Acne
Introduction
Acne (ak-nee) is a very common skin condition that affects most young people in their teenage years. It often causes skin spots that are commonly known as ‘pimples’ and ‘blackheads’. They are not harmful, but may be unpleasant, painful and lead to self-consciousness. Fortunately, there are many treatments available that your doctor will discuss with you.
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Teenager with severe painful nodulocystic acne and acne scarring on cheek and jaw on isotretinoin therapy
Who gets it?
More than 8 in 10 young people will have acne at some stage, most commonly in their early teenage years (~13-17 years old), but sometimes in pre-teen years or early adulthood. Girls and boys are generally affected equally, although young men may have worse symptoms. Acne affects young people of all ethnicities.
What causes it?
Acne is due to increased oil production in the oil glands of the skin. Excess oil combines with dead skin cells (a normal part of skin turnover), to form a plug that can block pores. Bacteria that normally live on the skin can then lead to redness, swelling and pus. There are many factors that may contribute to acne, but in many cases there is no one clear cause.
Hormones of puberty: Important hormonal changes that occur during puberty (as pre-teenagers develop into young adults) often also lead to acne. Some of these hormones (known as androgens) naturally occur in higher levels in young men, which is why boys and male teenagers often experience worse acne. Some young women may also find their acne fluctuates.
Other hormonal conditions: Some medical conditions that cause hormonal changes may worsen acne, such as polycystic ovarian syndrome, a very common hormonal condition that affects up to 1 in 10 young women.
Genetics: Although it is not clearly inherited, many young people with acne will have a brother or sister who also has acne, or parents who had acne when they were younger.
Skin products: Some skin products can block pores and worsen acne. This can include some makeups and skincare products.
Diet: There is no specific food that has been shown to cause acne, but some patients find that an unhealthy diet (particularly eating too much “junk food”) can worsen acne. In some people dairy has also been shown to flare acne.
Other: Some medications can affect acne, particularly those that treat epilepsy and some autoimmune conditions. It is very important not to stop taking medications because of acne, but to speak to your doctor about options instead.
What does it look and feel like?
Looks like…
Most people recognise what acne looks like, but acne actually refers to a number of different types of ‘spots’ or ‘pimples’. Acne tends to be distributed across the face, chest, and upper back. In severe cases, it may be more widely distributed (e.g. affecting the upper arms or lower back).
Types of acne spots:
Comedonal acne:
These include non-inflamed blackheads and whiteheads (known as open and closed comedones). This type of acne happens when pores fill with debris, oil and bacteria. The whiteheads happen when the pore closes up and they look like white or skin-coloured bumps and may only be seen in certain light or if skin is stretched. The blackheads occur when the pore remains open.
Inflammatory acne:
This type of acne causes red bumps that sit on the surface of skin (know as papules) and some that contain pus (known as pustules).
Cystic acne:
In very severe cases, acne may lead to the formation of cysts, which feel like small bumps under the skin.
Feels like…
Acne is rarely painful, but occasionally can feel uncomfortable or sore (in severe cases). However, acne can be distressing, and often leads teens to feel self-consciousness or suffer from low self-esteem. In some cases, it may be a contributing factor in mental health problems.
What tests might be needed?
Most of the time, your GP or dermatologist will not need to perform any tests. Occasionally, the doctor may request blood tests if they think that an underlying hormonal issue could be contributing to acne symptoms. In most cases hormones are normal.
What treatments are available?
What can I do?
Maintaining a healthy lifestyle with a balanced diet is always good for children and young people, and may also help with acne symptoms. There are no specific diets or foods that are known to improve or worsen acne, and it is important not to stop eating major food groups. However, avoiding “junk foods” and maintaining a low glycaemic index diet may be of benefit. There is also some evidence that a low dairy diet helps improve mild acne.
Many treatments for acne are available from shops or over-the-counter. Although these do not require a doctor’s prescription, it is always best to seek advice from your GP or a dermatologist if you are unsure. Not all products marketed to treat acne are effective, and some may be very expensive. A mild ‘soap free’ liquid face cleanser is a good place to start. Look for products that are listed as ‘non-comedogenic’ or ‘non-acnegenic’. If you are using prescribed acne creams, it is important to look for a gentle, oil-free cleanser that will also moisturise skin (to prevent it from becoming too dry).
Some skincare products contain salicylic acid, which helps to reduce the oil and dead skin cells that cause acne. Salicylic acid can be effective at treating mild acne, but it can also be irritating for people with sensitive skin.
It is important to avoid the temptation to squeeze, pick or scratch acne, which can make symptoms worse and lead to scarring.
Medical therapies
There are many prescribed treatments available for acne, which can significantly improve symptoms.
Clinic procedures: peels, lasers and lights can be used to treat acne.
Prescription creams: Benzyl peroxide and retinoid creams can be used to improve mild to moderate acne.
Tablets: In some cases, tablets can be used to help to treat acne that is not improving with creams. Some medications that you may have heard of include low-dose antibiotics (such as doxycyline, minocycline), the oral contraceptive pill (for young women only), and isotretinoin (known as Roaccutane or Oratane) for severe cases.
What happens after treatment?
Acne generally improves over time. Some young people will require on-going treatment to manage acne throughout their teenage years, but acne usually resolves as the hormone changes of puberty pass. In some people, particularly young women, it can persist into adulthood. In these cases, it is important to see a doctor for advice. Some people who have had severe acne may have problems with scarring, which remain even after acne spots have gone. There are many treatment options available to improve the appearance of acne scars, including laser and light therapies. These treatment options require consultation with a dermatologist.
What support is available?
Your GP and dermatologist will work together to look after you (or if you’re a parent, your teenager) and improve your acne. Additional information and support can be found at All About Acne, a website created by experts, with reliable advice: https://acne.org.au . Additionally, if you or your teenager are struggling with feelings of self consciousness or depression relating to acne, additional support is available at headspace: https://headspace.org.au
Authors/Reviewers:
Author: Dr Imogen Kate Thompson
Paediatric Reviewer: Dr Mayuri Sivagnanam
Editor in Chief: Dr Tevi Wain
