Around three-quarters of all teenagers and young adults suffer from acne. However, men and women in their 30s and 40s can also suffer. The exact cause of acne remains unclear but more is known about how the spots that are part of acne form. And there are more and more treatments to help deal with this distressing condition.

The causes of acne

Acne is a skin condition caused by overactivity of the glands that secrete oily substances on to the skin. The blackheads and spots usually occur on the face, where the greatest number of these oil-producing "sebaceous" glands exist.

The back, chest and shoulders can also be affected. Several factors are involved in the development of acne. Central to this are the sex hormones, which are produced at puberty. The male hormone testosterone - found naturally in women as well as in men – triggers the sebaceous glands to produce more of an oily substance called sebum, making the skin more greasy. However, most acne sufferers don’t have a hormone problem and their hormones are at normal levels in their blood.

When there is an excess of sebum, the area around a hair follicle and the opening through the skin – the pore – can become clogged. A bug, a bacterium called Propionobacterium acnes, that lives normally on the skin, can thrive within the blocked pore. This infection causes inflammation, which is responsible for the redness and swelling of a spot.

Sometimes as in severe acne, the pocket of inflammation within a pore can rupture, causing damage to the skin that can result in scarring. Drugs such as certain steroid tablets and some beauty products that block the pores can contribute to acne. Contrary to popular belief, acne is not caused by eating fatty food or chocolate.

The spots

Acne can cause a number of different types of spots. Typically, people with acne get blackheads (comedones). These are caused by a blockage of the pores, which get their dark colour through excess skin pigment. Whiteheads are also common. These occur near the surface of the skin when excess sebum gets trapped inside the follicle. The sebaceous glands can also become infected. In this more severe "inflammatory acne", cysts develop beneath the skin's surface. These acne cysts can rupture, spreading the infection into nearby skin tissue. This can result in scarring.

Treatment

Acne is not a trivial complaint. It can be the source of considerable emotional distress. But there is a range of treatment options to tackle the problem.

Home treatment

It’s important to keep spot-prone areas clean, so wash the affected area twice a day with an unperfumed cleanser. Antibacterial face washes and soaps specifically for greasy skins are also available. However, the skin needs a certain amount of oil to maintain its natural condition, so avoid aggressive washing with strong soaps. Also try to avoid the temptation to pick at spots: over-enthusiastic squeezing can cause scarring. Acne tends to be less of a problem in the summertime. This may be due to the sunshine helping to dry the skin. No home treatments for acne will work immediately. It can take weeks, if not months, for significant effects to be noticeable.

Non prescription remedies

Over-the-counter remedies are available from a pharmacy to treat mild acne. Lotions that contain benzoyl peroxide dry out the skin and encourage it to shed the surface layer of dead skin. Benzoyl peroxide also has an antibacterial action. Together, these effects make it harder for pores to become blocked and for infection to develop. Benzoyl peroxide can cause redness and peeling, especially to start with. This tends to settle down within a few days.

Prescription medicines

If you go to your GP, they will often also start treatment for mild to moderate acne with a preparation containing benzoyl peroxide. If this does not work, or if you have more severe acne, there are a range of other treatment options that can either be rubbed onto the skin (topical) or taken in tablet form (oral):

Topical treatments

There are several topical treatments you may be prescribed.

• Azelaic acid, which is an alternative to benzoyl peroxide, which may cause less skin soreness.
• Topical retinoids, which are medicines based on vitamin A, and are rubbed into the skin once or twice a day. They work by encouraging the outer layer of skin to flake off, and may cause irritation and skin peeling at the start of treatment. Disadvantages of this treatment include them making the skin hypersensitive to sunlight.
• A topical antibiotic lotion applied to the skin can be used to control the Propionobacterium acnes bacteria. Treatment needs to continue for at least six months. Preparations that combine an antibiotic with other acne medication are available.

Oral treatments

• Oral antibiotics (tablets), taken daily for around 3 months, can be prescribed for inflammatory acne. This acts to kill off the bacteria infecting the skin. The success of this treatment can be limited because the strains of bacteria are often resistant to the common antibiotics. It might take four to six months for the benefits to be seen. Antibiotics do not prevent pores from becoming blocked so treatment to prevent blackheads, such as benzoyl peroxide, is often also prescribed at the same time. Some people find that it’s a prolonged course of antibiotics is a nuisance. This explains why some people do not always complete the course.
• Hormone treatment. For women, a standard combined oral contraceptive pill (containing an oestrogen and a progestogen) can improve acne symptoms. But in some women, it can also make symptoms worse. One particular type of Pill, called Dianette, contains a medicine called cyproterone acetate which cuts the amount of male hormone in circulation and be an effective treatment for acne.
• Isotretinoin (Roaccutane) is a powerful medicine known as an oral retinoid - which also exists in topical form (see above). It tends to be used in severe forms of acne that have proved resistant to other treatments. It works by drying up oily secretions. There are a number of side effects of this drug including dryness of the skin, aches and pains and headaches. It can also damage an unborn baby if taken by a pregnant woman. For safety reasons, isotretinoin is only prescribed by hospital specialists.

Acne also affects people with black or brown skin. The processes that cause it are exactly the same but the impact is altered by the skin pigmentation.