Acne

Acne is a common skin condition that affects millions of people worldwide, particularly adolescents and young adults. It occurs when hair follicles become clogged with oil, dead skin cells, and bacteria, leading to comedones, papules, pustules, and in severe cases nodules, cysts and scarring. It can have a big impact on people’s quality of life and mental health. Occasionally other skin conditions can mimic acne so it’s essential to see a dermatologist for a diagnosis if acne is not settling down with appropriate treatment.

Acne develops due to a combination of factors, including:

• Seborrhoea (excess oil production). This is common in puberty due to a raise in sex hormones.

• Dead skin cells accumulate in hair follicles, mixing with sebum and forming plugs that block pores.

• Skin bacteria (including Propionibacterium acnes), multiplies in clogged pores and trigger inflammation.

Other factors that can trigger and aggravate acne can be hormonal fluctuations (puberty, menstruation, pregnancy and postpartum), diet (high glycaemic index foods), stress and certain medications and supplements ( steroids and some contraceptives, lithium)

There are different types of acne, according to severity:

• Comedonal Acne: Usually affects the face with open and closed comedones (blackheads and whiteheads) and small papules. It is usually classed as mild.

• Inflammatory Acne: Characterised by inflammatory lesions like papules and pustules. It can sometimes affect chest and back. It is usually classed as moderate.

• Nodular Acne: This acne is severe, with painful deep lesions (nodules and cysts) that lead to scarring. It can also be extensive on the chest, neck and back. The lesions are painful.

• Acne conglobata: A very severe form of acne with painful cysts and sinuses that lead to deep scarring and ulceration. Patients may also feel unwell due to severe inflammation.

Fortunately, we have very effective treatments for acne, which depends on the severity:

• General measures: Healthy diet, gentle cleansing, non-comedogenic products, hydration.

• Mild acne: topical treatment with Benzoyl peroxide, retinoids, and salicylic acid (keratolytic).

• Moderate acne: Antibiotics (topical and most often oral) in combination with a topical retinoid or benzoyl peroxide preparation to prevent resistance. Hormonal treatments can be added if appropriate for female patients (combined contraceptive pill or similar)

• Severe acne: Oral isotretinoin (an oral retinoid) is the treatment of choice. This is a strong medication that is very regulated and can have serious side effects, so it needs to be prescribed and monitored by a dermatologist.

• Other treatments: Spironolactone can be very effective for hormonal acne in females. Gentle comedone extraction and cyst injections.

• Scar treatments: Chemical peels, laser resurfacing, scar subscision, microneedling.

Although acne is more common in adolescents it can affect people of all ages and have a significant physical and emotional impact. It is important to treat acne early to prevent sequelae like scarring. Make an appointment to discuss the best treatment option for you and be comfortable on your own skin again.