Acne

Acne is a common skin condition that affects most people at some point.

Acne is a common inflammatory skin condition. It is usually seen in younger people, and often clears up on its own. For some (12% woman and 3% men) it can continue into adulthood. Treatment is sometimes needed to improve how the skin looks, to prevent scarring, and to avoid psychological damage. The main aims of treatment are reduction of oil (sebum), soften up the skin to prevent blocked pores, and treat any bacteria overgrowing in blocked pores. In general, most treatments take two to four months to produce their maximum effect. Sometimes a number of treatments need to be tried before things settle down.

Acne treatments fall into the following categories:

Topical treatments, i.e. those that are applied directly to the skin like creams or gels
Oral antibiotics, i.e. tablets taken by mouth (these are anti inflammatory and fight off bacteria)
Oral contraceptive pills (hormonal medications)
Isotretinoin (Roaccutane) capsules

Topical Treatments

These are usually the first choice for those with mild to moderate acne. There are different products that can work, such as benzoyl peroxide, antibiotics (e.g. erythromycin, tetracycline and clindamycin), retinoids (e.g. tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide. Some of these can be bought over the counter, and some are prescribed by a doctor.They should be applied to the entire affected area of the skin (e.g. all of the face) and not just to individual spots, usually every night or twice daily depending on the treatment. Most topical treatments are initially irritating to the skin, so often you will be advised to use smaller amounts less often, to build up tolerance.

Oral antibiotic treatment

Your doctor may recommend a course of antibiotic tablets. Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement, for at least six months. Often the doctor will suggest continuing a single topical cream (ie not one with antibiotic in it) along with an antibiotic tablet.

Oral contraceptive treatments

Combined hormone contraceptive pills can help girls or women who have acne; they can reduce the amount of oil the skin produces. It usually takes at least three to four months for the benefits to show. Your doctor will discuss whether you are eligible for these medications; as there are some risk factors in your personal or family history which may prevent this being an option such as clots in the legs or lungs.

Isotretinoin

This is a powerful and highly effective treatment for acne which continues to benefit most patients for up to two years after a course of treatment. However, can cause a number of side effects and can only be prescribed under the supervision of a consultant dermatologist. Isotretinoin can harm an unborn child and so there are strict rules about how it is prescribed and monitored.

Women (including teenagers) enrol in a pregnancy prevention programme and need to have a negative pregnancy test prior to starting treatment. Pregnancy tests will be repeated every month during treatment and five weeks after completing the course of treatment. Effective contraception must be used for at least four weeks before treatment, whilst on treatment, and for at least four weeks afterwards.

In a small number of patients isotretinoin may cause depression and suicidal feelings. Acne itself often makes people feel depressed so this can be complicated. Details about any personal and family history of depression or other mental illness should be discussed with your own doctor and dermatologist prior to considering treatment with isotretinoin.

Most courses of isotretinoin last for four months during which time the skin usually becomes dry, particularly around the lips. Regular application of a lip moisturiser is usually helpful. Often, acne becomes a little worse for a few weeks before improvement occurs.

It should be emphasised that many thousands of people have benefited from treatment with isotretinoin without serious side effects.