What is acne?

Acne is a skin problem that usually starts in your teens. Your skin becomes greasy, its pores get blocked and you develop whiteheads, blackheads, pimples or cysts.

What happens?

During teenage years, young men and women often have a slight hormonal imbalance in favour of the male hormone testosterone. Testosterone makes the glands in hair follicles on your face, back or neck produce too much oil, which then gets clogged in the pores. Bacteria grow in the trapped oil and break it down to produce fatty substances that irritate your skin. This gives you whiteheads, blackheads, pimples or deep cysts.

Types of acne

Whiteheads

Whiteheads are round, white blemishes that form when hair follicles become blocked by a plug of sebum and dead skin cells.

Blackheads

Blackheads are round, dark blemishes that form when the sebum and skin cell plug reaches the skin’s surface and the air.

Pimples

Pimples are red, swollen bumps that form when the plugged follicle walls break near the skin’s surface.

Deep cysts

Deep cysts are red, pus-filled pimples. They form when plugged follicle walls break deep within the skin.

How did I get it?

Acne is common in teenagers because of the normal hormonal changes occurring at that age. There may be a hereditary factor making it a bit more likely to run in some families. In some girls, testosterone levels may be abnormally high, so if your acne is severe this possibility may need to be investigated by your doctor. This problem can be treated.

What makes it worse?

• for women, it can get worse around period time
• contraceptive pills which contain hormones that can have a mild male hormone activity
• some drugs, such as steroids and anti-epilepsy pills.

It is not made worse by greasy hair, hair on the face or using swimming pools. It is not infectious and cannot be ‘scrubbed away’ by keeping the skin excessively clean. No special diets are necessary, although a balanced, healthy diet will help you feel better generally.

What makes it better?

• Leaving it alone: removing blackheads is not recommended. You should also try not to pick or squeeze pimples – it can make the inflammation worse and cause scarring.
• Gentle regular cleaning: avoid excessive scrubbing. Special soaps and shampoos are not necessary.
• Benzoyl peroxide cream or lotion, which gets rid of some of the bacteria on the skin and makes the top layer of skin peel off, unblocking the pores. It can help if you have a lot of blackheads but may irritate your skin. If so, stop using it. You can buy this product without a prescription.
• Vitamin A-based (tretinoin) creams, lotions or gels, which are also mainly for blackheads, make the skin dry and peel. They can be very irritating so only spread a small amount very thinly on your face, no more than once a day. They may make your acne worse at first, but it should improve after a few weeks. Take care in the sun – you may burn more easily, and you should not use them if you are pregnant or there is any likelihood of becoming pregnant.
• Azelaic acid cream, which is put on twice a day. If it irritates your skin, use less or use only once a day.
• Antibiotic liquids or lotions can help stop infection if you have pus-filled spots. They do not help blackheads or whiteheads. They are dabbed on once or twice a day over your whole face, not just on the spots. The liquid can be very drying. You can also get these without prescription.

How can my doctor help me?

Your doctor can help you choose which treatment is best for you. If your acne is bad and not getting better, he or she may give you antibiotic tablets for up to six months. However, you should not take them:

• if you are under 12 years old – they can make your teeth go yellow
• if you are pregnant or there is any likelihood of becoming pregnant – they can harm the baby
• if you are taking the contraceptive pill – it may work less well, usually only for the first month on the antibiotic. Ask your doctor whether they are confident the pill will work effectively after this time or if they recommend additional contraception.

Stopping your antibiotic treatment too soon or as soon as your skin is clear will result in the acne returning as the medication only controls the problem rather than cures it.

Hormonal contraceptive pills or other hormone treatments that act against the male hormone testosterone may also be prescribed by your doctor.

Your doctor may refer you to a skin specialist (dermatologist). There are several other stronger drugs, such as isotretinoin, which they may prescribe but they must be used very carefully. The specialist will explain these treatments in detail.

What happens if it is not treated?

Acne is caused by inflammation not infection, and it may get better with time. You should try not to let it lower your self-esteem or make you feel depressed.

A few people, however, may have problems into their 30s and 40s, and those with severe acne may be left with some scars.

Original material provided by UBM Medica (NZ) Ltd. Reviewed in October 2001 by Dr Nick Birchall.