Almost all adolescents will get the occasional spot, however 15% find the problem significant enough to seek medical help.
90% of those affected by acne get scarring.
Acne usually settles by the early 20s but, unfortunately, in females it can persist for another few years. More severe acne can also tend to be more persistent.
It is important to stress that poorly controlled acne is more likely to scar – this is usually preventable.
What is the cause of acne?
Acne has 4 main causative factors:
1. Hormone mediated sebum (oil) production on the face, back and chest
2. Comedone formation (blackheads and whiteheads) which is caused by dead cells blocking the pilosebaceous ducts – this is also partly caused by hormones
3. Colonisation (infection) with the bacterium P. acnes
4. Inflammation due to the above factors
Factors that may affect acne:
- Many young women find that acne worsens in the few days before their period
- Some medical conditions including Polycystic Ovarian Syndrome (PCOS)
- May benefit acne
- May worsen acne
- This is unproven but may relate to the tenancy, in some, to scratch the spots as they appear (this is called acne excoriee)
- May benefit acne
- Eating more fresh fruit & vegetables, whole grains, fish, olive oil and garlic
- Eating less sugary foods, cakes, ice-creams and also drinking less bottled drinks
- Oil-based cosmetics may worsen acne
- May worsen acne
- Steroids (tablets and creams)
- Anabolic steroids
What does acne look like?
- Greasy skin
- Comedones (blackheads and whiteheads) – sometimes stretching the skin makes these more visible
- Scarring due to:
o Loss of tissue - atrophic scars
- Pigmentation (skin colour darkening) which is much more common in darker skin types
Blackheads - Ref PCDS
Whiteheads - ref PDCS
Moderate inflammatory acne – ref PCDS
Atrophic scars – Ref PCDS
Severe acne causing keloid scarring – Ref PCDS
Are investigations necessary?
It is uncommon for tests to be necessary.
In certain cases, glandular conditions will be considered and we may recommendation blood tests or onward referral to an Endocrinologist.
Can acne be cured?
There is currently no cure for acne but there are very effective treatments to prevent new spots, and more importantly, scarring.
How can acne be treated?
For those who have already tried over-the-counter remedies, the following options should be considered. It is important to note that most treatments take 2-4 months to achieve their maximum effect:
- Topical treatments
o Benzoyl peroxide
o Antibiotics including erythromycin, tetracycline and clindamycin
o Retinoids including isotretinoin and adapalene
- Oral antibiotics
o Usually erythromycin or a type of tetracycline
o This may be recommended in addition to a topical treatment
- Oral contraceptive pill (OCP)
o Some types of OCP can help females with acne
o Usually take 3-4 months for the benefits to be seen
o The most effective OCP has a slight risk of blood clots and are therefore not recommended in people who smoke, are significantly overweight or have a family history of blood clots
o This powerful Vitamin A based treatment is used in severe acne
o Can continue to give benefits 2yrs after the treatment
o Due to a small risk of potentially serious side-effects, it is only prescribed under the supervision of a consultant dermatologist
Dr Cormac adopts a holistic approach to acne and skin health in general.
He provides a supportive environment and assists, when required, in terms of choosing a next step. He strongly recommends a shared-care approach with your family GP.
How can acne scarring be treated?
Unfortunately, acne scarring is a very common problem, with more than 90% of acne sufferers having some residual scarring.
As stated previously, the most effective approach is that of focusing on prevention of new scarring.
Thereafter, scarring is usually addressed when the acne itself is under control.
Up to 50% of scars (especially smaller ones) will naturally improve over 6-12 months.
It is critical to note that scarring can be IMPROVED BUT NOT REMOVED
The above is absolutely key, as expectations must be managed to avoid unrealistic expectations. We aim to improve the scar by up to 50-75%:
- Atrophic scars
o Ablative lasers - one of the most effective treatment options available. This technologically advanced approach may be used in conjunction with more traditional approaches. Such treatment has a recovery time which can be numbered in weeks or even months, and patients have to be carefully selected and counselled – this treatment is currently offered in Glasgow and Epsom by Dr Cormac
o Microneedling - a technique commonly used to improve scars by stimulating new collagen. It has much less ‘down-time’ than laser ablation and has a much milder effect, normally requiring a course of multiple treatments
o Punch excision - some small, deep scars are best removed as this can allow a new, more controlled wound to result
o Subcision - especially effective for ‘rolling’ scars, this surgical technique can be used to treat rolling scars. Here, the upper layer of the skin is separated from the underlying scar tissue, allowing blood to pool under the affected area. This helps form connective tissue, which pushes up the rolling scar so it's level with the rest of the surface of the skin
What does it feel like to have acne?
Acne can often cause intense feelings of anxiety and stress, which can sometimes make people with the condition become socially withdrawn. This combination of factors can lead to people with acne becoming depressed.
You may be depressed if during the last month you've often felt down, depressed or hopeless, and have little interest or pleasure in doing things.
If you think that you or your child may have depression, it's important to speak to your GP.
Treatments for depression include:
- talking therapies such as cognitive behavioural therapy (CBT)
- a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)
Read more about treatment for depression.
Support for acne
There's currently no main charity or support group for people affected by acne in Scotland.
However, there's a range of informally run message boards and blogs about acne on the web. You may find it supportive to read about other people's experience of living with acne.
Two such examples are:
- Changing faces is a charity that supports people with any condition or injury that affects their appearance. They offer:
o brief and confidential advice and information
o the opportunity to get in touch with a Changing Faces Practitioner
If you have any questions or would like to book a consultation, please complete the form below