Acne and spots
 
Introduction
 
Around 75% of all teenagers and young adults suffer from acne. However, men and women in their 30s and 40s can also develop acne.

The exact cause of acne remains unclear but more is known about how the spots that are part of acne form and there are more and more treatments to help deal with this distressing condition.

Acne is a skin condition caused by overactivity of the sebacaceous glands that secrete oily substances onto the skin. The blackheads and spots of acne usually occur on the face, where the greatest number of these oil-producing sebaceous glands exist. The back, chest and shoulders can also be affected.
 
The causes of acne
 
Several factors influence the development of acne. Central to this are the sex hormones, which are produced at puberty. The male hormone testosterone - found naturally in women as well as in men - triggers the sebaceous glands to produce more of an oily substance called sebum, making the skin more greasy. However, most acne sufferers don't have a hormone problem and their hormones are at normal levels in their blood.

In the presence of excess grease, the area around a hair follicle and the opening through the skin - the pore - can become clogged. Then a bug, a bacterium called Propionobacterium acnes, that lives normally on the skin gets in on the act, thriving within the blocked pore. This causes inflammation - the redness and swelling of a spot. This pocket of inflammation can sometimes rupture, causing damage to the skin. Drugs such as certain steroid tablets and some beauty products that block the pores can contribute to acne. Contrary to popular belief, acne is not caused by eating fatty food or chocolate.
 
The spots
 
Acne can cause a number of different types of spots. Typically, people with acne get blackheads (comedones). These are caused by a blockage of the pores, which get their dark colour through excess skin pigment.

Whiteheads are also common. These occur near the surface of the skin when excess sebum gets trapped inside the follicle. The sebaceous glands can also become infected.

In the more severe 'inflammatory acne', cysts develop beneath the skin's surface. These acne cysts can rupture, spreading the infection into nearby skin tissue. This can result in scarring.
 
Treatment
 
Acne cannot be taken lightly. It can be the source of considerable emotional distress. But there is a range of treatment options to tackle the problem.
 
Home treatment
 
It's important to keep spot-prone areas clean, so wash the affected area twice a day with an unperfumed cleanser. Antibacterial face washes and soaps specifically for greasy skins are also available. However, the skin needs a certain amount of oil to maintain its natural condition, so avoid aggressive washing with strong soaps.

Also try to avoid the temptation to pick at spots: over-enthusiastic squeezing can cause scarring. Acne tends to be less of a problem in the summertime. This may be due to the drying effect of the sunshine. No home treatments for acne work immediately. It can take weeks, if not months, for significant effects to be noticeable.
 
Non prescription remedies
 
Over-the-counter remedies are available from a pharmacy to treat mild acne. Lotions that contain benzoyl peroxide dry out the skin and encourage it to shed the surface layer of dead skin. Benzoyl peroxide also has an antibacterial action. Together, these effects make it harder for pores to become blocked and for infection to develop. Benzoyl peroxide (contained in spot treatments such as Oxy and Clearasil Max) can cause redness and peeling, especially at the beginning. This tends to settle down within a few days.
 
Prescription medicines
 
If you go to your GP (General Practitioner), they will usually start treatment for mild to moderate acne with a preparation containing benzoyl peroxide. If this does not work, or if you have more severe acne, there are a range of other treatment options that can either be rubbed onto the skin (topical) or taken in tablet form (oral):
 
Topical treatments
 
There are several topical treatments you may be prescribed.
  • Azelaic acid, which is an alternative to benzoyl peroxide, may cause less skin soreness
  • Topical retinoids, medicines based on Vitamin A, are rubbed into the skin once or twice a day. They work by encouraging the outer layer of skin to flake off, and may cause irritation and skin peeling at the start of treatment. One disadvantage of this treatment is that they will make the skin hypersensitive to sunlight
  • A topical antibiotic lotion applied to the skin can be used to control the Propionobacterium acnes bacteria. Treatment will need to continue for a few months. Preparations that combine an antibiotic with other acne medication are also available
 
Oral treatments
 
  • A course of oral antibiotics (tablets) taken for around 3 months, can be prescribed for inflammatory acne, and can be continued for a prolonged period depending on the severity and response. This acts to kill off the bacteria infecting the skin. The success of this treatment can be limited because the strains of bacteria are often resistant to the common antibiotics. It might take four to six months for the benefits to be seen. Antibiotics do not prevent pores from becoming blocked so treatment to prevent blackheads, such as benzoyl peroxide, is often also prescribed at the same time. Some people find that it's a prolonged course of antibiotics is a nuisance. This explains why some people do not always complete the course
  • Hormone treatment. For women, a standard combined oral contraceptive pill (containing an oestrogen and a progestogen) can improve acne symptoms. But in some women, it can also make symptoms worse. One particular type of Pill, called Diane-35, contains a medicine called cyproterone acetate which cuts the amount of male hormone in circulation and is an effective treatment for acne
  • Isotretinoin is a powerful medicine also known as oral retinoid - which exists in topical form (see above). It tends to be used in severe forms of acne that have proved resistant to other treatments. It works by drying up oily secretions. There are a number of side effects using this drug including dryness of the skin, aches, pains and headaches. It can also cause damage to an unborn baby if taken by a pregnant woman. For safety reasons, isotretinoin (Roaccutane) is only prescribed by dermatologists

Acne also affects people with black or brown skin. The processes that cause it are exactly the same but the impact is altered by the skin pigmentation.
 
Further information
 
AcneNet
http://www.skincarephysicians.com/acnenet/index.html

American Academy of Dermatology
http://www.aad.org/pamphlets/acnepamp.html

Dermatology.co.uk
http://www.dermatology.co.uk/index.asp
 
Healthwise (Health Information Resource Centre)
Tel : (852) 2849 2400
Fax : (852) 2849 2900
Email : info@healthwise.org.hk
Homepage : http://www.healthwise.org.hk/

This leaflet is for information only. For a detailed opinion or personal advice, please consult with your own doctor
 
 
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