Acne: tips from the experts

Posted by Cedars Dermatology Clinic, 7th September 2015

Acne is a very common skin condition characterised by blackheads, whiteheads and pus-filled spots pustules. 80% of 11-30 year olds are affected.  It usually starts at puberty. Most teenagers in the Western world will have acne lesions at some point.  Areas affected by spots include the face, neck, back and chest. Some may have a more significant problem that may cause scarring and impact on self-confidence. Facial scarring can affect 1 in 5 sufferers.

The impact of acne is often trivialised and underestimated. It’s reported that 92% of sufferers have felt depressed and 14% even suicidal and we suspect this will only get worse in the era of the selfie. Fortunately, most acne resolves by the late teens or early twenties, though it can persist for longer in some people. In the meantime there are many treatments that can help.  There are washes and creams, tablets treatments (such as antibiotics, hormonal medication and isotretinoin), chemical peels, light and laser treatments.  There are lots of great resources out there that give information on the different treatments.  These include acne.org, bad.org.uk and aad.org.  We won’t give an exhaustive list of treatments but we will give some helpful tips that are perhaps less well known.  In the first part of this blog we talk about getting the right diagnosis and diet to help you break free from acne.

Get the right diagnosis

Before treating the acne make sure that’s what you have. For most people the diagnosis of acne is one that can be self-made.  We can usually all recognise the classic blackheads, whiteheads and pustules of teenage acne.  Occasionally, however, some common and rare conditions can be mistaken for acne.

These include conditions such as acne-like drug reactions, bacterial and fungal infections and rosacea

Drug reactions -The most common drug that can trigger an acne like rash is corticosteroids and can persist once it’s been stopped.  Corticosteroids are given for many conditions such as asthma and arthritis.  In the short term they can make acne better and actually we inject large acne cysts with steroid to make them disappear more quickly.  When used for longer periods or in higher doses they can make acne worse or bring out an acne rash.  Other drugs which can cause an acne like rash include antipsychotics like lithium, pain killers like naproxen and antifungals like nystatin and itraconazole.

Infections -Some infections like folliculitis can look very similar to acne pustules.  One condition called Pityrosporum folliculitis, caused by a yeast, is often overlooked.  Adult female acne is predominantly on the lower half of the face and doesn’t usually consist of blackheads or whiteheads and so if you are getting these later in life on the upper face particular along the hairline you might need antifungal treatment rather than the usual acne medication.

Rosacea- Often incorrectly described as acne rosacea this is a similar but distinct entity from acne vulgaris (the full name for common acne).  It usually occurs in later life, involved the central face (cheeks, chin and/or nose) and is not associated with blackheads or whiteheads.  It can be associated with facial flushing, broken blood vessels and even gritty eyes.

Food, complimentary treatments and acne

Before we even get on to discussing treatment options one of the first things we are asked by patients is about the effect of diet on acne and alternative therapies. A review by Cochrane, one of the most trusted evidence databases in medicine, suggests there is some low-quality evidence from single trials which suggest that low-glycaemic diet may reduce total skin lesions in acne vulgaris. So Choosing low- GI alternatives ( e.g switching baked or mashed potato for sweet potato or boiled new potatoes or instead of white and wholemeal bread, choosing granary, pumpernickel or rye bread) might make a small difference.

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Tea tree oil and bee venom have also been shown to have a small effect on acne but there is a lack of evidence to support the use of other alternative therapies, such as herbal medicine, acupuncture, or wet-cupping therapy. There is a potential for adverse effects from herbal medicines; however, future studies need to assess the safety of all of these therapies.

There is weak evidence that dairy might worsen acne particularly in young men.  There isn’t any proven link with spicy food.

There aren’t any useful tests for food that worsen acne but people still waste thousands of pounds on food intolerance tests which are not only of no value in acne at present but can even lead you to dangerous changes in your diet. If you really think diet may be playing a part then keeping a food diary for a few months might help you identify possible triggers.

Topical treatments

There are lots of topical treatments those that are applied directly to the skin) available, both over the counter an prescription.  These are usually the first line of treatment for mild acne as they can be effective and relatively safe compared with other treatments.

Here are some useful tips:

  • Face-washing

You might think acne is due to the skin being dirty and washing your face vigorously will help.  However this is a myth and washing the face too often or too vigorously can worsen acne.  You have to choose the right face wash for you skin type but also balance it with the other treatments you use.  For example, if you have oily skin then a benzoyl peroxide or salicylic acid wash may be very helpful.  But if you have combination skin then just using these all over may dry your skin in some areas.  Also if you are using prescription products like retinoids then again these washes might be too harsh for the skin and you might be better with something less drying.

  • Combination treatment

Often the most effective topical regime is one that consists of a combination of treatments that target the different components of acne and work synergistically.  For example, a morning treatment might contain a topical antibiotic which targets the P. acnes bug and inflammation, whilst retinoids at night can reduce pore blockage and help other creams enter the skin, reduce antibiotic resistance as well as reducing inflammation.

  • Skin type

It’s important to pick the right treatment for your skin type otherwise it won’t work or it may cause other problems and you won’t use it.  For example most of the treatments are made with light skin in mind.  But if you have black or Asian skin then some of the harsher treatments can worsen the dark pigmentation marks that acne leaves behind in these skin types.  Azeleic acid preparations can help with both acne and pigmentation in these skin types

  • Other skin products

The other things that you put on the skin can also worsen acne.  Moisturiser and sunscreen, in particular, can clog pores.  You need something that hydrates the skin without excessively occluding it.  There are a number of brands such as Neutrogena and Bioderma which do oil-free moisturisers and sunscreens for acne prone skin. Also avoid other products which might excessively dry the skin like toner.  Finally use a make-up range that won’t aggravate spots (non-comedogenic or non-acnegeic).  Mineral make up is often one of the best types.

 

Dr Nisith Sheth is a Consultant in the Dermatology Surgery and Laser Unit of St John’s Institute of Dermatology. He trained in the UK, Canada and the USA. He sees and treats all skin conditions.  Read more about Dr Nisith Sheth over on our About us page.

In the next part of Acne: tips from the experts, we will talk about oral treatments and device treatments. Why not share your tips on how to beat acne with us over on Twitter with the hashtag #bestkeptbeauty? We’ll RT our favourites!

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