Teenage Acne

[Dr Stephen Kownacki]

Sarajane

Acne is a cruel condition at any age but in the teenage years we have enough concerns about appearance and bodily changes.

Please see my reply to the older patient on this forum most of which also applies to your daughter. I would emphasise the need to persevere since no treatment works quickly. Benefits are seen after months and treatments especially retinoids need to be continued long term (years.)

Yes is the answer to your question about seeing a dermatologist if your GPs are not sure what to do next to help. There is another website which may help... <www.pcds.org.uk > .. which is written by my colleagues and is aimed at GPs and nurses but there is much to learn about acne to be found there for the public.

It is good that your daughter has a mum who is taking acne seriously and not, as some parents and I fear GPs regard it as just a teenage nuisance.

[Wendy Green]

Hi Sarahjane13,

As you are probably aware teenage acne is due to the hormonal changes taking place in the body. As you have tried everything your doctor has offered perhaps it's time to try an alternative remedy?

The herbal remedy vitex agnus castus is said to help balance hormones and have a beneficial effect on acne and may be worth trying. Companies that sell this supplement include Holland and Barrett - here's the link: http://www.hollandandbarrett.com/pages/ ... prodid=321 and Healthspan - http://www.healthspan.co.uk/herbal-medi ... tAodz34Arg

Explain to your daughter that supplements can take up to 3 months to work, so she'll need to be patient.

Another area to focus on is your daughter's diet; a review of 50 years of research into the link between diet and acne concluded that high GI foods - i.e. sugary and refined carbohydrates such as sweets, fizzy drinks, white bread, cakes and biscuits do encourage acne; it's thought these foods trigger a spike in hormone levels, including insulin, which is thought to stimulate sebum production; sebum is the oil your skin produces to lubricate and protect it - excess sebum can cause blocked pores and acne. Encourage your daughter to cut down on high GI foods and opt instead for a low GI diet of fruit and vegetables, unrefined carbohydrates such as wholemeal bread, brown rice an pasta, oatcakes, and see if there is an improvement.

I hope these suggestions help your daughter

Wendy

[Dr Anton Alexandroff]

Dear Sarajane,
I completely agree with Dr Kownacki.and Wendy.
By the time patient with acne come to see me in hospital I usually recommend Epiduo gel (adapalene and Benzoyl peroxide) in combination with an oral antibiotic and if appropriate in combination with an oral contraceptive pill (it can work really well for acne in female patient!).
In milder cases Benzoyl peroxide alone or Epiduo gel with or without oral antibiotics may be appropriate.
If this fails it would be appropriate to consider an oral short acting retinoid (isotretinoin) which is prescribed under a strict monitoring by a specialist because it is a very powerful medicine (and because female patients should not get pregnant before and during the treatment with isotretinoin).

You may also consider casting your vote on how acne treatment/management should be improved in the UK:
http://www.acnepsp.org/

One more tip - if your daughter consumes too much of dairy produce she may want to cut it down - it may exacerbate acne sometimes. However DARK chocolate appears to be safe in this respect.
I hope this is helpful.
With best wishes,
Dr Anton Alexandroff MRCP(UK) PhD FAAD FRSM
Consultant Dermatologist in Leicester and Bedford
www.alexandroff.org.uk
twitter @bedford_skin_dr
blog: http://privatehealthnews.co.uk/category ... rmatology/

[KaneFraser]

My 17 year old daughter has had acne for several years. Our dermatologist has put her on tetracycline, and she goes for weekly treatments (inserts probe into pimples, which he says helps to prevent scarring). She's been on tetracycline, and going for the weekly treatments for over a year now. Not as much improvement as I was hoping for. She still regularly breaks out, but he says the medication is very mild and would put his own child on it. I'm wondering why doctors don't test hormone levels as well to see if there's an imbalance. She also has painful periods and I've read that acne/painful periods could be excess testosterone.

Is it advisable to go on the pill at this age for acne alone? Why don't doctors routinely check hormone levels in teens to see if this could be the cause of their acne? Have heard that excess androgen hormones (male hormone) can be the cause of acne.

Is long term use of tetracycline a problem or a concern?

My daughter wants to go on Proactive, but have heard negative things about it...any thoughts?

[Dr Stephen Kownacki]

Your description suggests your daughter has been having "expression" of comedones which can sometimes be helpful but weekly sounds rather frequent. It has to be done carefully to avoid damaging the skin. If someone has scanty or very irregular periods and/or excessive hair growth then tests for Polycystic Ovarian syndrome may be indicated but subtle hormonal changes cannot be tested for.

Oral antibiotics such as tetracycline usually show good results within 6 months and if not then changes may be helpful and remember with tetracycline it must be taken 1/2 hour before or 1 hour after food and not with milk/iron/antacids at the same time. It can be taken safely but never in under 12 year olds or in pregnancy. Oral contraception with the combined pill is often very effective especially if there are co-existing period difficulties but discussion about the rare but significant risks of pill taking is important also.

Proactive is not known to me but the salicylic acid content may help to clear comedones a little. I doubt it will be a complete cure and there is cost!