Skin

Acne or spots can affect people of all ages but it tends to be more common in teenagers and young adults. Most people grow out of acne by their mid-twenties, only rarely does it continue into later life. Acne sufferers may experience just a few occasional spots, but sometimes the problem can be more serious and widespread. The high visibility of acne means that it can often affect the self-esteem and confidence of sufferers, particularly during adolescence.

Acne develops when the skin starts to react abnormally to the male hormone testosterone, which everyone, male or female, has in varying amounts. During the teen years the levels of testosterone shoot up, which causes body hair to develop and makes the skin produce more oil (sebum) in the skin. At the same time, the skin pores from where the oil is normally secreted start to narrow and become blocked with a plug of protein called keratin. To add to this, the bacteria that live naturally on the skin break down this oil producing substances that cause irritation, redness and swelling.

The skin has a greasier feel than usual; spots can vary in size and appearance and are sometimes tender and painful. Spots can appear as whiteheads or blackheads (comedones). Acne can also appear as small red lumps called papules, or yellow, pus-filled lumps called pustules. These spots are more painful and generally mean that there is a bacterial infection. If spots are not treated early, they can form scars. In females, symptoms can get worse before a period because of the hormonal changes in the body. Spots can also get worse if you get hot and sweaty.

Medicines

You do not have to put up with acne. For mild acne, there are several products available over the counter from your local pharmacy. Treatments are generally divided into keratolytics, antibacterials and cleansing agents that are available in a choice of formulations including creams, gels, lotions and washes. The pharmacist will be able to recommend the product that best suits you. You must remember that treatment should be used continuously and that it may take some time to start working. For moderate or severe acne your doctor will have a choice of treatments to prescribe including antibiotics, retinoids (vitamin A derivatives) and hormones.

Talk to your pharmacist if you think you may have acne. Your pharmacist will be able to confirm that it is acne. The pharmacist will assess the severity of your condition and decide whether it is necessary for you to see your doctor. For mild acne, the pharmacist may recommend a gel, cream or lotion containing benzoyl peroxide. This product acts against the bacteria that cause the swelling and irritation associated with acne. It also has a keratolytic effect, breaking down the keratin plug that blocks the pores, allowing the sebum to drain more easily. The pharmacist will advise you to start on the lowest strength product and to use it continuously. An improvement is usually seen in 8 to 12 weeks. Alternatively, your pharmacist my recommend other keratolytic preparations containing salicylic acid or sulphur. An alcohol-based or detergent-based cleansing lotion may be recommended to remove excess oil and any loose dead skin.

For moderate or severe acne, or if your acne has failed to respond, your pharmacist will advise you to see your doctor.

If you have tried over-the-counter medicines for two months and your spots have not improved, see your doctor. If your acne is particularly severe and you have noticed scarring, see your doctor. If your prescribed treatment does not appear to be working, see your doctor. For mild to moderate acne the doctor may prescribe the vitamin A derivatives, isotretinoin, tretinoin or adapalene in the form of creams or gels. These products remove the keratin plug and allow the skin's oil to drain from the pores more easily. They also help reduce inflammation. For moderate to severe acne the doctor may choose antibiotics such as erythromycin, clindamycin, minocycline or tetracycline either to be taken orally in the form of tablets or to be applied directly to the spots in the form of creams, gels or lotions. For severe acne resistant to antibiotics where there is a risk of scarring, the doctor may want to refer you to a skin specialist who may decide to use isotretinoin in the form of capsules to be swallowed. Alternatively, for women with severe acne, a high dose oestrogen containing oral contraceptive may help by lowering the testosterone levels that are responsible for the excess sebum secretion. If the acne has caused scarring of the skin, you may be advised to see a cosmetic surgeon who will use techniques such as dermabrasion, laser treatments or collagen injections. These techniques either remove the outer layer of skin or fill dents in the skin caused by scarring to leave the skin with a more even surface.