What is acne?
Acne is a skin problem that usually happens in your teens. Your skin gets greasy, its pores get blocked and you get blackheads, pimples or cysts. Acne can occur in infants, but it is usually only mild.
What causes acne?
In their teens, both young men and young women have more male hormone (testosterone) in their blood. This hormone makes the sebaceous glands at the bottom of the hairs on your face, back or neck churn out too much oil (called sebum), which then gets clogged in the pores. Bacteria can grow in the trapped oil in the glands and break it down into substances called free fatty acids that irritate your skin. This gives you whiteheads, blackheads, red bumps, yellow pus-filled spots or deep cysts.
Acne is very common in teenagers and more so in some families. Some people are more sensitive to testosterone: it does not usually mean the levels of the hormone in your blood are too high. However, in some girls with severe acne, this can be the case, particularly if the acne is associated with certain other symptoms such as excess male pattern hair growth.
What can make acne worse?
- Having your period.
- Being stressed.
- Taking contraceptive pills that contain male hormones.
- Taking some medicines, such as steroids and anti-epilepsy pills.
- Working in hot, humid places or with oil and grease.
- Using oily cosmetics.
Myths about acne
- Contrary to popular belief, acne is seldom made worse by food (a few people, however, may react to chocolate or fatty foods).
- It is not made worse by greasy hair, hair on the face and swimming pools.
- It is not infectious (catching) and cannot be ‘scrubbed away’ by keeping the skin excessively clean.
- No special diets are necessary, although a balanced, healthy diet will help you feel better generally.
How do I treat acne?
By leaving it alone. Taking out blackheads is not recommended, and try not to pick or squeeze pimples: it can make the infection worse and cause scars.
Gentle regular cleaning. Avoid excessive scrubbing. Special soaps and shampoos are not necessary.
Benzoyl peroxide cream or gel, which gets rid of some of the bacteria on the skin and makes the top layer of skin peel off, unblocking the pores. It can help if you have a lot of blackheads but may irritate your skin. If so, stop using it. You can buy this product without a prescription. Take care in the sun as you may burn more easily than previously. Your pharmacist can show you how to use this treatment properly to minimise the risk of skin irritation. Benzoyl peroxide treatments include Benzac AC Gel and Wash, Brevoxyl, Oxy, Panoxyl and Ultra Clearasil Acne Treatment Cream. Benzoyl peroxide is often used in combination with an antibiotic formulated for use on the skin and prescribed by your doctor. It is available in a variety of strengths; you should start with the weaker ones. As with all creams, it is wise to start with a ‘test patch’ first so if you do get a reaction it is confined to a small area. You should also rinse the cream off one hour after the first use, building up this time over a few days until you can use it overnight.
Anti-acne preparations containing salicylic acid (e.g. DermaVeen Acne Cleansing Bar) or sulphur (e.g. Clearasil Acne Treatment Cream). Like benzoyl peroxide, these can also be used to help unblock pores.
Your doctor may prescribe synthetic vitamin A-based (retinoid) creams or gels, which can make the skin dry and peel. They can be very irritating, so spread only a small amount very thinly on your face, no more than once a day. They may make your acne worse at first, but it should improve after a few weeks. Take care in the sun as you may burn more easily than previously. Also, you should not use these products if you are pregnant or there is any likelihood of you becoming pregnant. Retinoid creams and gels include tretinoin (Retin-A and Stieva A), adapalene (Differin Topical Cream and Gel), isotretinoin (Isotrex Gel) and tazarotene (Zorac Cream).
Azelaic acid lotion or gel (e.g. Acnederm Medicated Lotion and Finacea), which is put on twice a day. If it irritates your skin, use less or use only once a day. Talk to your pharmacist before using azelaic acid if you may be pregnant or are likely to become pregnant while using this medication.
Antibiotic liquids or lotions can help stop infection if you have pus-filled spots. They do not help blackheads or whiteheads. They are dabbed on once or twice a day to affected areas. The liquid can be very drying. They include clindamycin (ClindaTech Solution and Dalacin T Topical Lotion) and erythromycin (Eryacne 2% Gel).
When to see a doctor
Your doctor can help you choose which treatment is best for you. If your acne is bad and not getting better, he or she may give you antibiotic tablets for 6 months or more. Your doctor may not prescribe antibiotics if:
- you are under 12 years (they may discolour your teeth);
- you are pregnant or there is any likelihood of your getting pregnant (they can harm the baby); or
- you are taking the contraceptive pill (it may make it less effective).
Some contraceptive pills or other hormone treatments that act against the male hormone may be given to females with acne.
Your doctor may also suggest zinc tablets. These can be helpful but are not as effective as oral antibiotics and can also cause nausea, diarrhoea and oily, irritated skin.
Your doctor may refer you to a skin specialist (dermatologist). There are several other stronger medicines which they may prescribe, but these must be used very carefully. The specialist will explain these treatments in detail.
What happens if acne isn't treated?
Acne usually gets better over time, although some people can still have problems into their 30s and 40s. Those with severe acne may be left with scars. A variety of cosmetic medical techniques may be effective for those left with severe acne scars.
Other conditions affecting older people may look like acne but they are not. So if you seem to be developing acne for the first time after your 20s, check with your doctor.
- 1. Acne treatment [revised Feb 2009]. In: eTG complete [Internet]. Melbourne: Therapeutic Guidelines Limited; Nov 2009 (accessed Dec 2009).
2. Acne vulgaris. In: The Merck Manual for Healthcare Professionals (revised Aug 2008). Available from: http://www.merck.com/mmpe/sec10/ch111/ch111b.html (accessed Dec 2009).