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Acne is a scourge of almost 90% of people, WKL readers included, at some point in our lives. While it is obviously mild and transient for most, it can become a big issue for many. In a strictly medical sense there is no strong reason for treating acne, but when it impacts on self esteem or mood, as it sometimes will, there is a case for sorting it out. Sometimes quite mild acne will cause devastation in one teenager’s life, while someone else with severe skin changes won’t be particularly bothered. So how we deal with acne depends almost entirely on how the patient feels about it.
Acne develops when there is a surge of steroid hormones during adolescence. The majority of it will clear by early 20s, though obviously some people are afflicted for life. Acne is composed of two things – first pores become blocked and create blackheads or little white spots. These can then become infected, and small boils containing pus will form.
There is limited evidence that decreasing dairy products can improve acne. Simple steps include shampooing regularly – especially for oily skin. A simple wash in lukewarm water twice a day, and after sweating is recommended. Avoiding oily skin products or anything that is harsh on skin like exfollients will help reduce acne. Scrubbing hard or squeezing will usually just damage skin, and make infection more likely. A gentle ‘non-abrasive’ cleanser can be massaged in with the finger-tips – but the rest of the time keep fingers off the face!
Getting rid of it - No treatment works straight away, so it’s important to give any treatment a month or two before passing judgement on it. The first step, for milder acne, is a cream called Benzoil Peroxide. This is quite good, and apart from feeling a bit ‘burny’ at the beginning will help reducing the blockage. If there is pus or boils you will generally need to add a suitable antibiotic ointment. Antibiotic creams stop working after a few weeks if they are used without benzoil peroxide. This is because the bacteria get smart and develop resistance. So antibiotic creams need to used with BP cream.
If after say 2 months this isn’t working there are two options – retinoic acid cream or longterm antibiotic tablets. Nobody really likes the idea of this, but sometimes they can be useful if nothing else is working. Again, with time you can expect resistance to occur so may need to change antibiotics.
People often wonder whether taking longterm antibiotics for a benign skin condition is wise or safe. I agree that it does seem like a drastic solution to a cosmetic problem, though the effects on the bowel, and the effects on general resistance is not much greater than what happens when taking a typical 5 day course of antibiotics.
If we still haven’t sorted the acne at this point there is the option of Roaccutane. This is something only prescribed by dermatologists. There are concerns about the effect on various blood results, on the bowel, it dries skin quite a lot, and may even affect mood. Given that the only real reason we are treating acne is to help self-esteem and mood, you would be cautious in proceeding this far. Like everything though you have to weigh up the likely pros and cons.
Acne is much more treatable than many realize – the question to ask is how much is it bothering me?