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Acne

Published by Bupa's health information team, September 2008.

This factsheet is for people who have acne, or who would like information about it.

Acne is a skin condition that causes spots. Acne usually affects the skin of the face, back, neck, chest and arms and the severity of the condition can vary.

• About acne
• Symptoms of acne
• Complications of acne
• Causes of acne
• Diagnosis of acne
• Treatment for acne
• Living with acne
• Questions and answers
• Related Bupa products and services
• Further information
• Sources

About acne

About 80 percent of teenagers are affected by acne between the ages of 13 and 17. However, about five percent of women and one percent of men aged 25 to 40 continue to get or develop acne (late-onset acne). Rarely, new-born infants develop acne from three to 24 months of age.

The processes that cause acne are exactly the same in people with all skin colours but the impact of acne can be worse if you have darker skin.

Symptoms of acne

Acne typically causes one or more of the following:

• greasy skin
• blackheads (open comedones)
• whiteheads (closed comedones)
• red or yellow spots (pustules)
• deep inflamed lesions (nodules and cysts)
• scars

Complications of acne

There are a number of things that can make your acne worse. These include the following.

• If you pick and squeeze the spots, it may cause further inflammation and scarring.
• Excessive production of male hormones may cause acne. For example, testosterone from conditions such as polycystic ovary syndrome.
• Some contraceptive pills may make acne worse. This is due to the type of progestogen hormone in some pills. However, some other types of contraceptive pills can improve acne (see Treatments). Ask your GP for advice about which contraceptive pill to take.
• Some cosmetic products such as moisturisers can make acne worse if they are greasy.
• Some medicines can make acne worse. These include some epilepsy medicines and steroid creams and ointments that are used for eczema. Don't stop a prescribed medicine if you suspect it's making your acne worse, but tell your GP. He or she may be able to recommend an alternative medicine.
• Steroids can cause acne as a side-effect.

Causes of acne

Acne is caused by overactivity of the sebaceous glands that secrete oily substances on to your skin.

The surface of your skin has lots of small sebaceous glands just below the surface. These glands make sebum (a natural oil) that keeps the skin smooth and supple.

Tiny pores (holes in the skin) allow the sebum to come to the surface of your skin. Hairs also grow through these pores.

The sebaceous glands of people with acne are especially sensitive to normal blood levels of a hormone called testosterone, found naturally in both men and women.

If you are prone to acne, testosterone triggers the sebaceous glands to produce excess sebum. At the same time, the dead skin cells lining the openings of the hair follicles (the tubes that hold the hair) aren't shed properly and clog up the follicles.

The combination of these two effects causes a build-up of oil in your hair follicles. This causes blackheads and whiteheads to form.

For some people, their acne doesn't progress beyond this stage.

However, in other people the build-up of oil in the hair follicles creates an ideal environment for a bacterium called Propionibacterium acnes to grow.

These bacteria usually live harmlessly on your skin but when the conditions are right, they grow. They feed off the sebum and produce substances that cause an immune response. This inflames the skin and creates the redness associated with spots.

In more severe inflammatory acne, cysts develop beneath the skin's surface. If these cysts rupture, the infection can spread. This can result in scars.

Contrary to popular belief, acne isn't caused by diet or hygiene. However, acne can be hereditary.

Acne isn't infectious, so you can't catch it.

The skin

Diagnosis of acne

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Acne is easily recognised by the appearance of the spots and by their distribution on the body.

There are several types of acne and your GP will be able to tell you which type you have after examining your skin.

Treatment for acne

There is a range of treatment options to help treat acne. As acne can't be cured, treatments aim to control the symptoms by:

• preventing new spots forming
• improving those already present
• preventing scarring

Your GP will usually assess your treatment after six weeks and, if beneficial, treatment will continue for four to six months.

Self-help

It's important to keep spot-prone areas clean, so wash the affected area twice a day with an unperfumed cleanser. The skin needs a certain amount of oil to maintain its natural condition, so it's best to use gentle soaps and not to scrub your skin too hard when washing.

