Acne is almost a universal condition affecting nearly every teenager at some stage. When it progresses from more than the occasional pimple or extends into later life we consider it a medical condition. There are many types of acne and so assessment by a dermatologist ensures the appropriate treatment is prescribed and tailored specifically to your type of acne. Our treatments include specialized face washes, gels and creams, systemic treatment (tablets) including antibiotics, hormonal treatment and Roaccutane (which can only be prescribed by a Dermatologist) as well as laser therapy.
Assessment by a Dermatologist is the first step to clearer skin.
What is Acne?
Acne is the most common skin disease and affects 80% of all people at some time between age 11-30 years. It begins from age 10-13 at a time when a child is undergoing puberty. It therefore can have far-reaching psychosocial consequences as well as result in permanent disfigurement.
What causes acne?
Acne has many causes and is a disease of the oil producing glands of the skin called the pilosebaceous glands.
There are four interrelated factors involved:
Excess sebum (oil) production
Blockage of the pilosebaceous gland
Infection with a bacteria called Propionibacteriun acnes
Can Acne run in families?
Yes, the activity of the pilosebaceous glands is inherited.
Are there any differences in acne between different skin colours?
There is a great deal of variation in the incidence of acne throughout the world, with South-Eastern Asians having less sebaceous gland activity and tending to show a decreased incidence of acne as well as it being less severe.
Black-skinned patients are more likely to form whiteheads and white skinned patients more likely to have inflammatory acne Patients with black skin may respond to inflammatory acne by forming keloid scars which can result in gross disfigurement.
A specific form of comedomal acne that is very common in black patients is Pomade acne, due to the application of waxes, greases and oils to the hair, resulting in pilosebaceous duct blockage and therefore comedogenesis. Ideally, the patient should cease from using such materials on the hair.
What part of the body does acne affect?
The distribution of acne occurs where the density of sebaceous glands is the greatest, namely the forehead, cheeks, chin, upper chest and upper back.
How is acne treated?
Early treatment of acne is essential for the prevention of lasting cosmetic disfigurement associated with scarring and treatment depends on what type of acne is present.
Mainly comedonal (Whiteheads and blackheads) acne
This form of acne is very common in pre-teenage or early teenage years. Treatment at this stage may prevent further development of the acne: topical tretinoin or adaptalene used once daily at night. We prefer to use retinoids at night as they can photosensitize the skin and therefore are best washed off in the morning before going into sunshine. Topical retinoids are effective against whiteheads and blackheads and may also bene?t patients with increased pigmentation. Salicylic acid up 2% in numerous formulations may be used as an anticomedone treatment and mild anti-inflammatory agent. Azelaic acid formulations can also be effective.
A specific form of comedomal acne that is very common in black patients is Pomade acne, due to the application of waxes, greases and oils to the hair, resulting in pilosebaceous duct blockage and therefore comedogenesis. Ideally the patient should cease from using such materials on the hair.
Mainly inflammatory acne
Mild inflammatory acnemay be treated by either 5-10% benzyl peroxide on its own, or benzyl peroxide combined with erythromycin. This treatment is ideal as it is the most effective topical antimicrobial therapy. Topical clindamycin and erythromycin are also effective and can be used twice daily. More severe inflammatory acne will require systemic antibiotics such as tetracycline and erythromycin and its derivates minocycline, doxycycline, or a combination of trimethoprim plus sulfamethoxazole. Systemic (oral medication) retinoids in the form of isotretinoin is the treatment of choice for severe cases. A 4-6-month course of 0.5-1.0mg/kg per day causes complete remission in most cases.
Hormonal therapy can be very effective in female patients with acne whether or not their serum androgens are abnormal. The most used is ciproterone acetate combined with an estrogen.