - small red bumps that feel sore to touch
  • Pustules - pus filled papules with a white tip
  • Nodules - large painful lumps under the skin
  • Cysts - large lumps filled with pus that look similar to boils

What causes acne?

Acne is mainly driven by male hormones, which usually become active during the teenage years. Sensitivity to such hormones, combined with surface bacteria on the skin and lipids (fatty acids) within sebaceous (oil) glands, cause acne.

Though acne is essentially a normal physiological occurrence, certain conditions may aggravate the condition including:

  • Fluctuating hormone levels around the time of periods in women
  • Manipulating (picking/prodding) acne lesions
  • Clothing and headgear (for example hats and sports helmets)
  • Air pollution and certain weather conditions, especially high humidity

Self-help for acne

In some cases, basic self-help techniques can help manage or prevent acne:

  • Only wash areas of the skin affected by acne twice a day. Too frequent washing may irritate the skin making the symptoms worse.
  • Use a mild soap or cleanser and lukewarm water. Water that's too hot or cold water can make acne worse.
  • Don't squeeze the spots or try to clean out blackheads. This can make things worse or lead to scars.
  • Don't use too much make-up or cosmetics. Non-comedogenic water-based products are designed to reduce the risk of blocking pores.
  • Remove all make-up before bed.
  • Use a water-based emollient that's fragrance-free for any dry skin.
  • Shower after a workout or exercise to stop sweat irritating acne.
  • Regular hair washing and keeping hair off the face can also help.

How is acne treated?

Over-the-counter acne treatments may help, or prescription treatments after seeing a GP for more severe acne. In some cases, a referral to a skin specialist or dermatologist may be recommended. Treatments may take some months to have an effect, and include:

  • Benzoyl peroxide: Benzoyl peroxide cream or gel helps prevent dead skin blocking follicles and kills bacteria on the skin. This treatment may have side-effects, including dry skin, burning, itching, redness and extra sensitivity to sunlight.
  • Topical retinoids: Treatments using topical retinoids, such as tretinoin and adapalene cream or gels reduce the production of fatty secretions called sebum and stop dead skin cells blocking hair follicles.
  • Azelaic acid: Azelaic acid cream or gel may be used to remove dead skin and bacteria if benzoyl peroxide or topical retinoids cause troubling side-effects.
  • Antibiotics: Antibiotics applied to the skin (clindamycin, erythromycin), or taken as tablets (tetracycline and its derivatives) control surface bacteria, which aggravate and often foster acne. Antibiotics are more effective when combined with benzoyl peroxide or retinoids. The oral retinoid isotretinoin is reserved for people with severe (nodular or cystic) disease. Isotretinoin shrinks the size of oil glands, the anatomical origin of acne. Without active plump oil glands, acne actively diminishes. Side effects can include dry skin, elevated lipids (cholesterol) and birth defects. Women of child-bearing age must practise birth control before, during and after treatment (often a year) with isotretinoin. The use of isotretinoin requires rigorous testing (lipids, pregnancy) and follow-up for the recommended period.
  • Hormone therapy: Hormone therapy may be helpful for some women with acne, especially for those with signs and symptoms ( irregular periods, thinning hair) of androgen (male hormone) excess. The hormone therapy consists of low-dose oestrogen and cyproterone acetate. For some women, taking the Pill may be recommended, even if it is not needed as a contraceptive.

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