What’s the best way to get rid of adult acne?
MY GRANDSON, 33, is a vegan and has long had adult acne. He was put on tetracycline and it clears up while he’s taking the tablets, but then comes back. Would taking this medication all the time affect his health? Is there anything he can do instead?
Audrey Thomas, Barry.
ACNE is common and not to be underestimated. Although it causes no physical disability, it can have a major psychological impact, often leading to anxiety and depression.
It is a myth that it only affects teenagers — I have seen adult patients who have struggled for decades with severe acne.
Fortunately, there is much that can be done, but deciding on the right treatment requires thought and care.
There are different types of acne — comedonal (blackheads), papulopustular (a mixture of small red spots and pus-filled spots) and nodular (larger, inflamed red cysts); some people have a combination of these.
That your grandson has been treated with oral antibiotics — namely, tetracycline — tells me he has the papulopustular type, where there is significant inflammation (redness and swelling).
The antibiotic works by reducing the bacterium propionibacterium acnes, which causes the inflammation (the two other factors in the development of acne are that pores become plugged due to over-production of keratin, the skin’s main protein, and there is an increased production of sebum, the oil that makes skin flexible and waterproof).
REsIsTANCE to antibiotics is on the rise in patients with acne, which may be why some do not respond well to the medication, though this does not appear to be the case with your grandson — his problem is a tendency to relapse once the bacteria can proliferate again.
As for the medication’s effect on his overall health, studies have shown an increase (possibly threefold) in streptococcal throat infections in those on long-term antibiotics for acne, but no other health effects have been established.
As with any long-term antibiotic treatment, there may be concerns about the effects on other bacteria in the body, particularly the ‘friendly’ organisms that live in the intestine. But at this stage nothing has been proven.
The best alternative for your grandson would be referral by his GP to see a consultant dermatologist for treatment with isotretinoin, also known as Roaccutane. This is reserved for those with severe acne as well as some milder cases that are resistant to antibiotics, or acne that causes scarring.
The drug is associated with many adverse effects, so it can only be prescribed by specialists in dermatology and must be used with skill and caution. But a 20-week course is highly effective — in the first published study, on 14 patients, 13 had cleared their acne completely after four months of treatment.
The drug works by shrinking the oil-secreting glands, inhibiting the bacteria which are dependent on sebum. It also reduces the overproduction of keratin, thus minimising the blockage of pores.
This is the only drug that permanently switches off the acne process. Antibiotics just put it on hold in the hope that the problem will resolve of its own accord — which doesn’t always happen.
As a vegan, your grandson may have reservations about taking medication which contains gelatin (it seems isotretinoin capsules usually have this in their coating). And perhaps he does not wish to take strong chemicals known to have side-effects — for the duration of treatment, isotretinoin usually causes dryness and cracking of the lips, dry eyes, nose and mouth, and skin irritation; other potential side-effects include depression.
There have been studies of lightbased treatments for acne, including pulsed light, lasers and photodynamic therapy (where the skin is coated with a light-sensitive agent, then exposed to a light source to kill bacteria). But how these work is not well understood and most are unavailable on the NHs. AT A recent eye test, I was told I was developing a cataract in my right eye and would eventually require surgery. I am reluctant to have an operation while I can see well enough to drive wearing glasses. Is there any treatment available? The optician said the condition could not be improved by prescribing new glasses.
David Houghton, Bristol. CATARACTs occur when the lens of the eye becomes cloudy, eventually leading to loss of vision if left untreated. The lens is a structure consisting of specialised cells, which are mainly made up of a clear, transparent protein.
As we age, these cells can degenerate and become less transparent — quite why that happens is not yet well understood. We do know that the chances of cataracts developing are lower in non-smokers. There is also some evidence that quitting tobacco may result in a degree of reversal of smoking-related damage. Other risk factors are excessive alcohol, exposure to sunlight, diabetes and long-term treatment with steroids. There is no known treatment either to prevent cataracts forming or to slow the progression, though many authorities believe that a healthy diet rich in lutein, zeaxanthin and B vitamins (potent antioxidants found in many fresh fruits and vegetables) will reduce the risk of them developing.
ONCE cataracts have developed, the only effective treatment is surgery, which involves removing the opaque lens and replacing it with a synthetic plastic lens.
But surgery is only recommended once glasses no longer help to compensate for loss of function.
I realise this may be unwelcome news to you, but the results of surgical correction are good and safe, even in very senior people.
I have seen a study on 200 patients aged 90 or over who underwent cataract surgery — 80 per cent had improved vision and, remarkably, half were alive five years later.
Do not be alarmed about the 20 per cent who did not find their vision had improved.
It is likely that they had, at that age, problems with the retina (the light-sensitive layer of cells at the back of the eye) which could not be detected before the operation due to the density of the cataracts. such age-related macular degeneration has not been identified in your case.
In due course, you may need to overcome your reluctance to undergo surgery.