What is Acne?
Acne is the development of inflammatory and comedonal lesions (blackheads and whiteheads) on the skin and mainly affects the face, chest and back. Acne affects nearly every teenager at some stage, but it can also affect adults. When it progresses from more than the occasional pimple or extends into later life (adult acne) we consider it a medical condition. Acne can be resolved but then reoccur again later in life in some cases. Acne vulgaris is the more formal and historical name for acne.
What causes Acne?
Acne is caused by changes in the pilosebaceous unit, the skin structure consisting of a hair follicle and its associated sebaceous gland, via androgen stimulation. This is why acne can only occur during or after puberty apart from some very rare circumstances.
Acne is more common during teenage years, and this is because of the change in hormone levels during and shortly after puberty. Adult acne is more common in women, and they account for about 80% of cases. This is because of the hormonal changes women go through with their menstrual cycle on a monthly basis, as well as the hormonal changes during pregnancy. Conditions such as polycystic ovary syndrome can also promote acne, as well as certain prescription medications, such as oral corticosteroids. The use of anabolic steroids to increase sports performance or muscle mass can also lead to the development of acne.
The role of diet on acne has been a controversial topic over the years. We now know that high sugar and high fat foods can exacerbate acne in people who are prone to this condition. There are also weaker associations with certain food groups and their link to acne but food allergies as such do not cause the common form of acne.
Acne can also be caused by occluding the pores on the skin this can occur from young patients using heavy moisturising creams or rich anti-ageing formulations which are necessary for this age, the use of heavy emollients, oils or hairstyling products such as pomades.
What are the symptoms of Acne?
Acne is characterized by non-inflammatory follicular pustules or comedones and by inflammatory papules, pustules, and nodules in its more severe forms. Acne vulgaris affects the areas of skin with the highest concentration of sebaceous glands which is the face, the upper part of the chest and the back. Acne can be more inflammatory or more non-inflammatory, however in most cases it is usually a mix of both. Inflammatory or nodular lesions tend to be larger and our position deeper in the skin and so may be painful. Acne of any severity may result in scarring.
The majority of teenagers with mild acne are able to control this condition by the use of non-prescription washes or creams that are freely available in the pharmacy. If the acting becomes worse or is not controlled by these simple measures then a visit to the dermatologist can rectify this situation. Certainly if a person’s acne is causing scarring or post inflammatory hyperpigmentation, however mild the acne may be, this would be another reason to visit the dermatologist.
How is Acne diagnosed?
The diagnosis of acne is a clinical one. The dermatologist would examine your skin and then determine the extent, type and severity of your acne and devise a tailored treatment plan. Occasionally a swab may be taken if there is any suspicion of a superimposed infection complicating the acne.
How do you treat Acne?
The good news is that acne can be treated. Early treatment can prevent or result in less scarring. A Dermatologist can prescribe a broader range of treatment than a GP.
Assessment by a Dermatologist is the first step to clearer skin. On your initial appointment, the dermatologist will assess the extent, type and severity of your acne as well as asking you about any relevant medical or lifestyle factors. They would also explore any contraindications to certain treatments and put together a treatment plan which is both practical and effective.
The dermatologist can then devise a personalised treatment plan that will be the most effective for your type of acne and also that suits your skin type and lifestyle.
Treatments include specialized face washes, gels and creams (many of which require a prescription), systemic treatment (tablets) including antibiotics or hormonal treatment.
Isotretinoin (which is sold under the Roaccutane® brand name in the United Kingdom and Accutane brand name in the United States) can only be prescribed by a Dermatologist and is a very effective treatment. As there are risks involved with this treatment blood tests are required before commencing treatment and during treatment to monitor the impact of the medication. This form of treatment needs to be supervised by a dermatologist. This treatment is not an option if patients are trying to conceive, as are a lot of the other treatments for acne.
Lasers and light therapy can help with acne outbreaks but these often prove to be an expensive way to gain temporary results.
Steroid (triamcinolone) injections are popular with American Dermatologists for treating acne cysts however this treatment is not favoured so much in the United Kingdom. It can provide rapid and effective relief from large or painful lesions and is performed by our dermatologists at the London skin and Hair Clinic.
Specialized chemical peels can also be used to kickstart acne treatment regimes and unblock pores.
In general a Dermatologist would want to see patients on acne treatment every 4-12 weeks until the acne has resolved, depending on the type of treatment they are on.
Once the acne has been controlled your dermatologist will be able to advise you on good skincare products that are non-comedogenic (non-acne forming), good for maintaining your acne-free skin and also good for maintaining skin health.
Once acne has been resolved, there are treatments available to improve the appearance of the skin and address any residual acne scarring, pigmentation or redness. These may include a Dermatology-led skincare regime, prescription skincare such as topical retinoids, dermal filler, laser to stimulate repair and collagen production in the skin and laser resurfacing of the skin.
Are there any patient support groups for Acne?
The British Association of Dermatologists provides Skin Support which is a resource for patients who may be experiencing emotional or psychological distress due to their skin condition.
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