Acne Not So "Teenage Spots"!

Acne is a common inflammatory disease of sebaceous glands, which often affects the face, neck upper trunk and upper arms. Acne spots are made of whiteheads and blackheads, and if left untreated it may progress and form nodules and cysts. Unfortunately, severe cystic acne often leaves permanent scars behind.

Acne is extremely common: it typically starts at puberty and virtually all young people between 15 and 17 years of age have a degree of acne, and it can be moderate or severe in up to 20 percent of affected individuals [1]. Although traditionally acne is considered to be "teenage spots", in fact, it can last for a long time. For example, over 60 percent of 20 to 29 year olds suffer from acne and it remains relatively common in men and ladies up to 40 years of age. It is estimated that in the United States alone acne affects up to 50 million people. However, being common does not mean being trivial. A number of studies clearly demonstrated that acne is associated with self consciousness and can severely impair the quality of life, and even lead to suicidal attempts [2,3].

Dr Anton Alexandroff MRCP (UK), PhD, FRSM, FAAD, Consultant Dermatologist
So what causes acne? Despite the best efforts of doctors the exact answer is still unknown. However, a number of important factors are likely to contribute to the development of acne. First of all, hormonal changes at puberty are important, and, in ladies, acne often flares up around menstruations. It has also been shown that a bacteria called Propionibacterium acne, which often lives in hair follicles, may activate the immune system and cause skin inflammation locally, around hair follicles. In addition, epidemiological data demonstrates that excessive consumption of dairy products can make acne worse [4]. This is probably due to various hormones produced by cows into milk. As the result hair follicles are getting filled up with sebum, clog up and finally rupture into the skin causing inflammation and forming cysts and inflamed nodules.

Everybody likes clear skin and it is possible to treat acne. First of all, it is advisable to eat a balanced diet with fresh vegetables and fruits and to avoid an excessive intake of dairy products. In this context dairy includes full as well as low fat milk, yogurts, soft cheeses and butter (however, dark chocolate and heat treated products e.g. cheeses in pizzas appear to be safe).

It is also important to avoid wearing heavy makeup which can block skin pores and hair follicles. Among other brands, Cetaphil® makes an excellent range of light cleansers and moisturizers. Benzoyl peroxide, available over the counter, has a good activity against Propionibacterium acne and is a good starting point to treat mild to moderate acne. Other treatments, which you have to get from your doctor include topical and oral antibiotics, retinoid creams and sometimes, for ladies, oral contraceptives. Arguably the most successful treatment is oral retinoid, or a vitamin A related chemical, which is taken by mouth. It is usually very effective but rarely may cause serious side effects, and therefore, should be taken only under a close supervision of skin specialists.

Useful information and links:
1) Information from the British Association of Dermatologists:

1) De Mozzi P, et al. Br J Dermatol. 2012; In Press.
2) Simpson RC, et al. Clin Exp Dermatol. 2011;36:840-3.
3) Dunn LK, et al. Dermatol Online J. 2011;17:1.
4) Alexandroff AB et al. Br J Dermatol. 2010;162:12-21.

By Dr Anton Alexandroff MRCP (UK), PhD, FRSM, FAAD,
Consultant Dermatologist
University Hospital of Leicester & & Nuffield Health Leicester Hospital