Medicines

There are a number of over-the-counter remedies available from pharmacies to treat mild acne. These usually contain antibacterial agents such as benzoyl peroxide (eg Oxy and Clearasil Max).

As well as its antibacterial effects, benzoyl peroxide can dry out the skin and encourage it to shed the surface layer of dead skin. Together, these effects make it harder for pores to become blocked and for infection to develop.

Benzoyl peroxide can cause redness and peeling, especially to start with. This tends to settle down if you reduce the number of times you use it. You can then build up your use gradually.

Home treatments for acne won't work immediately. It can take weeks, sometimes months, for significant effects to be noticeable. If home treatments haven't worked after two months, or you have severe acne, you should visit your GP.

Your GP may start your treatment by prescribing a preparation containing benzoyl peroxide. If this doesn't work, or if you have more severe acne, there are a range of other treatment options. These come as creams or lotions that your can rub on to your skin, or as tablets.

Creams and lotions

There are several creams and lotions you may be prescribed, including those listed below.

• Azelaic acid (Skinoren) is an alternative to benzoyl peroxide and may not make your skin as sore as benzoyl peroxide.
• Retinoids (eg Adapalene) are medicines based on vitamin A, which you can rub into your skin daily. They work by encouraging the outer layer of skin to flake off.
• An antibiotic lotion, such as clindamycin (eg Dalacin T) or erythromycin (eg Stiemycin), applied to your skin can be used to control the P. acnes bacteria. You will need to continue this treatment for at least six months.
• Creams and lotions that combine an antimicrobial with other acne medication are also available (eg Quinoderm).

Creams and lotions are only effective where and when they are applied so you should apply these daily to all areas of your skin that are prone to acne.

Tablets

There are several oral treatments you may be prescribed.

Antibiotics, such as tetracycline, can be prescribed for inflammatory acne. You should take these daily for around three months, although it might take four to six months for you to see the benefits. The success of this treatment can be limited because the strains of bacteria are often resistant to the common antibiotics. Antibiotics don't prevent pores from becoming blocked so treatment to prevent blackheads, such as benzoyl peroxide, is often also prescribed at the same time.

Some types of oral contraceptive tablets help women who have acne. A combination of the usual contraceptive pill hormone called ethinylestradiol with cyproterone acetate (eg Dianette) suppresses male hormone activity. This drug has been shown to reduce sebum production so is often used in women with acne.

Isotretinoin (eg Roaccutane) is a medicine known as an oral retinoid, which is also available as a cream (see Creams and lotions). Isotretinoin works by drying up oily secretions. It tends to be prescribed to people with severe forms of acne that have proved resistant to other treatments. There are a number of serious side-effects of this drug, such as liver disorders and depression. You shouldn't take isotretinoin if you're pregnant, as it's very dangerous to an unborn baby. For safety reasons, isotretinoin is only prescribed under the supervision of a dermatologist (a doctor specialising in skin conditions).

Living with acne

Acne not only causes physical symptoms but may make you feel anxious or depressed as well. You should start treatment as early as possible to reduce the risk of scarring and follow your doctor's advice about treatment.

With good management and appropriate treatment, most people are able to control their acne.

 

Further information

British Association of Dermatologists
020 7383 0266
www.bad.org.uk

Sources

• Acne vulgaris. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 3 December 2007
• Diagnosis and causes. Acne. www.dermatology.co.uk, accessed 3 December 2007
• Layton AM. A review of the treatment of acne vulgaris. Int J Clin Pract 2006; 60 (1):64-72. www.blackwellpublishing.com
• Ayer J, Burrows N. Acne: more than skin deep. Postgrad Med J 2006; 82:500-506. http://pmj.bmj.com
• Polycystic ovary syndrome. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 18 December 2007
• Acne vulgaris. eMedicine. www.emedicine.com, accessed 18 December 2007
• Purdy S, de Berker D. Acne. BMJ 2006; 333:949-953. www.bmj.com
• Joint Formulary Committee, British National Formulary. 53rd ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain, 2007; 610-614

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: September 2008