Skin problems health centre

Acne overview: Spots, symptoms and causes

Most people develop acne - the most common skin condition - to some degree, but it primarily affects teenagers undergoing hormonal changes.

Acne may be mild (a few occasional spots), moderate (inflammatory papules) or severe (nodules and cysts). Treatment depends on the severity of the condition.

What causes acne?

Acne is primarily a hormonal condition driven by male hormones, which typically become active during the teenage years. Sensitivity to such hormones, combined with surface (skin) bacteria and lipids (fatty acids) within sebaceous (oil) glands, cause acne. Common sites for acne are the face, chest, shoulders and back - the sites of oil glands.

Acne lesions include comedones (whiteheads, blackheads), papules and pustules (small bumps), nodules and cysts.

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

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

How is acne treated?

Effective treatments for acne include benzoyl peroxide, retinoids and antibiotics. Most people require at least one or two agents, depending on the severity of their acne.

• Benzoyl peroxide, available as an over-the-counter product and by prescription, targets surface bacteria that often aggravate acne. Irritation (dryness) is a common side effect.
• Retinoids (vitamin A derivatives) treat blackheads and whiteheads, the first lesions of acne. The most common side effect is irritation.
• Antibiotics, either topically applied to the skin (clindamycin, erythromycin), or taken orally (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 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.

How can acne be prevented?

To reduce acne and its damage to your skin follow these tips.

• Choose a cleanser specially formulated for acne. These products often contain salicylic acid or benzoyl peroxide, which help to clear acne spots.
• Clean your face gently, as trauma to the acne breakouts may worsen the acne or cause scarring. When washing your face use your hands, as any face cloth or other scrubbing material may cause acne sores to rupture.
• When you sleep at night make sure you are sleeping on a clean pillowcase and that you are the only person using your pillowcase. Pillowcases absorb traces of oil during the night, and can aggravate break-outs if not changed regularly.
• If you have longer hair, make sure to pull it back when you sleep at night. The oil in your hair can aggravate your skin as well.
• If you need to use a moisturiser, use only light, non-comedogenic moisturisers, which do not aggravate acne. There are oil-free moisturisers on the market that contain antibacterial agents for acne-prone skin. This type of product may be your best option.
• If you are a woman, use an oil-free foundation. Heavy make-up or other cosmetic products that block pores may cause a flare-up of acne.