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During puberty certain hormones cause the grease-producing glands next to hair follicles in the skin to produce larger amounts of oil. This is known as abnormal sebum. The abnormal sebum changes the activity of usually harmless skin bacterium making it more aggressive. In turn the glands become inflamed and produce pus, resulting in an outbreak of acne, this can occur on the face, back and chest.

Acne is chronic, this means it can last for many months or years. The severity can change with skin becoming less inflamed between acute flare-ups. Symptoms can worsen as a result of hormone fluctuations, certain contraceptives, makeup, face creams or hair products.

If you find that your acne has suddenly got worse and you are struggling to manage it your GP can help, but before you make an appointment there are some things you can do to improve the situation for yourself.

How to help manage your acne at home:

  • Try not to clean your skin too much – too much scrubbing can irritate the skin and dry it out, which makes your pilosebaceous units make more sebum making the acne worse. Morning and night (and after exercise) with perfume-free soap and water is plenty.
  • Make sure the flare-up isn’t being caused by the introduction of a new product into your daily routine.
  • Double check whether it is a side effect of any medication you may be taking to treat another health condition.
  • Tempting as it is, try not to pick your spots – this will cause more irritation and inflammation.
  • Use skin friendly makeup and creams. Look for ones that have a pH (acid balance) close to skin – around 5.5. It should say on the packaging.
  • Eat well and drink plenty of water. Your skin loves good nutrition and good hydration.

 

I have done all of the above! Which creams can help?

Mild to moderate acne can benefit from topical treatments – these are creams or gels that you put on your skin in the affected area. Your doctor will assess your suitability for these, especially if you have sensitive skin or allergies. Some topical treatments can make your acne worse before it gets better. Always seek medical advice if any creams applied cause further skin irritation. Try the treatment in a small area first to see if your skin will tolerate it and to check you aren’t allergic (this is known as a patch test).

Topical retinoid (adapalene, tretinoin, isotretinoin)

These are anti-inflammatory substances which work to calm the irritation in your skin, reducing redness and swelling.

Topical antibiotic (clindamycin, erythromycin, tetracyclines)

Antibiotics work by attacking the bacteria that might be causing infections leading to acne. Antibiotics are always given with topical benzoyl peroxide to stop the bacteria becoming resistant to the antibiotics.

Azelaic acid 20% Anti-inflammatory

Helps heal the skin cells lining the hair follicles that can get damaged with acne. Depending on your skin type, there are different creams, lotions and gels available so try some and see which one works best for you. Your doctor will advise you on how often to use the topical treatment but once or twice a week is usually recommended at the start of treatment, building up to daily usage, as needed.

 

Topical treatment didn’t work, what can I do now?

If step one didn’t work, there is the option of adding an oral (tablet) antibiotic. Topical retinoids or benzoyl peroxide are usually the preferred approach in order to reduce the risk of antibiotic resistance.

Oral antibiotics (lymecycline or doxycycline)

This should be used for a maximum of 3 months, if your acne gets worse or your get side effects you can switch to a different antibiotic.

Severe acne

If, after two courses of antibiotics, your acne is still unresponsive your doctor can refer you to a dermatologist to consider treatment with isotretinoin.

Isotretinoin works by targeting different factors that cause acne including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle.

A dermatologist is a specialist skin doctor who can look at stronger treatments for your acne. They will also be able to diagnose rare forms of acne, conglobate acne or acne fulminans, which require specialist treatment.

Complications of acne

  • Scarring: Acne can cause scarring, both raised and indented, these scars can occur as a result of the acne itself but the scarring is made worse if spots are picked. Scars can be raised or indented.
  • Pigmentation changes: Inflammation and scarring can alter the pigment in your skin, making patches where you had spots darker or lighter.
  • Psychosocial effects: Bad skin can negatively impact our mental health so it’s important to speak to someone if you’re worried or anxious about your skin. Always talk to someone if you are feeling low in mood, there are always people who can help you.

 

More info

https://www.bad.org.uk/shared/get-file.ashx?id=65&itemtype=document

https://cks.nice.org.uk/topics/acne-vulgaris/management/primary-care-management/

https://www.dermnetnz.org/topics/azelaic-acid/

https://dermnetnz.org/topics/isotretinoin/

 

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