The definitive guide to blitzing spots

THIS will come as no consolation to people who live with it, but acne is the most common skin condition — some 80 per cent of people will be affected by it between the ages of 11 and 30, and it accounts for 3.5 million GP visits in the UK every year.

Although commonly thought of as a teenage problem, for some unlucky souls acne can persist into middle age.

‘I have just seen a 46-year-old dentist and she is still suffering from this,’ says Dr Anton Alexandroff, a consultant dermatologist in Leicestershire and spokesperson for the British Skin Foundation. ‘At any age it can be very distressing, a cause of anxiety and social interaction problems and even depression.’

Acne is a collection of skin symptoms triggered by the male hormone testosterone stimulating more oil production. Every hair on the body grows out of its own follicle — or pore — which have tiny glands that produce an oily substance called sebum, designed to prevent hair and skin drying out.

When these sebaceous glands go into overdrive, excess sebum mixes with dead skin cells and plugs the follicle. The results can be limited to small blackheads and whiteheads.

But if these become infected by the normally harmless bacteria that live on the skin — known as P.acnes bacteria — tender red bumps called papules may develop, or what most of us would consider ‘spots’.

Adult acne cases seem to be on the increase, and experts don’t know why, says Dr Anjali Mahto, a consultant dermatologist at the private Cadogan Clinic in London and formerly London North West Healthcare NHS Trust. ‘The biggest causes are hormones and genetics, while stress and sugar consumption play a much lesser role,’ she says.

Crucially, poor hygiene is not to blame. Frequent washing will make no difference to your acne and could make your symptoms worse by aggravating your skin.

Some women who develop acne may be overly sensitive to the male sex hormone testosterone or just be producing too much of it, explains Dr Howard Stevens a consultant dermatologist at The Skin Care Network in Chelsea.

‘Those who go to the gym and work out with weights, for instance, will build more muscle and their testosterone levels will soar, so they can become more susceptible to acne. The same can happen to men who start building muscle in the gym.’

DR MAHTO says: ‘ The usual first line of treatment is over-the-counter products.’ These include products containing benzoyl peroxide, which attacks the bacterium P. acnes. It is available in various cleansers — such as Clearasil — as well as stronger, topical gels and lotions such as Acnecide.

Other over-the-counter options are products containing azelaic acid, which has an anti-inflammatory effect and retinoids (a type of ingredient derived from vitamin A) which gently exfoliate the skin to get rid of blackheads and whiteheads and reduces sebum production.

‘Nicotinamide products containing vitamin B, which have an anti-inflammatory effect, and anti-bacterial tea tree oil products can be useful,’ she adds.

GPs can offer prescription-only retinoid ( vitamin A- derived) creams or antibiotic creams and oral antibiotics such as tetracycline. Under NICE guidelines, oral antibiotics should always be combined with a topical treatment.

Another treatment for women with acne is the combined contraceptive pill, which has been shown to improve acne by balancing hormones.

‘However, if these treatments are not working after several months you should be referred to a dermatologist, as there may be a risk of acne scarring,’ says Dr Mahto. ‘ They can prescribe the drug Roaccutane, which is the gold standard treatment for cystic acne. (See box above.)

‘My go-to treatment for hormonal acne at the moment is an offlabel use of the drug spironolactone — my patients love it because it gets good results.’

Although spironolactone is licensed for high blood pressure and fluid retention, it also has an anti-androgen effect — blocking receptors for hormones such as testosterone and limiting hormone fluctuation.

Because it’s a diuretic and can raise the amount of potassium in the blood, you need close moni- toring for kidney function and potassium levels, but it’s usually well-tolerated long term.

Dr Howard Stevens says photodynamic therapy, where a light-sensitive medication and a light source are used to destroy bacteria and reduce the activity of the sebaceous glands, can also be effective in people with severe acne who have failed to respond to drug treatments or who can’t take Roaccutane.

‘ It is expensive, though, at around £700 per treatment, and around three to four may be needed,’ he says.

At-home hand-held red and blue light devices, such as the Neutrogena Visibly Clear Light Therapy Acne Mask (£ 59,

amazon.co.uk), can also be beneficial for mild to moderate acne says Dr Mahto.

‘The blue light targets and kills the bacteria that cause acne and the red light reduces inflamma- tion. It’s a temporary treatment to relieve symptoms.’

PAINFUL LUMPS

HIDRADENITIS suppurativa (HS) are painful lumps or boils in the armpit, under the breasts, groin, buttocks, nape of the neck and inner thighs.

Sometimes, the boils are smelly and develop channels under the skin and leak pus and cause other boils to form.

HS is a chronic skin disease that affects around 1.3 million people in the UK, affecting three times as many women as men. Although they form when a hair follicle is blocked, it’s not understood why.

Dermatologist Dr Adil Sheraz explains it’s an inflammatory skin condition that affects areas where the apocrine sweat glands are found. These glands, in the armpits, groin and under the breasts, produce an oily liquid full of fat and protein. They are often misdiagnosed as standard boils and more common in overweight people or smokers.

‘ Some people I see are so embarrassed by them they don’t want to let me examine them.’

Treatment is focused on trying to control inflammation and infection, explains Dr Sheraz.

HIBISCRUB, an antibacterial wash used by surgeons, can be used to clean the area — it’s available on prescription, but can also be bought over the counter from pharmacists; oral antibiotics may also be prescribed.

Alternatively, a combination of the antibiotics clindamycin and rifampicin may help. Other options include Roaccutane or the immuno- suppressant drug ciclosporin, which also has an anti-inflammatory effect.

Biologic drugs, made with proteins that mimic chemicals in the human body, including Humira (more typically used to treat rheumatoid arthritis), may also help — a review of studies in 2015 by the Cochrane database found 40mg weekly improved quality of life for people with HS.