Most people associate acne with teenagers, but it can linger longer than that and result in scarring if treatment isn’t sought.
“Research suggests that 80% or more adolescents will have some degree of acne,” says Carmel Blake, clinical manager and advanced nurse practitioner with the Irish Skin Foundation.
“It might only be blackheads or whiteheads but a small percentage develop severe acne, which can affect face, neck, back, chest and shoulders. Acne occurs equally among boys and girls but males tend to get the more severe type.”
Carmel, whose main work is as a dermatology advanced nurse practitioner in Tallaght University Hospital, says that the social implications of acne nowadays can be serious.
“With social media and Instagram and people being expected to post ‘flawless’ photos of themselves it can be very difficult for those with acne.”
She defines acne as a very common inflammatory condition involving the blockage of pores in the skin. It most commonly starts around puberty, 12-14 years of age and peaks at around 16-17 years of age in females and 17-19 in males.
“Sometimes acne can persist, or even appear for the first time, in adulthood.”
Why do you get spots/acne?
Acne commonly occurs around puberty because of the natural surge of hormones in adolescents and the increased production of sebum (a natural oil that lubricates the skin). That’s why acne and adolescence often go hand in hand, she states.
“The combination of dead skin cells and the overproduction of sebum causes these dead cells to stick together and ‘plug’ or block the pore. Add in bacteria on the skin and all this can lead to the development of spots or acne in areas where there are a lot of what’s called pilosebacious glands eg on the neck, chest, shoulders and back as well as the face.”
Acne is often graded according to severity from mild to moderate, moderate/severe and severe.
“Even mild cases of acne can cause distress,” she says.
Types of acne include non-inflammatory (blackheads and whiteheads) and inflammatory. The inflammatory category consists of papules and pustules, nodules and cysts.
“The first type of inflammatory acnes involves papules – the common little pink lumps on your skin and pustules (small bumps or spots that are filled with pus so they have a yellow colour). Severe acnes consist of nodules and cysts which are inflamed, swollen and painful.”
Won’t grow out of it
Parents often believe that their teenagers will “grow out of” their acne, but this doesn’t always happen. Many teenagers only look for treatment when they become self-conscious about their appearance, she says.
“Young men frequently seek treatment when they start playing sport and would be using communal changing rooms. They become very conscious of how their skins looks, Some have bad truncal acnes and when they strip off their whole back may be covered in spots. It is important to treat acne early to decrease the risk of scarring.
“Unfortunately, I see it so many times, the poor parents saying, ‘I thought they’d grow out of it’, but sadly not everyone grows out of acne.”
Carmel advises early treatment in order to avoid scarring.
“Teenagers may conceal truncal acne and their parents are not aware of what is under the shirt! Teenagers should not be embarrassed asking parents for support with treatment.”
Blackheads or whiteheads – small amount: Ask your pharmacist about over the counter (OTC) products. If these do not help see your GP.
Papules and pustules: Seek GP advice about prescription topical treatments eg a topical antibiotic treatment or there are also combination creams (antibiotic) and keratolytic (a product that contains an antimicrobial and a product that gently peels the skin and unblocks the pores.) Some private clinics provide laser, light treatments and chemical peels which may/may not be effective.
Moderate acne: A GP may prescribe a course of oral antibiotics (systemic treatment) for three to six months. Females may be prescribed an oral contraceptive pill that may help.
Severe acne: Referral to a dermatologist for other treatments. Roaccutane is frequently prescribed by dermatologists. This drug involves close monitoring due to potential side effects. People who did not respond well to other treatments usually get good results from Roaccutane. Corticosteroids can be injected directly into nodules and cysts to help reduce the size and pain of these inflamed acne lesions.
Patience is necessary
Patience is required when it comes to treatment, however.
“We always say to people ‘please persist with your treatment’. It can take three to six months to see a difference. You’re not going to see overnight clearance.
