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Acne is a condition of the sebaceous or oil glands in the skin. Although it causes more problems in teenagers, adults can also be affected. Acne is initially characterized by pimples and blackheads but it may also cause cyst formation and permanent scarring.

Nearly all teenagers get some acne but about 5% to 10% are troubled by the more severe cystic type. Acne occurs predominantly on the face, and to a lesser degree on the back, chest and shoulders.

Hormonal factors play a major part in the cause of acne. The oil glands in the skin are stimulated by the male-type hormones (androgens) to produce more sebum or skin oil. Certain bacteria can act on the oils to produce free fatty acids. These substances are very irritant to the surrounding skin and cause inflammation and the formation of pimples. The free fatty acids also damage the lining of the oil glands and encourage blackheads to form. In women the progesterone level is at its highest in the week before menstruation. Progesterone has a partly androgenic effect. This is why women tend to notice more skin blemishes prior to a period.

Hereditary factors may also contribute; sometimes severe acne runs in certain families. It appears that diet plays very little part at all. Some people swear that they break out in pimples after a meal of junk-food or chocolate. Perhaps a food sensitivity may operate in these people. A balanced diet with the emphasis on fruit, vegetables and grain foods is recommended anyway.

Although not well understood, stress does seem to be a factor in some people; it is no coincidence that a student's skin is often at its worst near exam time. In contrast, the extra ultraviolet radiation over summer often allows acne to improve. However, this should not limit the protection we take against harmful ultraviolet radiation.

There are some general measures that will help most people with acne. The skin should be carefully cleansed night and morning, using plenty of water. If soap is required it is better to use simple soap and rinse well. Avoid picking and squeezing the skin; secondary bacterial infection and scarring can result. Avoid greasy cosmetics that might clog the skin pores and make acne worse. Water-based cosmetics are best and they certainly do not have to be the most expensive.

Quite a few medications are available for the treatment of acne. It is unusual to actually cure acne; the aim of treatment is to satisfactorily control the symptoms. Usually a stepwise approach is followed, starting with the mildest medications...

  • Benzoyl Peroxide applications. Antibacterial action, and also reduce blackhead formation. Usually applied at night for increasing periods. May irritate the skin initially.
  • Retinoic acid derivatives for topical use. May also irritate the skin. Special care with sun-exposure because light sensitive rashes can occur. Most effective in reducing blackhead formation.
  • Topical antibiotics in solution, especially Clindamycin, reduce bacteria in the skin. Usually morning applications are advised.
  • Oral antibiotics. Several are available, especially the tetracycline type. Usually only recommended after other measures have been tried.
  • Oral contraceptive pill. May help some women with acne. Newer pills have lower progesterone levels or a different progesterone altogether.
  • Anti-androgen medication. Only for women with moderately severe acne. Must be in some combination with contraceptive pill.
  • Isotretinoin capsules. ( Roaccutane ). For use in severe cystic acne where permanent scarring is likely. This medication is very effective in decreasing the size of oil glands and the amount of oil secretion. Because significant side-effects can occur it is available only on prescription from a skin specialist. Close monitoring is required. Due to a potential risk of foetal abnormalities, women on this medication should also be on the contraceptive pill.


Health tip:  
* Acne can have a huge impact on people's confidence and self-esteem. Fortunately, the treatment has improved considerably in recent years. You don't have to put up with troublesome acne; discuss the problem with your doctor.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001