Some 85% or so of people in the UK are likely to experience acne at some point in their lives. Often this begins in adolescence, when, due to hormonal changes, the skin becomes more oily and blackheads and whiteheads result from blockage of the pores. These pores can become infected, causing pus spots or papules to develop.
There is no clear evidence of triggers that might give rise to an outbreak of acne. With regard to diet, suspicion has fallen on dairy products and chocolate in the past but studies have not conclusively proved a connection. And, whilst keeping the skin clean is clearly desirable, acne is not caused by a lack of cleanliness. Similarly, exposure to sunlight is not a factor in its development.
Mild acne can be treated with over the counter topical creams, for example, those containing benzoyl peroxide or your GP may prescribe a stronger antibacterial cream containing topical retinoids, such as Tretinoin.
If your acne fails to respond to such treatments, your doctor may prescribe a course of oral antibiotics, such as tetracyclines, over a period of up to six months. Another therapeutic option, (for female patients) is the combined oral contraceptive pill for its hormonal effect on the skin but this can take up to a year before its full benefits are achieved.
Some cases of acne – especially where boils, cysts or nodules are present or where there is a risk of scarring – may require referral to a dermatologist.
At your first consultation, your dermatologist would take a history from you to establish previous treatments you have had and whether you have any other medical issues or history of allergies.
A treatment of choice in cases of resistant acne is a Vitamin A derivative, Isotretinoin (brand name, Roaccutane). It is normally taken daily over a period of 4-6 months and in over 90% of people, it will eliminate the acne. There are possible side effects and these will be discussed before treatment begins. Roaccutane is not suitable for patients who are pregnant or planning a pregnancy during the proposed course of treatment.
Careful treatment of acne should prevent scarring. However, if it is present, plastic surgeons can offer treatment. Usually, such treatment is regarded as a type of cosmetic surgery and is not available on the NHS, but exceptions have been made in the past when the scarring has caused significant psychological distress.