Acne service

Acne is a common inflammatory skin condition that’s caused when our hair follicles are blocked with dead skin cells and sebum. Sebum is a type of oil that is made by a gland in our follicles and helps to moisturise and protect our skin. Bacteria can also collect in the follicle, causing pus to form.

Acne often affects the face but can also affect other areas of the body like the back, chest, neck, shoulders, and upper arms. Acne can cause the skin to become red as well as causing spots, pimples, and cysts. It is treatable in many cases, although the most suitable treatment varies from case to case.

Acne is quite common, affecting around 95% of people aged between 11 and 30 years old. How bad the acne can get can be very different from person to person. Most people will find that their acne clears up in early adulthood, but around 3% of people will continue to have acne when they are over 35 years old.

Acne can appear in different forms, and some of the most common types are listed here.

Blackheads

Blackheads are caused when a follicle becomes clogged by dead skin cells and sebum, and the follicle remains open. With the follicle open, the contents are exposed to air, allowing them to react with oxygen in the air. This causes the contents to turn black in a process known as oxidation.

Whiteheads

Whiteheads are similar to blackheads, the main difference between them is that the follicle is closed. With the follicle closed, oxidation does not occur, and the contents remain white instead of turning black.

Papules

Papules are small bumps on the skin that usually turn red and have no pus visible beneath the skin. With a papule, the contents of the plugged follicle have put enough pressure on the walls of the follicle to cause them to break. The contents then spill out into the surrounding area, causing irritation and tenderness to the surrounding tissues.

Pustules

A papule will often turn into a pustule within a few days. The main difference between a pustule and a papule is that a pustule will contain pus that’s visible on the surface. Much like a papule, a pustule will typically have a red or pink base, although the centre of the bump will be white or yellow in colour.

Nodules

Nodules occur when clogged pores grow larger and become more irritated. One of the key differences between nodules and the acne types already mentioned is that nodules are deeper under the skin. They can be hard and painful.

Cysts

Cysts are the largest type of acne. They go even deeper than nodules do and often occur because of an infection. Cysts can be very painful to the touch and can also result in permanent scars.

A hair follicle is a small opening in the outer layer of the skin. Individual hairs grow from the base of follicles and through the opening of the follicle on the skin surface. Next to our hair follicles are glands that make sebum and once secreted from the gland, sebum will usually travel up the hair follicle to the surface where it can nourish and protect the skin.

Sebum will sometimes not make it to the surface of the skin, becoming clogged in the follicle instead, potentially causing the follicle to become inflamed and swollen. Dead skin can also gather in the follicle, along with bacteria, and where bacteria collect you are also likely to find pus. The result is the spots and pimples that acne causes.

Many people with acne will have periods where their acne is under control, only for it to flare up occasionally. During flare-ups, the patient can have more spots and the spots they have can become more severe. Certain triggers are known to cause acne flare-ups:

Hormonal changes

Teenagers are the most likely age group to have acne because of hormone changes in their bodies. During puberty, an increase in the levels of certain hormones causes the sebaceous glands to grow larger and start making more sebum. This increase in sebum production is one of the main causes of acne. Some people will go through hormone changes later in life that can cause acne, especially women, for example during pregnancy or at certain stages of their menstrual cycle.

Diet

It is often thought that greasy foods and chocolate can trigger acne, but this is not the case. Some studies have shown that eating foods high in carbohydrates is a potential trigger for acne. Foods that are high in carbohydrates include pasta, bread, beans, soft drinks, and pastries. However, while this is not proven, a healthy diet will always benefit your skin.

Medication

Some medicines can also trigger acne. Such medicines include, but are not limited to, some contraceptives, oral corticosteroids, and less commonly some B vitamins.

Stress

Although stress will not cause acne, studies suggest that stress can make acne worse for people who already have it.

There is a large selection of acne treatments available, and which treatment is most suitable for you will depend on the severity of your case, among other factors. One of our doctors will be able to recommend treatment most suitable for your case.

Antibiotic tablets are usually used for more severe acne, in combination with a topical treatment.

Lymecycline

Lymecycline is an antibacterial medication that works by killing the bacteria responsible for acne.

In most cases, only 1 capsule is taken per day. It’s important to drink plenty of water when you take the capsule, to avoid irritating your oesophagus (food pipe).

One study showed that lymecycline reduced acne severity by just over 42%.

Oxytetracycline

Oxytetracycline is a broad-spectrum antibiotic, which means it can be used to help kill a wide range of bacteria including those responsible for acne. The doctor will recommend the correct dose for you. The tablets should be taken on an empty stomach 1 hour before you eat, or 2 hours after you eat. You should also try to avoid drinking milk within 2 hours before or after taking the medication.

