Acne is a very common condition that will affect most men at some time in their lives. I see many men with acne in my clinic and in my experience it is not uncommon for men to delay seeking treatment and to present after many years of struggling with their skin leading to scarring and loss of confidence.
Whilst acne affects both sexes equally during the teenage years, men are more likely to develop severe acne and to have longer lasting acne that continues as an adult. Male acne may also affect areas such as the back and chest. The good news is that in almost all cases even severe acne can be effectively treated. and where scarring has already occurred significant improvements can be achieved.
Acne is caused by blockage of hair follicle openings 'pores'. The different types of skin lesion seen in acne reflect stages in the evolution of blockage of the hair follicle:
Whilst the diagnosis of acne is generally straightforward, there are a number of conditions that can be confused with acne and for which the treatment is very different. During an acne consultation, I will examine your skin to verify that the diagnosis of acne is correct and to ensure that there are no other co-existing conditions are also present. Conditions that can be confused with acne include:-
Most men experience breakouts as a teenager and whilst this will often resolve with time, some men continue to experience breakouts throughout their lives and are unaware that effective treatments are available.
The following are some factors that trigger breakouts in men:-
A lot of the information available online relates to treatment of acne or breakouts in women. Whilst some of this information does also apply to men there are important differences.
Mild acne can often be controlled with over the counter treatments. There is no need to overcomplicate things and I generally advise starting with a cleanser in morning and evening, daily sunscreen and benzoyl peroxide once or twice daily. If this is ineffective you can trial other non-prescription treatments including salicyclic acid, alpha hydroxy acids or retinol, however at this point is usually better to see a doctor to obtain medical-grade products which are far more effective (and often less expensive). This is particularly important when you have severe acne with scarring, which is highly unlikely to respond to topical (creams/ointments/lotions) treatments alone.
Benzoyl peroxide kills bacteria that contribute the formation of acne lesions and helps to prevent excessive skin cell division and clogging of hair follicles with dead skin cells. It is available in concentrations of 2.5-10%. It can cause dryness and irritation of the skin particularly when high concentrations are used.
Salicylic acid removes dead skin cells preventing the openings of hair follicles ‘pores’ from becoming blocked.
Alpha hydroxy acids (AHAs) encompass a wide range of products but the most widely used are glycolic acids and lactic acids. AHAs help to remove dead skin cells and reduce inflammation.
Retinol is chemically related to retinoids, which are frequently used prescription products for acne. It works in a similar manner reducing the production of sebum and regulating the division of skin cells (keratinocytes) to reduce blockage of hair follicles.
All of these products can be irritant particularly if you have sensitive skin and it is advisable to start with lower concentrations, to test on a small area of the face and to use less frequently than daily if irritation occurs.
Sunscreen does not treat acne per se, however it is important to help prevent pigmentation occurring from acne spots in those with darker skin types and of course plays a key role in protecting your skin from premature wrinkling and skin cancer.
It is important to use a non-greasy sunscreen. I like the following products:-
If you have acne-prone skin that is also dry than finding the right moisturiser can be challenging. You should look for non-oily, non-acnegeneic, non-comedogenic products. If you do not have dry skin at all then you most likely do not need to use a moisturiser and daily sunscreen will likely be sufficient.
You don’t need to spend a huge amount to find effective products. I like the following products:-
Shaving with acne can be painful and uncomfortable. Be careful that you do not shave the tops of acne spots. If a razor is irritating your skin then try using an electric shaver. Sometimes, when you have severe acne, any form of razor causes discomfort and you may try a beard trimmer instead which does not remove hairs but keeps them short.
Some men develop a condition called pseudofolliculitis barbae 'razor bumps'. This can look like acne but is actually caused by ingrown hairs in the beard area causing skin irritation. It is more common in those with curly hair in the beard area and in those with darker skin types.
Breakouts on the back often occur due to excessive sweating and can be triggered by exercise and warm weather. Some men continue to suffer from acne on the back even after acne on the face has been treated.
There are several things that you can do to minimize breakouts on the back:
Despite these measures it can be difficult to treat acne on the back with topical products (creams/ointments/lotions) since it is hard to access and it is a large area. For this reason patients with back acne will benefit from consultation with a doctor to consider tablet treatment options.
Untreated moderate and severe acne will often lead to scarring of the skin. Men will sometimes come to me for treatment of acne scarring when they still have active acne lesions. In this scenario it is essential to get control of the acne - with powerful tablet treatments if necessary - before commencing treatments for acne scarring such as laser resurfacing. Indeed such treatments are futile without controlling acne since new acne scars will continue to appear!
After acne has been controlled scars will often improve significantly in appearance over time due to the natural remodeling of collagen that occurs with skin healing. For this reason it is usually advisable to wait for a minimum of 6 months and usually a year after completing treatment of acne before performing invasive procedures for treatment of acne scars. Another reason to delay treatment is that certain powerful tablet treatments for acne can impair wound healing and increase the risk of poor healing.
During an acne consultation, I will ask you 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 ensuring that the diagnosis of acne is correct, that there are not other co-existing conditions. I will also determine the types of acne lesions that are present, the severity of your acne and whether the distribution of the acne 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:
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.
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.
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:
Many patients prefer to come in person for an initial visit, however with clear photographs acne can be effectively assessed and treated remotely. Acne scarring is better assessed in person as an evaluation of the 3-dimensional morphology of the skin is required as well as dynamic assessment for tethering of the skin surface to deeper structures.