Acne

Acne is a very common skin condition which causes spots and oily skin, and generally develops on the face. Acne on the back affects around 50% of people and about 15% of people have it on the chest.

Nearly 90% of teenagers suffer from acne, although most will just have a few “spots”. Up to 60% experience sufficient problems to seek treatment mostly from the pharmacy.

Acne nearly always clears up by the late teens or early 20‘s, but more severe acne tends to last longer.

Acne is not contagious, and, to date, there is no evidence to implicate diet. Acne may cause scarring but most of the time this is preventable by using the correct treatment in a timely fashion.

A few people have persistent acne lasting up to and sometimes past the age of 30 to 40 years. These people often have a family history of persistent acne.

If acne suddenly starts in adult women, it can be sign of hormonal imbalance, especially if it’s accompanied by other symptoms such as excessive body hair or irregular or light periods. The most common cause of hormonal imbalances in women is Polycystic Ovary Syndrome (PCOS).

Read more about being diagnosed with Polycystic Ovary Syndrome (PCOS) on the NHS website.

Selfcare and more information

Type of spots

Blackheads: Small black or yellowish bumps that develop on the skin. Dead skin cells form inside the pore and they are black because the inner lining of the hair follicle produces pigmentation

Whiteheads: These have a similar appearance to blackheads, but may be firmer

Papules: Small red bumps that can feel tender or sore

Pustules: Similar to papules, these have a white tip in the centre, caused by a build-up of pus

Nodules: Large, hard lumps that build up under the skin and can be painful

Cysts: The most severe type of spot caused by acne; they are large pus-filled lumps that look similar to boils and carry the highest risk of causing permanent scarring

Acne Severity Definitions

Mild acne (predominantly facial): blackheads and whiteheads predominate but papules and pustules may also be present

Moderate acne: inflammatory lesions (papules and pustules) predominate. The acne may be widespread involving the upper torso, there may be a risk of scarring

Severe acne: there are nodules and cysts (nodulocystic acne), as well as a preponderance of inflammatory papules and pustules. There is a high risk of scarring

What causes these spots to develop?

Sebaceous glands are found just under the surface of your skin. These glands are attached to hair follicles, which are small holes in your skin through which an individual hair grows. Sebaceous glands naturally lubricate the hair and skin by producing an oily substance called sebum.

With acne, the glands over produce sebum, which mixes with dead skin cells and forms a plug in the hair follicle.

Acne in younger children

Acne in young children is very unusual, though it’s quite common between birth and age 1 year. The sebaceous glands do not usually become active until puberty. The most likely cause of childhood acne is a side effect of prescribed medicines. It is important if your child is suffering from acne that it is investigated, as it could be a symptom of something more serious.

Pre-teen acne is far more common than childhood acne. It is essentially the same as teenage acne and is due to the age at which puberty begins. It can affect children between the ages of 8-12 years.

You should visit your GP if your child is experiencing discomfort or if the pre-teen acne is moderate to severe.

Your baby can also suffer from acne. When breastfeeding, your baby can get what is known as infant acne. This is harmless and completely normal and around a fifth of new-born babies will get infant acne.

During breastfeeding you will pass many hormones to your baby through breast milk. These hormones can cause your baby’s skin to produce an excess of sebum that causes spots. Generally, these spots will not last beyond 6 months. Once your baby stops breastfeeding the acne should clear up.

Click here to read more about childhood acne on the UK Health Centre website.

Acne scars

Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring, but it is more frequent when nodules and cysts burst and damage nearby skin. Scarring can also occur if you pick or squeeze your spots, so it’s important not to do this.

Managing my condition

Treatment for acne depends on its severity. It can take several months of treatment before acne symptoms improve.

There are many self-help techniques which can be used to help manage your acne, such as:

  • Don’t wash the affected areas of skin more than twice a day, since this can irritate the skin and make symptoms worse
  • Wash with mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse
  • Don’t try to ‘pop’ or squeeze spots – This can make them worse and can cause permanent scarring
  • Avoid using too much make-up and cosmetics. Use water-based products that are ‘non-comedogenic’ – This means the product is less likely to block the pores in your skin
  • You should completely remove make-up before going to bed
  • If dry skin is a problem, use a fragrance-free, water-based emollient
  • Exercise doesn’t improve your acne, but it will boost your mood and improve your self-esteem. Be sure to shower as soon as possible, once you finish exercising as sweat can irritate your acne
  • Wash your hair regularly and try to avoid letting your hair fall across your face
Acne and toothpaste

Many websites suggest that toothpaste can dry up individual spots. Toothpaste does contain antibacterial substances, but also contains substances which can irritate and damage your skin. Using toothpaste is not recommended, since there are more effective, safer treatments available from the pharmacist.

Who can help?
  • If you have a few blackheads, whiteheads or spots, a pharmacist should be able to advise you on how to treat them successfully with over the counter creams or gels that contain benzoyl peroxide

You should visit your GP if your acne is moderate or severe, or if the over the counter treatment hasn’t worked. Remember that all medicines can cause side effects.

Medications used to treat acne
  • Topical retinoids – Removes dead skin cells from the service of the skin and helps prevent build up within hair follicles. Tretinoin and adaplene are types of topical retinoids and they’re available in a gel or cream.
  • Topical antibiotics – Helps kill bacteria on the skin that can infect plugged hair follicles. This is available as a lotion or gel.
  • Azelaic acid – This is often used if side effects of benzoyl peroxide or topical retinoid are irritating or painful. Azelaic acid gets rid of dead skin and kills bacteria. It is available as a cream or gel.
  • Antibiotic tablets – In most cases, a class of antibiotics called tetracyclines are prescribed, unless you’re pregnant or breastfeeding. Taking erythromycin is safer to use in this case. Tetracyclines can make your skin sensitive to sunlight and UV light.
  • Combined oral contraceptive pill for women– Your GP may recommend this, even if you aren’t sexually active. The combined pill can often help improve acne in women but may take up to a year before the full benefits are seen.
  • Isotretinoin tablets – Has several beneficial effects, but the drug can also cause a wide range of side effects. It is only recommended for severe cases of acne. Because of the risk of side effects, isotretinoin can only be prescribed by a specially trained GP or a dermatologist. You would need to be referred by your GP for this treatment.

Videos about my acne

How acne develops – acne support | http://www.bad.org.uk/

British Association of Dermatologists | published on 13 June 2018

What causes acne? | https://www.bbc.com/earth/uk

BBC Earth Lab | published 24 February 2017

​Waiting for a specialist opinion

If you have been referred for a specialist opinion your details will be reviewed and it may be recommended that you are seen by a hospital clinician. Information to support you in choosing your preferred hospital, including waiting times can be found using the links below.

How long will I wait?

If a hospital assessment and/or treatment is clinically recommended your information will be sent to a specialist. Click below to find out more about waiting times for routine hospital assessment and/or treatment.

What support is available

Support for managing acne