“Sometimes people get fed up if they are not getting the quick fix they had envisaged so it’s important that they’re told that it’s going to be slow. Do not give up on treatment if you are not getting the desired result. Talk to your doctor or dermatologist to discuss other treatment options.”
If you are prone to acne it is important to cleanse morning and evening, Carmel says.
“There are lots of good over-the-counter cleansing products. Often medication for acne can dry the skin but there are several companies that have good acne ranges that won’t be as drying on the skin.
“Your pharmacist, doctor or nurse specialist will be able to recommend a suitable skin care range.”
Those who wear make up, eg foundation, need to be careful however.
“They should look for foundations and moisturisers that are oil free and won’t block the pores.”
While sugary and fast food used to get the blame for spots and acne, the evidence isn’t very strong.
“There is no clear cut evidence that this is the case,” Carmel says. “It used to be ‘Ah, you’re eating too many chips and too much chocolate’ - that was the thing - but the evidence isn’t robust on that. There are some studies suggesting that a low glycaemic diet, eating slow release energy foods, is beneficial for those with acne. We always advise patients to eat a healthy diet that includes fruit and vegetables.
1 Don’t give up on treatment. If the antibiotic hasn’t worked for a month, keep going. There are other options. Don’t get disillusioned.
2 Use a facial wash to cleanse twice a day but avoid vigorous washing and pat dry with a clean towel.
3 Make sure all make up is removed before you go to bed.
4 Keep long hair that’s greasy off the face so that it doesn’t cause a flare-up of acne.
5 Resist squeezing or picking the spots as this can cause scarring if the spots are inflamed. Pimple popping damages your skin.
6 Avoid rubbing and touching spots. This will decrease the risk of infection.
7 Shave carefully. If shaving, test both electric and safety razors to see which is more comfortable. Shave gently, slowly and in the direction of the hair growth. Shave only when necessary to reduce the incidence of nicking pimples.
8 Choose cosmetics, toiletries and sunscreens that do not block pores. Look for ‘“oil free” or “non-comedogenic” products. Topical retinoid treatments may make wearing make-up difficult if the skin is irritated or peeling.
9 Apply prescribed topical treatments to the whole face, not just the affected area. By applying to all the face you are treating all the active spots you have and reducing the risk of new breakouts of the other areas.
10 Avoid sunburn and suntan as many acne treatments increase sensitivity to the sun.
Inflammatory acne lesions may form scars as they heal, in some cases. During the healing process, loss of collagen (often referred to as the “body’s scaffolding”) at the acne lesion site may result in dips in the skin, also known as “pitting” or “ice-pick” scars.
Alternatively there may be an overproduction of collagen, which may result in raised scars also known as “keloid scars”.
Unfortunately, scarring is irreversible but there are treatments available to improve the appearance of scars. Speak with your GP for referral to a specialist.
While research has shown that this drug can achieve positive results for those with severe acne, those taking it must be monitored closely.
Females of child-bearing age who are prescribed the drug are counselled on the importance of not getting pregnant whilst taking the drug or for five weeks after as the drug can cause deformity in the developing foetus.
“If sexually active they have to use two forms of contraception and they come into their clinic every month to get a pregnancy test before they get their next prescription,” Carmel says.
Roaccutane has also been linked to depression.
“Patients are assessed for low mood or depression before commencing the drug. Often acne can cause depression and low self-esteem. When starting Roaccutane, we involve the parents or family member and ask, if they notice any change in mood or behaviour, to contact us immediately.”
Dermatologists monitor those on the drug very closely for any side effects.
“If my son had severe acne I know that I would want him to take Roaccutane because I see the fabulous results it has in my patients and the renewed confidence it gives them,” Carmel says.
If you have a diagnosis of acne and would like guidance about an aspect of your care, contact the Irish Skin Foundation helpline (open Monday to Friday, 10am-4.30pm) on 01-486 6280. The service is free. See irishskin.ie/acne/