Introduction

About 70% of teenagers have some degree of acne. Acne consists of blackheads, whiteheads, spots, cysts and sometimes scarring. It occurs on the face, but sometimes also on the chest and back. It may be mild or can occasionally be an extremely unpleasant condition. There is associated oiliness of the skin due to increased sebum production which can influence fats in hair follicle and cause inflammation of the spots.

Cysts are not common and are associated with the more severe forms of acne. Scarring tends to result from the more severe types of acne.

Hormonal factors

Sebum secretion is under hormonal control and the output of sebum is increased by male hormones (androgens, present in both males and females). Oestrogens have the opposite effect and decrease sebum production, and so can be used in the treatment of women with acne.
There is no evidence that any particular foods either aggravate or help acne.

Treatment

• Washing - use ordinary soap twice a day; washing does not adversely affect acne.
• Cosmetics - avoid heavy foundation creams and use non-greasy ones if you want to cover your spots; avoid night creams; non-oily cosmetics such as blusher or powers are well tolerated.
• Sun oils - avoid the greasy or oily ones.
• Sunlight - most patients with acne benefit from exposure to sunlight; a good holiday in the sun can work wonders for acne; care should be exercised with artificial ultraviolet light and it is best used under the supervision of the hospital.
• Do not squeeze spots

Treatment applied to the skin

Many acne preparations contain Benzoyl Peroxide, e.g. Acetoxyl, Acnegel, Panoxyl Aquagel, Acnecide gel and Benzagel. Most contain 5 to 10% Benzoyl peroxide. One of its actions is to kill the principal bacteria which aggravate acne. It also loosens blackheads so that the follicles become unblocked.

Never start with a preparation stronger than 5% and start treatment once a day, building up to twice a day if necessary. Improvement may take several weeks, but if the preparation is well tolerated you can increase the strength to 10% after several weeks.

The main side effect is that Benzoyl Peroxide is an irritant, and the skin can become dry and sometimes irritated. This happens particularly in fair skinned individuals who will often only manage to use the 5% preparation, whereas darker individuals will be able to increase to the 10% strength. Benzoyl Peroxide is a bleach and so care needs to be taken to wash thoroughly before using towels. Application at night is liable to bleach pillowcases.

Antibiotics applied to the skin can be used for periods of about three months and are sometimes very effective. If this is the case they can be used for longer. Zineryt and Stiemycin are examples of these.

Treatments taken by mouth

Antibiotics help acne in a variety of ways. They must be taken for many months. The benefit may only start to take effect after two months of treatment, and this will continue to develop for at least 6 to 8 months, and so most patients will have an oral antibiotic for at least 6 to 9 months and probably for a year or more. Intermittent courses of antibiotics given for a few weeks at a time are not effective.

Hormone treatment

Dianette is a contraceptive pill which in this country is used in the treatment of acne.

The Retinoids (Accutane) are a group of drugs that are derived from Vitamin A. The one used in acne is Isotretinoin (Accutane). It is a dramatic drug for very severe acne. It is most effective in those with many cysts and nodules and much inflammation. It works by almost drying up sebum excretion and also by loosening blackheads and suppressing inflammation.

The course is usually for 4 months, but the benefit seems to last long after that and in most cases is permanent. It is not a first-line treatment and it has some important side-effects. The main side-effect of Roaccutane is that it damages unborn babies and so it is vital not to take it during pregnancy. For the very severe case that has not responded to the other treatments mentioned, it can be a very effective drug. It is, however, extremely expensive, costing anything up to $500 for a course of treatment.