Adult acne

[charrockz]

I have suffered from acne since I was 12 years old and I'm now 25. I've always felt self-conscious about it and doesn't help with my depression and anxiety attacks. I always feel that people look at me and feel that I will always look about 12 years old because of it.
I have been to the doctors a lot about it, they always tell me I will grow out of it, they have given me different treatments and they don't work or my acne will always come back. I have tried to be referred to a dermatologist but they won't do that either.
I don't know what else to do so some advice would be most hopeful.

[Dr Stephen Kownacki]

I am sorry to hear of your continued problem with acne. Unfortunately it is not an uncommon story but there is hope.
Acne is mostly genetically determined but some general measures as well as specific treatment from a doctor can help. A healthy diet and simple washing perhaps twice a day, using non-comedogenic (i.e. water based) make-up is a good start. The mainstay of treatment is to reduce any bacteria on the surface of the skin and to stop the formation of comedones (blackheads and whiteheads). Benzoyl peroxide is an important basis for opening and draining spots as well as an antiseptic to reduce the bacteria. (no stronger than 5% because it can be drying and cause redness and soreness.) The strong recommendation for everyone with acne is the use of retinoids such as Adapalene or RetinA which prevent the formation of the precursors of comedones.
If inflammation is widespread especially if on chest and/or back then oral antibiotic may be needed in addition. NB often several treatments used together may be need for many months and for retinoids years!
If you have done and had all these for many months at a time then it is perfectly reasonable for you to return (perhaps to another GP in your practice) and request referral which is your right so to do. The degree of psychological distress is an important factor and is an independent reason for referral to a dermatologist or in some areas to a specialist GP (GPwSI) clinic.
Good luck, it is worth persevering.

[Dr Anton Alexandroff]

Dear charrockz,
I completely agree with Dr Kownacki. 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 in female patients in combination with an oral contraceptive pill. If this fails it would be appropriate to consider an oral short acting retinoid (isotretinoin) which is prescribed under a strict monitoring of 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/

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/