Let's talk about acne

Dr Jo Coldron advises on treatments for acne and ways to minimise it. 

I think it’s one of the terrible injustices of life for the teenagers that not only do they have to deal with school and exams, navigating a new and expanding social life, managing emotions and relationships, and now the added perils of the online world… as well as all this they have to deal with acne. There is, however, a lot that can be done for acne. Much of it doesn’t need any contact with your doctor, but if that isn’t working, knowing what else is available, and also that it’s very reasonable to seek advice and potentially prescriptions, is really important. Ideally with some well-timed interventions and possibly prescriptions, the impact of acne can be minimised until the body has ‘grown out’ of it and the skin naturally recovers.

Lifestyle

There are a lot of myths about acne, many of which have been proven to be untrue, but here are some things we do know:

• Smoking is related to acne and makes it worse.
• Diet seems to play a role but it is not clear cut. A high GI diet (i.e. lots of high energy quick release foods) may make acne worse, but although chocolate is one of these foods, there is no proven direct link between eating chocolate and acne.
• Acne is not caused by dirty skin, in fact excess cleansing and scrubbing, especially with traditional alkaline soap, can irritate the skin and make spots worse. Use a specific, non-alkaline, synthetic face wash rather than soap – there are lots of brands available at supermarkets.
• Make-up and moisturisers do not make acne worse as long as they are oil free, and you effectively cleanse the skin each day.

Treatments for acne

The most important thing to know about any interventions for acne is that they all take time to work. You are not treating the spots of today – instead you are enabling clear skin in the future. All interventions take 3-6 weeks to have ANY positive effect and a lot of the time you don’t see the full impact until 3-6 months!

• Benzoyl peroxide is available to buy in various strengths over the counter in supermarkets and pharmacies. It acts as an antibacterial, killing the germs that cause spots. Initially it can dry the skin and cause it to be red or irritated – if this happens start at a lower strength or use it less often and build up. A really useful leaflet providing all the facts so you can feel confident trying it is nhs.uk/medicines/benzoyl-peroxide
• Topical treatments: if you have moderate acne despite trying everything discussed so far, your doctor is likely to suggest trying a different cream available via prescription. Moderate acne means some inflammatory spots, not just blocked pores, but no nodules or scarring spots. These creams tend to be combination creams and different brands contain various mixtures of antibiotics, benzoyl peroxide and retinoids – so there are a few different ones to try.
• Oral treatments: if you have more severe acne - lots of inflammatory spots, nodules or evidence of any scarring - your doctor is likely to suggest topical treatments AND a course of antibiotic tablets as well. For some girls it might be appropriate to discuss whether the combined oral contraceptive pill could also be used as this can be a very useful anti-acne treatment. If a treatment is started by a doctor, you should be reviewed at about 12 weeks to see whether things are improving, and whether treatment can be stopped at that point, continued or changed.
• For very severe acne or significant acne that cannot be controlled with these prescription medications, we refer to our dermatology colleagues who have access to more specialist treatments.

The NHS Patient Information Leaflet on acne has lots of useful information at nhs.uk/conditions/acne