I conducted my first research on acne in 1974 as a final year undergraduate. At that time, I had mild facial acne, which would persist, although I didn’t know it then, until I became pregnant, aged 37, in 1990. I’m almost 60 now and most of my professional scientific career has been as an acne researcher. Why did acne capture my imagination at 21 and why does it still hold my interest almost 40 years later?
There are two answers, scientific curiosity and unfinished business. As a scientist and as someone who’s had acne, I find it a fascinating, perplexing and frustrating disorder. Why do some people have spots only on their face whereas in others the entire upper body is also affected? What makes one follicle suddenly turn into a spot whilst all its neighbours remain healthy? Why do spots come in all shapes and sizes? Why do some people have mild acne, some very severe acne and others escape acne altogether? What makes acne spontaneously resolve in the late teens/early twenties? When and how does diet affect acne? Can it be prevented? Why do some people get acne scars and others not? If acne is caused by male hormones why don’t all men get it? After more than five decades of research, we can’t answer any of these tantalising questions. I’d be more than happy to end my career knowing I’d helped find a robust answer to any one of them. Acne is especially difficult to study because so many different factors are involved. However, it isn’t impossible to disentangle them given enough time, effort and resource. The reality is that acne may be my scientific passion, but it comes way, way down the priority list when it comes to popular conditions to study. We could know so much more than we do if more people, in industry and in academia, were involved in acne research.
When I was 21, my very first project was to look for natural antibiotics produced by bacteria that live on the skin, the theory being that such antimicrobials were likely to be highly and specifically active against acne –causing bacteria, which are also residents of healthy human skin. In other words, my first acne research was part of the search for new and improved treatments that is still going on and which over the years has born relatively little fruit. Almost all of the medicines we use to manage acne were developed to treat other things and were found by serendipity or trial and error to reduce acne severity. Why are we still relying so much on drug based therapies and why has so little been done to evaluate and develop alternatives? That’s the unfinished business I referred to earlier. Without more curiosity driven research on the causes of acne, newer and better treatments may still be a long way off. Until we know much more precisely what goes wrong, it is very hard to devise highly targeted and highly effective interventions.
I was lucky to spend most of my career in a thriving group that included world leaders in acne research; these days the new world leaders are overseas and very little research on acne is undertaken in the UK. I’m currently Project Manager of the Acne Priority Setting Partnership that is seeking to find out and then prioritise the evidence gaps which are preventing us from managing acne more effectively. We’re asking people with acne and the professionals who provide treatments to tell us what’s wrong with existing treatments and what changes they’d like to see. For too long, researchers like me have decided what gets done – now we are willing to listen and start answering the questions that matter most to the people that matter most – those with acne and those who treat them. If you’d like to take part, please go to www.acnepsp.org and make your opinion count. At the end of the day, it doesn’t matter where in the world the research gets done or by whom, but it does matter that it leads to improvements in acne treatment and demonstrates that we’ve not only listened but acted on what we’ve been told.