Spots (Acne)

Most people will suffer spots (Acne) at some time in their lives. The peak age for women is 16 - 17 years old and for men slightly later, 17-19 years. The spots are usually seen on the face but can extend onto the shoulders, upper chest and back. 90% of those people with spots will have a clear skin by the age of 23-25 years but a very small number will continue, sometimes even into their forties.

The spots are easy to recognise as they start as plugging of the sebaceous (grease) glands close to the surface (blackheads) or deeper down in the glands (whiteheads). These then become red and swollen and inflamed forming lumps (papules) which then produce larger lumps filled with fluid (cysts). These may discharge, finally healing and leaving scars.

The Causes

There are several factors that combine to produce acne:-

	Extra grease formation on the skin.
	High level of male hormones (androgens) that are produced by both males and females during adolescence.
	The water retention that some women experience before their periods.
	Normal bacteria on the skin get into the glands causing the infective phase of acne. That is when the spots become swollen and discharge.

Prevention

	Regular washing with soap and water to remove grease from the skin and hair.
	Antibacterial cleansers may help the cleansing (buy at the chemist).
	Sunlight can help to improve acne. In fact most people find their spots are better when they have been in the sunshine in the summer. Do not over-do it and become burnt. A small amount of sunlight is all that is needed.

Treatment

Don't pick or squeeze your spots. It won't prevent more coming up and can cause infection and scarring. There is a danger of releasing germs into your bloodstream and this can occasionally cause significant complications. The above preventative measures should always be tried first. If they do not work then try a preparation like benzoyl peroxide which can be bought at the chemist. Start with a low strength like 2.5% and slowly increase the amount you put on as your skin gets used to it. Treatments for acne tend to take at least two months to become effective, so be patient.

What can your Doctor do to help ?

When you have tried all the above remedies your doctor may:-

	Prescribe some lotion or cream to put into your skin (topical treatment). This may be an antibiotic (e.g. clindamycin or erythromycin) or a lotion to prevent the pores blocking up (e.g. benzoyl peroxide, azelaic acid, retinoic acid). The latter lotions tend to irritate the skin if applied excessively and if this happens you need to stop the treatment for a few days to let the skin settle down before starting again but more sparingly. Remember, none of the skin treatments work well for a couple of months, so there is no hurry!
	Prescribe some antibiotic tablets to take by mouth each day (systemic) treatment. Common antibiotics in use are oxytetracycline and erythromycin. Oxytetracycline must not be taken by pregnant women as it can stain the babies teeth. It also needs to be taken on an empty stomach to be well absorbed, preferably an hour or more before food. Calcium in food (e.g. in milk in tea, coffee, with cereals, in cheese etc) binds oxytetracycline in the gut and stops it getting to your skin. This is the most common reason why oxytetracycline fails to work well. Take your first dose as soon as you wake up with a glass of water and leave breakfast as late as possible to give the antibiotic a head start. Take the second dose last thing at night but avoid milky drinks in the evening. Erythromycin does not share this problem; it sometimes makes people feel nauseated and interferes with some drugs like certain antihistamines in a dangerous way (check with your doctor or pharmacist if you are on other drugs). Minocycline is also used occasionally. It is similar to oxytetracycline but is absorbed easily from the gut. It is much more expensive.
	If you are a female and also requiring contraception or help with your menstrual cycle your doctor may discuss prescribing a hormonal pill called Dianette. This blocks the effect of the tiny amounts of male hormone in your body which normally stimulates the grease glands in your skin to become overactive. Your acne will usually improve as a result. Dianette contains an oestrogen (female) hormone in similar proportions to the combined oral contraceptive pill and will incidentally provide contraception in a similar manner. Click here for more details about the oral contraceptive; the same rules about side effects apply to Dianette.

Each one of these will take at least two months to begin to work well and it is very important that you take the medication as instructed for maximum benefit..

Finally, if you still have troublesome acne that is not responding to treatment and is causing scarring your doctor can refer you to a skin specialist for advice and possible treatment with other more potent drugs such as etretinate. This can cause significant side effects, so its use must be monitored but can lead to a prolonged remission from acne.