My girl’s life is wrecked by her acne

Q MY DAUGHTER is 19 years old and spent the past six years on various medicines for her acne. The only thing that worked was one form of the Pill, Dianette, but this made her depressed. Antibiotics made no difference and upset her stomach. She is frightened by the thought of using very strong drugs, which have some worrying side effects.

I’d be interested in anything to help her as sometimes she won’t go out. It really affects her life, even though I tell her how lovely she looks.

A ACNE is a hugely debilitating condition that can impact on self-esteem and mood. At a time when teens become so conscious of their appearance and making first impressions, severe acne is a cruel blow. It is not always easy to treat.

The usual first lines of treatment include topical creams, lotions and oral antibiotics.

Both benzoyl peroxide and azelaic acid creams are proven scientifically to work well for acne when it is mild or moderate. Adding in an oral antibiotic tablet is the next usual step.

Antibiotics need at least three to six months to start working; if they are not working, it is always worth trying a different type as we can use at least four or five kinds, including lyme cycline.

Dianette is an oral contraceptive Pill licensed for use in acne. Depression can be a side effect of using it due to the specific hormone in it. In that situation, it would be worth trying another contraceptive pill instead.

The Pill is not usually prescribed simply for acne but in a young woman who may want birth control anyway, it is a reasonable approach. One with a different hormone to Dianette may clear up her skin without the side effects. An empathetic GP should consider that. The final resort in terms of treatment would be Roaccutane. This is prescribed by a dermatologist with strict monitoring of mood, as it too has been linked to depression.

Given the huge toll that severe acne can have on quality of life, many choose to try Roaccutane and do so with huge benefits and negligible problems. In a situation where no drugs seem to be helping and acne is so bad that it causes isolation, a consultation with a dermatologist to discuss stronger treatment would be warranted.

Q FOR over a month I’ve had insomnia, getting just three nights of actual sleep. My GP has given me sleeping tablets for a week but they worked only on the first night. Is there another way to help me get some sleep?

A SLEEPING pills can be of value and can sometimes kick-start a sleep pattern again. For this to work, sufferers are advised to take a sleeping tablet every night for a week to ten days, then wean down. Sleeping tablets beyond that are really not recommended as they are addictive and actually in many cases not very effective.

Treatment for insomnia has to look beyond medication. For insomnia to resolve, good ‘sleep hygiene’ is essential. This involves creating the best environment and mind for a good night’s sleep. It is a way to encourage your body to relax and fall asleep.

The environment of sleeping is crucial: a relaxed dark room, no screens, no lights and as quiet as possible.

Many people use an eye mask or ear plugs to create this.

In the last two to three hours before bed, relaxation should be key, with no screens nor phones, and no stimulation like physical activity or eating. A bath, reading and breathing exercises can all be helpful to allow the mind to relax.

I see many patients sceptical about the benefits of sleep hygiene compared to strong pharmaceuticals but it is a scientifically based approach that can be far more effective.

Sufferers should also try to look beyond the sleep itself as to what has caused the insomnia.

Often this is stress- or anxiety-related. Using daytime exercise, mindfulness or therapy to deal with the stress or anxiety can often help.