A study has shown that oxytetracycline reduces acne symptoms by around 70%.

Hormonal treatment may work well for women with acne, especially if it flares up around the time of their period. Some combined contraceptive pills will reduce the levels of certain hormones known as androgens in the body. A reduction in androgens will, in turn, help to reduce how much sebum is produced, helping to control acne.

It’s important that combined contraceptive pills are used because they need to contain both oestrogen and progestogen to be effective. The mini pill, which contains only progestogen, may actually make acne worse.

Retinoids are a group of drugs that are made from vitamin A. Vitamin A is important for healthy skin because it encourages the production of elastin and collagen, and retinoids encourage the production of new skin cells.

New skin cell growth will cause dead skin cells to be removed (exfoliation), helping to clear pores of dead skin cells and excess oil. Retinoids also help to reduce inflammation, reducing pain and irritation and helping to improve the appearance of the skin.

Most people will use acne treatment that’s available without a prescription. Such treatments will usually be in the form of face washes or creams that are applied directly to the affected area and help to keep follicles clean of oil and debris, as well as helping to kill bacteria. It’s important not to over wash the face as acne is not caused by poor hygiene. Washing twice a day with a gentle soap or face wash is enough.

One of the most common ingredients in acne washes and creams is benzoyl peroxide (BP), which is an antibacterial agent. The effectiveness of non-prescription acne treatments varies. Those that contain active ingredients like BP are more likely to be effective.

Topical treatments are applied directly to the affected skin. For people with mild to moderate acne, the doctor will recommend trying a single topical treatment: a topical retinoid, an antibiotic cream, or azelaic acid. Some of the most effective treatments are listed below.

Zineryt

Zineryt contains erythromycin and zinc acetate. Erythromycin is an antibacterial agent that can help to kill bacteria responsible for acne. Zinc is a healing agent, meaning it can repair some of the damage caused by spots and pimples.

Wash your hands and the affected area before using this medication. Zineryt should be applied directly to the affected area twice a day and the whole area should be covered. The eyes, nose, and mouth should be avoided, however. The treatment should be used for up to 10 to 12 weeks.

One study showed Zineryt to be just over 64% effective at reducing acne by the end of the course.

Zineryt will only be prescribed to people who are pregnant and/or breastfeeding.

Epiduo

You should wash your hands and the affected area before using Epiduo. The medication contains benzoyl peroxide and adapalene. Benzoyl peroxide helps to kill bacteria causing acne, while adapalene is a retinoid. This means it exfoliates the skin to remove dead skin cells, dirt and oil, and also helps to accelerate the turnover of skin cells.

Apply a thin layer of the medication to the affected area once a day. Care should be taken not to apply Epiduo on cuts, scratches, and sunburnt areas and you should also avoid getting it in your eyes, nose, and mouth.

One study showed that just over 75% of participants using the treatment saw a reduction in acne by more than 75% in the total number of lesions.

Differin

Differin also contains the retinoid adapalene. It acts on the skin processes that cause acne, with anti-inflammatory properties that help with discomfort and irritation. Differin is usually applied to the affected area once a day, just before you go to bed. You must wash and rinse the area thoroughly with warm water and pat dry.

Aknemycin Plus

Aknemycin Plus contains erythromycin and tretinoin. Erythromycin, an antibiotic, helps to kill bacteria in the affected area. Tretinoin, a retinoid, accelerates the turnover of skin cells and clears dead cells and dirt from the skin.

Make sure that you clean the affected area before applying the treatment. Aknemycin Plus should be applied using the applicator, and the whole affected area should be covered. Take care not to apply the medication to broken or sensitive skin and avoid the eyes, nose, lips, and mouth.

A variety of non-pharmaceutical treatments are also available for acne, including:

Drainage or extractions

Many people will try and deal with their spots by squeezing them to remove them. If you do this, however, you might end up making the situation worse. Not only that, but some spots are too deep under the skin to be squeezed out.

Other non-pharmaceutical treatments

In addition to those mentioned, there is a wide range of other treatments that some have suggested might work. These can range from homemade facial masks to getting more exercise. Some of these treatments have no basis in science, whereas others can be reasonably effective. It is important that you talk to a doctor first before trying a new acne treatment.

Which acne treatment is right for you will depend on various factors, including the type of acne you have. If you are unsure of which treatment you need, our doctors will be able to recommend the most suitable treatment for you and give you a prescription if needed.

Acne is not down to poor hygiene, but regular cleaning can still help to keep acne under control. Wash the affected area regularly using a mild soap to avoid irritating the skin. Also, be mindful of which cosmetics or other products you are using on your face.

You should also try and identify triggers that might be causing flare-ups. Keeping a diary of your activities, including what you eat, can help you identify what makes your acne worse.