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A common problem that need not be suffered in silence; In the 21st century, there is no reason for anyone to be significantly troubled by acne, according to consultant dermatologist Dr Alun Evans. Here he explains what the condition is and what treatment is available HEALTH.

Byline: Dr Alun Evans

Q What is acne?

A Acne, sometimes referred to as spots or pimples, is an inflamed skin condition that affects everyone at some time in their life. People - usually women - who escape it in their teens are usually affected later in life. Although it is not infectious or dangerous, it can cause significant cosmetic problems, which can affect confidence and self-esteem and result in permanent scarring.

Q What causes acne?

A Several factors are involved in triggering acne. The sebaceous glands in the skin produce too much grease (sebum), which is released through the narrow openings of the hair follicles. At the same time, skin cells lining the openings of the hair follicles become too sticky and clog up the pore, creating a blockage. The term comedone, or blackhead, is used when the blockage can be seen as a dark plug at the skin's surface. A tiny white bump lying just under the surface is known as a closed comedone or whitehead. The Propionibacterium acnes bacterium lives on normal skin but in those prone to acne, the build-up of sebum creates an environment in which these bacteria can multiply. This triggers inflammation and the formation of the well-known acne spot. Acne is not related to diet, but can be triggered by applying greasy creams or ointments to the skin. Prescription drugs such as lithium and prednisolone and anabolic steroids used by body builders can also cause acne.

Q Is acne hereditary?

A Acne can run in families to some extent, but it is not thought of as hereditary.

Q How can acne be treated?

A In the 21st Century there is no reason for anyone of any age to be significantly troubled by their acne. All grades of acne can be treated successfully and safely. Any patient with acne scarring should be referred to a dermatologist. Unfortunately some patients still suffer significant scarring while on inadequate treatment due to a delay in referral.

There are a wide variety of creams, gels and lotions available. The most effective ones are only available on prescription. Over-the-counter products tend to be too mild to be effective.

These products contain combinations of benzoyl peroxide, nicotinamide, antibiotics, azelaic acid and retinoids. They should be applied to the whole of the affected area as a preventative measure and not just to individual spots. Many will cause dryness and irritation in the first month but patients should persist with treatment where possible.

A short break in treatment of two to three days may be needed, to allow the skin to adjust to the treatment regime.

A topical regime by itself is only effective for patients with mild acne.

Oral antibiotics are effective in the treatment of inflamed acne lesions. The full effect of treatment takes at least two months to achieve. Doxycycline is a good starting point and if it is ineffective after three months it can be replaced by lymecycline. Oxytetracycline is poorly absorbed by many people and erythromycin is not particularly effective.

The oral contraceptive pill may be of benefit to females with acne. This can be used alone or to boost the effect of oral antibiotics.

Isotretinoin (Roaccutane) is a powerful treatment and acts directly on the sebaceous glands. It can be prescribed only by a dermatologist. It is almost 100% successful in clearing acne lesions, although a small proportion of patients will require a top-up course at a later date. Isotretinoin can harm unborn babies, so a pregnancy prevention plan is used in all female patients. A course of isotretinoin therapy lasts for between four and six months. Concerns about depression and suicidal feelings are probably overstated, but in all cases a careful in-depth consultation should take place before a course of treatment starts.

Recent advances in acne treatment include laser and light treatments.

However these are not generally available on the NHS and are no more effective than basic antibiotic regimes.

Dr Alun Evans is a consultant dermatologist at the Princess of Wales Hospital in Bridgend, and Vale Healthcare in Cardiff Bay.

Explaining the myths and facts

Acne is not due to a lack of hygiene and is not infectious.

Expect to use your treatments for two months before you see an improvement. Make sure you follow instructions carefully, so you get the maximum benefit.

Wear oil-free, water-based or "non-comedogenic" make-up. Gently remove at night with mild soap or gentle cleanser and water. Scrubbing too hard can irritate the skin and make your acne worse.

Remember that squeezing spots usually aggravates them. If you must squeeze a spot, wait as long as possible before you do so.

Acne is not caused by an allergy or diet.
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Title Annotation:Features
Publication:Western Mail (Cardiff, Wales)
Date:Nov 10, 2008
Words:778
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