Author: Dr Roy Palmer
Acne affects people’s self-confidence, sometimes to a major degree. Acne is a disorder of the sebaceous glands (which produce an oil called sebum) and the pores through which they drain onto the surface of the skin. In acne too much sebum is produced and/or the pores become blocked. These problems commonly occur during the teenage years when the glands and pores are exposed to adult hormones for the first time, but older people can also be affected.
A comedone is a blocked pore. ‘Closed comedones’ are ‘whiteheads’; they are small raised white lumps. ‘Open comedones’ are ‘blackheads’. Once a pore has become blocked, inflammation occurs underneath the blockage and a raised red inflammatory lesion of acne results. Cysts can also develop. Anything that blocks the pores can exacerbate acne. Psychological stress makes acne worse via hormonal mechanisms. If acne becomes severe it is especially important to treat it in order to prevent scarring.
Treatments that are applied to the skin (instead of taken by mouth) are called ‘topical treatments’. The most commonly used treatment for acne is benzoyl peroxide gel; it is available without prescription. Salicylic acid face washes, nicotinamide gel, and some other topical treatments are also available without prescription and can be effective. Prescribed topical treatments include antibiotics (such as Zineryt), azelaic acid, and retinoids. The latter are derived from vitamin A. Gels that combine two different treatments are available; they include Duac (an antibiotic with benzoyl peroxide) and Epiduo (a retinoid with benzoyl peroxide).
If topical treatments are insufficiently effective, oral antibiotics can be used. Patients are often concerned about taking an antibiotic for a prolonged period, but it is possible to use one that is safe for long-term use, and that is used little in general medicine so that the issue of bacterial resistance is less important. Visible light therapy (which can be used at home) is sometimes helpful, but rarely greatly so. Intense pulsed light and skin peels are not treatments that I recommend because they are not usually particularly effective. Laser treatment can be temporarily helpful but is not usually greatly so.
Roaccutane is an oral treatment that is derived from vitamin A. It is highly effective at treating acne; it always works if enough of it is taken for long enough. It is unusual to be able to be so confident that a treatment will work! However, it has potential side effects, and is only licensed for use by dermatologists. Where appropriate, in particular if a person’s life is being affected in a major way, the person is not at particular risk of side effects, and other treatments have failed, then Roaccutane is prescribed. Most patients are delighted with the effects of treatment.