A spot of advice for treating acne

It’s officially summer! For me, that means trips to the beach, outdoor picnics and brisk swims in the sea if I’m feeling brave. It also means showing a bit more skin than I usually would, and, much as I wish I didn’t have cellulite, broken veins and wrinkles, this actually doesn’t worry me in the least.

This isn’t the case for many young people though, 80 per cent of whom will suffer from acne.

‘‘Spots’’ or ‘‘zits’’ may seem like a trivial ‘‘rite of passage’’ into adulthood to those of us who are long past that stage, but acne can be one of the most distressing things for young people, affecting their self-esteem, body image, and mood. And yes, it also impacts on their desire to do the usual lovely summery things that involve a bit of body exposure.

Although so common that it is often considered just part of growing up, the spectrum of how severe acne can be is huge.

Some at the luckier end will have a small number of spots every now and then, but others are affected so badly their face, chest and back are covered with painful lumps, resulting in scarring that will never go.

The important thing is to listen to how the person affected feels about their acne – sometimes those with the more severe kind can cope with it, while others with a small number of spots might feel self-conscious and embarrassed.

If you have a young person in your life who is dealing with this, acknowledge it, ask them how they feel about it, and encourage them to talk to a doctor if it is something they want to address.

Acne is essentially a problem caused by blockage of the hair follicles in our skin, which then become infected. This leads to blackheads, whiteheads and sometimes painful, red bulges beneath the skin as well.

We don’t fully understand why some people get it so badly while others are barely affected, but there is definitely a genetic component. Nearly every young person I see with acne has a parent who suffered from the same thing at a similar age.

It affects boys more than girls, and although it is most common in the 15-25-year-old group, it can persist much longer. In girls it is more likely to flare up before their period. Occasionally, it is caused by an underlying condition, such as polycystic ovarian syndrome, or Cushings disease.

The different ways of treating acne can be worked through in a ‘‘step-wise’’ approach, going from the mildest treatments to the more intense, depending on what has already been tried and how affecting the acne is.

Non-medical treatments

It is a myth that acne is caused by a bad diet or poor hygiene, but there are some simple things that you may be able to do that can make a difference in mild cases.

Try to avoid sweaty or humid conditions as they tend to make blocked pores worse.

Don’t pick or touch your spots – we all have bugs on our hands, and causing more infection on already inflamed skin won’t help things to heal.

If you wear makeup, it can be tempting to use extra foundation or concealers to cover your spots. This is totally understandable, but your skin needs to be able to breathe so try to have a couple of days a week where you don’t wear any if you can.

Topical treatments

A large number of lotions and potions are on the market for spots. The ones that are scientifically proven to do something include:

❚ Salicyclic acid – this can be effective on whiteheads and blackheads, but doesn’t tend to work on the bigger, more-painful spots

❚ Benzoyl peroxide – this is a good option for all types of spots, but can be quite irritating to the skin so should be used sparingly. It is really effective for some people when used in combination with a topical antibiotic (known as dual therapy). Prescriptions for dual therapy are available from your GP. Some versions can be bought over the counter but are quite pricey.

❚ Topical antibiotics – clindamycin, erythromycin and tetracycline are all effective, but because of the risk of antibiotic resistance should never be used on their own. They can be combined with either benzoyl peroxide or a topical retinoid, and use should be limited to 12 weeks if possible.

❚ Topical retinoids – these include adapalene and isotretinoin. They are effective for some people, but can be very irritant in sunlight so should be used with caution, especially over summer. They are contraindicated (not advised for use) if you are pregnant.

Oral medication

Antibiotics are the most common option for treating acne. They can be really effective but take a month or more to start working, so often I suggest using a topical treatment as well initially, until the antibiotics kick in.

Treatment is usually required for six months or longer, and sometimes more than one antibiotic is tried if improvement isn’t happening in the

Acne can be one of the most distressing things for young people, affecting their selfesteem, body image, and mood.

expected timeframe. Choices available here include doxycycline and erythromycin.

For young women, going on the combined oral contraceptive pill can feel like a life-changer. It regulates the cycle so will help with acne that tends to be worse around periods.

Most combined pills should help skin, but there is a specific one known as ginet that is thought to be the most effective.

Unfortunately ginet is a higher dose pill, so once acne is controlled the best management is then to ‘‘step down’’ to a normal pill that should still manage symptoms but will carry less risk.

Oral isotretinoin, known as isotane, can make a huge difference to acne sufferers. However it is not without risk so really should be used as a last resort if all the above treatments have failed or aren’t tolerated.

It works by reducing sebum production, but this also causes dry skin, eyes, nose and lips which can be really unpleasant. People on isotane should have regular checks with their doctor as it can sometimes affect cholesterol levels and liver function.