All you need to know about acne

Author: Dr Anjali Mahto

Date: Aug 2016

Acne is one of the most common skin conditions and nearly 80% of people will suffer with it at some point in their lives. Despite this, there are still many common misconceptions that surround the condition. Until these myths are dispelled, we have a long way to go in providing people with the support they need. For example acne sufferers will often be told they are dirty or not washing enough, or their diet is poor, or they will simply grow out of it.

Healthcare and allied professionals need to be trained in recognizing acne, assessing severity adequately and knowing when a specialist opinion from a dermatologist is required. Otherwise, patients will always be done a dis-service. There also needs to be a wider education of the broader public regarding this condition to dispel the myths and also recognize that this is an extremely common condition, which can be treated. Initiatives such as School Derm Time are a fantastic example of this.

Top tips to combat acne

  1. Firstly, do not suffer in silence. Seek support from a healthcare professional, ideally a qualified dermatologist. These are the only people properly trained in managing skin problems.
  2. Have a good skin care routine ensuring that cosmetics and sun creams are suitable for acne-prone skin and preferably “non-comedogenic” i.e. products that will not block pores.
  3. Regular use of a topical retinoid product. These are a class of compounds related to vitamin A that cause the skin’s outer layer to grow more quickly, stimulate collagen production, and exfoliate the top layers of skin cells. This all helps to reduce the formation of comedones (blackheads or whiteheads) and other acne lesions.
  4. Regular facials that involve steam extraction and manipulation of the skin to remove comedones and ease congestion.
    a. This will create an immediate sense of improvement to the skin in addition to reducing the number of future inflamed acne lesions.
    b. It is advisable to have this carried out somewhere reputable with experienced therapists as if done incorrectly, there is a risk of damaging or scarring the skin and making acne worse.
  5. Chemical peels will improve mild to moderate acne. They involve application of a chemical to induce an accelerated form of exfoliation. They can be used to treat active acne lesions, pigmentary change and superficial scars. The two most common peeling agents include salicyclic acid and glycolic acid.
    a. Salicylic acid is a beta hydroxy acid that is safe to use in all skin types. It is anti-inflammatory and helps break down the outer layer of skin which makes it an ideal treatment for acne. Even at low concentrations e.g. 3%, it can help speed up resolution of acne lesions and comedones. Usually higher strengths of 20% or more are used and applied to the skin for 5 minutes. This should be avoided in those with aspirin allergy or pregnancy.
    b. Glycolic acid is an alpha hydroxy acid that also reduces comedones and inflammatory acne. It also improves pigmentary changes in those that have darker skin types.
  6. For single, isolated stubborn large inflammatory acne lesions such as cysts, a dermatologist may occasionally use a small steroid injection directly into the spot. This is particularly useful if a quick response is required e.g. upcoming social event. The cyst usually flattens within 48 hours. There are potential side effects associated with this that your dermatologist will discuss with you.
  7. Light and laser treatments are an upcoming area in the management of acne. There are a number of these available on the market that seem to have benefit in mild/moderate acne e.g. Regenlite, photodynamic therapy.
  8. Oral medications are appropriate if there is a problem with persistent and/or scarring acne, or acne that is having a profound psychological impact on the individual. Your dermatologist may recommend:
    a. Antibiotics – e.g. Tetracycline, erythromycin, trimethoprim – that must be taken for a period of 3-6 months
    b. Spironolactone – a medication that was initially developed for blood pressure and heart failure but also seems to work in female adult acne by local action on hormones in the skin
    c. Isotretinoin which is a vitamin A derivative usually reserved for severe, recalcitrant acne or acne that is leaving marks or scars on the skin.

Common sites for acne & why they might be occurring

Forehead:

Certain hair styling products such as oils and waxes can cause forehead acne, particularly blackheads or whiteheads (comedones). The products themselves block pores resulting in acne (pomade acne)

Forehead acne can also occur if you keep your hair in a fringe. Hair will rub against the forehead skin causing irritation and potentially contributing to break outs (acne mechanica). The same applies for regularly wearing hats, caps, and helmets. If you hair is oily, this may further aggravate the problem.

Cheek and jawline:

Think about your smart phone use. Touchscreens contain large numbers of bacteria on their surface. Placing your phone against your cheek creates pressure that may activate your oil-producing or sebaceous glands. Combine this with heat generated from the phone and bacteria on the phone surface, and acne can result.

In men, shaving and in-grown hairs can commonly cause acne or folliculitis in the cheek, jawline and neck area.

Jawline and around the mouth (perioral):

Acne affecting the lower half of the face has often been linked to hormonal changes, particularly in women that develop spots at a later age (adult onset acne). This can often manifest as deep, red painful cysts under the skin rather than blackheads or whiteheads. Not all data backs this finding, however, and this type of acne may also be present in those without any underlying detectable hormone imbalance.

Back Acne

“Bacne” that often people get after sweating following sport! Solution to that is to shower immediately and not sit around in your sweaty gym kit.

Why does adult acne occur?

Acne has a multifactorial process. It is a disorder of the pilosebaceous unit of the skin, which is composed of an oil-producing gland, hair follicle and hair. Under the influence of hormones, the size and activity of the oil producing glands increases. In addition, skin cells become “sticky” blocking pores and bacteria known as Propionobacteria acnes start to multiply. This combination of factors results in the formation of acne.

Adult acne is more common in women and consists of two subtypes: persistent acne (acne that continues from teenage years and fails to clear) and late-onset acne (beginning after the age of 25 years). Acne in women can be particularly sensitive to hormonal changes during the menstrual cycle and many women will find their skin worsening during the pre-menstrual period. There will often be a family history of acne if it develops after adolescence.

Acne can cause psychological disturbance, impact quality of life and lead to low self-esteem. As it is largely still viewed as a teenage disease, it can lead to social anxiety in adult sufferers who feel they should have “grown out” of it by the time they are a bit older. Adults with acne may find they do not get the support they require.

How to tackle adult acne

General measures will include skincare advice and topical creams on the skin. If these fail, then there are a large number of treatments than can be tried including steam facials, chemical peels, laser or light treatments, oral antibiotics, hormonal treatments such as spironolactone, and isotretinoin. Lifestyle measures can also benefit some patients so these may be discussed in your consultation with a dermatologist.

Adult acne in men

Acne is more common in males than females during adolescence but this situation reverses in adulthood. At the age of 25 about 12% of women have acne and about 5% of men.

How to cope when shaving

Shaving with acne can be tricky and painful. Start by using warm water and a gentle anti-bacterial cleanser to soften the skin and open the pores. Use a shaving cream or shaving oils containing tea tree oil to help your razor glide over the skin. Always shave in the direction your hair grows to prevent irritation to the hair follicles. When you’re finished, using clean hands, remove any oils or residual shaving cream from the skin surface otherwise this will remain on the skin potentially causing pores to become blocked.

By Dr Anjali Mahto, Consultant Dermatologist & British Skin Foundation Spokesperson

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Last revised: 24 November 2017

Next review: 24 November 2020