ACNE VULGARIS

by Royal College of General Practitioners

What is acne?

A common skin disease that most people get in their teens and twenties. Acne causes comedones (the blackheads), papules (the pimples), and can cause pustuies, nodules and scars. It usually affects the skin on the face, back and chest.

What causes the acne?

First the grease glands in the skin get big and blocked up, causing greasy skin and blackheads; then skin germs (called propionibacterium acnes) get into a blocked-up gland and cause the pus-filled pimples.

What makes acne worse?

It varies. Some people find that certain foods like chocolate and cheese make their acne worse. Some people think acne gets worse when they are nervous. Some women get worse acne before their periods.

What helps acne?

Sunlight usually improves acne....

Benzoyl Peroxide lotion, cream or gel cleans the skin and kills the germs. You put it on the skin once a day. It can bleach clothes, irritate the skin (like a mild sunburn) Azeliac acid cleans the skin, affects the grease, and reduces the germs. It can irritate the skin and make the skin sensitive to the sun. Retinoid lotions and creams are used once or twice a day. They reduce blackheads.

Antibiotic lotions can be helpful if benzoyl peroxide doesn't work. Clindamycin Lotion is less irritating to dry or scaly skin.

Oral treatments

Antibiotics. Tetracycline is the usual antibiotic. It should be taken half an hour before food to ensure that it is absorbed into the body.

Other antibiotics are erythromycin, minocycline, doxicycline and trimethoprim. Antibiotic courses should be tried for at least three months before deciding if they work or not. Side effects include bowel upsets, thrush infections, folliculitis and minocycline can cause hyper pigmentation.

Hormonal Treatments

Hormone treatment can help. Treatment with Dianette (the antiandrogen cyproterone acetate with ethinyoestradio 35mcg) is as effective as tetracyline but may take 3-6 months to work.

Acne and contraception

Pills with norethisterone or levonorgesterol may make acne worse, but those with desqogesterol or gestodene do not. Contraceptive pills which contain cyproterone are ideal for women who require treatment for mild or moderate acne and contraception.

Acne and pregnancy

Some of the tablet treatments for acne should not be used if you are pregnant.

Severe acne

High dose antibiotics (tetracycline tabs 250mg 6-8 tablets a day or minocycline 200mg) can be used.

Oral Isoretinoin

Is prescribed by hospital dermatologists because of severe side effects. It reduces sebaceous gland activity and the germs. Severe nodular or cystic acne or moderate acne that is resistant to conventional treatment.