What is acne?

Acne is a very common condition that will affect most of us at some time in our lives. It is often mild, however it can have significant psychological and social consequences. However, in almost all cases, even severe acne can be effectively treated. .

Acne reflects results blockage of hair follicle openings 'pores'. The different types of lesion seen in acne reflect stages in the evolution of blockage of the hair follicle:

• Whitehead (closed comedome): This is caused by blockage of the neck of the hair follicle and appears as a whitish bump.
• Blackhead (open comedome): This is similar to a whitehead, however in this case the opening of the hair follicle is clogged with debris and appears black.
• Inflammatory acne: When the hair follicle becomes inflammed or infected it appears red, this is the classic acne spot.
• Acne nodules and cysts: Further inflammation can lead to the development of large lumps (nodules/cysts) that can persist for a long time and lead to significant scarring.

What triggers breakouts?

The following are common causes for acne breakouts:

• Age: Acne is most common in the teenage years and early 20s. It becomes less common with age but can come on for the first time in older individuals.
• Genetic factors: Acne and severe acne is more common when other family members have been affected. This reflects an inherited tendency rather than a specific acne gene.
• Hormonal changes: The production of sebum is increased by hormonal changes that occur at puberty and this is an important factor in the development of acne. Medical conditions that cause hormonal changes such as polycystic ovary syndrome (PCOS) can also trigger acne.
• A change in hormonal contraception, for example stopping the combined oral contraceptive pill, changing to a new brand or starting progesterone only contraception can trigger an outbreak.
• Moisturisers and make up can block the openings of the hair follicle triggering the development of acne.
• Sustained pressure, for example from a mask, motorcycle helmet or in the gym can compress the openings of hair follicles triggering acne.
• Medications: For example corticosteroids prescribed for the treatment of eczema can trigger acne flares.
• Diet: In most cases, diet does not play a significant role in the development of acne however some studies have shown an association between a diet high in milk or high glycaemic index foods.

How can I help?

During an acne consultation, I will begin by asking you to tell me in your own words about your skin - how long you have been suffering from acne, what treatments you have tried, how it is affecting your life, what your current skincare routine entails and whether you have any other skin concerns. I will also ask you about your general health and any previous treatments that you have used.

Next, I carefully carefully examine your skin with the aid of dermoscopy (skin surface microscopy). During this examination I will confirm that the diagnosis of acne is correct (certain other conditions such as rosacea, papular rosacea or milia can be mistaken for acne). I will determine the types of acne lesions (see above) that are present, the severity of your acne and whether the distribution of the lesions gives any clue as to the causes.

At this point I will discuss with you the treatment options. This will be influenced by the following considerations:

• The types of acne lesions that are present: blackheads, whiteheads, papules (red spots), pustules (pus-filled spots) and nodules (red lumps).
• The severity of the acne and whether there is scarring.
• How long your acne has been present.
• Previous treatments that you have tried for your acne.
• Whether hormonal imbalance is contributing to your acne.
• Other health issues that you may have and whether you are planning pregnancy in the near future.
• Any concerns that you might have regarding side effects of treatment.

It may be that there is more than one possible treatment that is suitable for you and a significant part of the consultation will be spent in weighing up the advantages and disadvantages of these different options and helping you to decide on a treatment plan. I will also advise you on your skincare routine.

Mild acne can usually be treated with topical treatments (i.e. creams and lotions). Where topical treatments are not effective I will move on to tablet treatments. With moderate acne there are more numerous acne lesions and early scarring can be present. Topical treatments are less effective and a tablet treatment is often required.

Inflammatory acne affecting the chin and jawline area in women can be driven by increased levels of the male sex hormone testosterone (which is naturally present at low levels in women as well). In my experience topical treatments are less effective, however tablets which block the male sex hormone can be effective.

With severe acne there are widespread lesions and it is important to treat promptly and effectively to minimize scarring. This will almost always require a systemic (tablet) treatment.

In order to get the most from your consultation and ensure that all of your concerns are addressed there are a few things that you can do in advance:

• Make a list of the treatments that you have tried previously, how long you used them for and whether they were effective.
• Make a list of questions that you have for me.
• Take some photographs in the weeks before your appointment as the severity of acne can fluctuate (you may wish to try the AcneSmart app for this purpose).
• Do some research as to what treatment options are available and which of these might be suitable for you.