Acne is almost a universal condition affecting nearly every teenager at some stage. When it progresses from more than the occasional pimple or extends into later life we consider it a medical condition. There are many types of acne and so assessment by a Dermatologist ensures the appropriate treatment is prescribed and tailored specifically to your condition. Our treatments include specialized face washes, gels and creams, systemic treatment (tablets) including antibiotics, hormonal treatment and medications (which can only be prescribed by a Dermatologist) as well as laser therapy and medical microdermabrasion.
Acne is the most common skin disease and affects 80% of all people at some time between age 11-30 years. It begins from age 10-13 at a time when a child is undergoing puberty. It therefore can have far-reaching psychological consequences as well as result in scarring and permanent disfigurement. Acne most commonly affects the face and can often affect the back and chest. There are many types of acne spots. The most common red spots are known as papules which can be tender. Pustules are similar to papules but contain pus and so appear to have a white tip in the centre. Blackheads and whiteheads are also types of acne, these are called comedones. More severe acne can result in nodules which are hard lumps that develop under the skin and be painful as well as cysts which are the most severe type of acne spot. Cysts are large, contain pus and are the most likely type of acne to cause scarring.
There are several factors which contribute to the development of acne. These relate mainly to the oil producing glands in the face called pilosebaceous glands. These glands produce sebum and are sensitive to the levels of hormones in the blood and can over produce oil. Excess oil and dead skin cells can block the glands causing a build up of oil. This produces blackheads and whiteheads. A blackhead is an open comdeone. This clogged pore is open at the surface of the skin and when exposed to oxygen it darkens and you get the characteristic black dot appearance. A whitehead on the other hand, is a closed comedone. The pore is also clogged, just like a blackhead, but is closed and therefore looks like a small white bump.
The other main cause of acne is the over growth of the bacteria called Propionibacterium acnes (P. acnes). P. acnes lives on everyone’s skin and does not usually cause any problems. However, in people who are prone to acne, the excess oil creates an ideal environment for this bacteria to multiply. The over growth of bacteria leads to inflammation which causes the papules and pustules (the characteristic red and pink acne spots).
Hormonal changes can also trigger acne. This can occur during the menstrual cycle or pregnancy as well as from the hormonal changes caused by medications like the contraceptive pill.
Yes, the activity of the pilosebaceous glands is inherited.
There is a great deal of variation in the incidence of acne throughout the world, with South-Eastern Asians having less sebaceous gland activity and tending to show a decreased level of acne as well as it being less severe.
Black-skinned patients are more likely to form whiteheads and white skinned patients are more likely to have inflammatory acne forming mostly papules and pustules. Patients with black skin may respond to inflammatory acne by forming keloid scars which can result in scarring and disfigurement.
A specific form of comedomal acne that is very common in black patients is Pomade Acne, due to the application of waxes, greases and oils to the hair, resulting in pilosebaceous duct blockage and therefore comedogenesis. Ideally, patients that suffer from this particular type of acne should cease using such materials on the hair.
The distribution of acne occurs where the density of sebaceous glands is the greatest, namely the forehead, cheeks, chin, upper chest and upper back.
Early treatment of acne is essential for the prevention of lasting cosmetic disfigurement associated with scarring and treatment depends on what type of acne is present. Acne scarring can be a result of any type and any severity of acne. Picking and squeezing spots can also damage surrounding skin and increase the risk of scarring. Acne scarring can be distressing for patients, leading to lack of self-confidence and even depression. Here at The London Dermatology CentreTM we offer a number of treatments to aid patients in improving their acne scars and becoming more confident in their appearance.
This form of acne is very common in pre-teenage or early teenage years. Treatment at this stage may prevent further development of the acne: topical tretinoin or adaptalene used once daily at night. We prefer to use retinoids at night as they can photosensitize the skin, making it more sensitive to the sun and therefore are best washed off in the morning before going into sunshine. Topical retinoids are effective against whiteheads and blackheads and may also benefit patients with increased pigmentation. Salicylic acid up to 2% in numerous formulations may be used as an anticomedone treatment and mild anti-inflammatory agent. Azelaic acid formulations can also be effective.
Mild inflammatory acne may be treated by either 5-10% benzyl peroxide on its own, or benzyl peroxide combined with erythromycin. This treatment is ideal as it is the most effective topical antimicrobial therapy. Topical clindamycin and erythromycin are also effective and can be used twice daily. More severe inflammatory acne will require systemic antibiotics such as tetracycline and erythromycin and its derivates minocycline, doxycycline, or a combination of trimethoprim plus sulfamethoxazole. Systemic (oral medication) retinoids in the form of isotretinoin is the treatment of choice for severe cases.
Isotretinoin is a very effective treatment for acne but can only be prescribed by a dermatologist. You will need to be monitored whilst on the medication and it is not suitable for pregnant women. Most patients see a vast improvement in their acne with 80% of people having clear skin after four months. It can cause your skin to become dry and sensitive to sunlight. Your dermatologist will advise you on how to manage any side effects from the medication.
Hormonal therapy can be very effective in female patients with acne whether or not their serum androgens are abnormal. The most used is ciproterone acetate combined with an estrogen.
For further information and advice on the treatment of acne, please contact us 0207 467 3720.
Content by Dr Sunil Chopra and Rebecca Perris.