Teenage Health and Wellbeing: Acne
What is Acne?
Acne (also called spots or pimples) is a common condition, particularly in teenagers. It can also occasionally affect middle-aged people. Acne can cause black spots (blackheads), white spots (whiteheads or red spots (papules), or even pustules and cysts usually on the face but, It can also affect the back and the top of the chest.
It often causes a lot of worry and distress but can usually be cleared up, or at least improved significantly – with the right treatment. Acne can often cause intense feelings of anxiety and stress, particularly in teenagers which in turn can affect their self-esteem, cause social withdrawal and these could result in depression.
Who gets Acne?
Most people with acne are aged between 12 and 25 years but some older people are affected. Boys are more commonly affected than girls. About 8 in 10 teenagers develop some degree of acne. Often it is mild. However, it is estimated that about 3 in 10 teenagers have severe acne bad enough to need treatment to prevent scarring. Untreated acne usually lasts about 4-5 years before settling by itself.
What causes Acne?
Acne is caused by blocked skin pores which then prevents the escape of skin oils ( sebum) and sweat to the surface of the skin. Clogged pores contain dead skin cells and natural oils called sebum that need to come out of the skin. When a bacteria called P.Acne infects the blocked sebum then it results in papules (red spots) and pustules that contains pus.
Teenage acne is thought to be triggered by increased levels of a hormone called testosterone which occurs during puberty. Testosterone stimulates maturity in boys and to a lesser degree present in girls at puberty. The sebaceous glands are sensitive to testosterone which causes the glands to produce more sebum than the skin needs.
Hormonal changes, such as those that occur during the menstrual cycle ( in particular during the periods) or in pregnancy can also lead to episodes of acne in women.
Rarely, certain medical conditions in girls and women may cause acne or make acne worse. For example, polycystic ovary syndrome and conditions that cause excess male hormone to be made in the ovary or adrenal gland. These conditions cause other symptoms in addition to acne, such as thinning of scalp hair, excess hair growth (hirsutism) of facial or body hair, and other problems. Being exposed to chemicals in the workplace, particularly things called halogenated hydrocarbons, can cause acne.
Acne can run in families. If your parents had acne, it is likely you will also develop it.
What makes Acne worse?
- Putting on a lot of make-up or foundation can make acne worse.
- Touching your skin or sitting with your hands over your cheeks or chin can spread germs from your fingers on to your face.
- Picking and squeezing the spots may cause further inflammation and scarring.
- Sweating heavily or humid conditions may make acne worse. For example, doing regular hot work in kitchens. The extra sweat possibly contributes to blocking pores.
- Spots may develop under tight clothes. For example, under headbands, tight bra straps and tight collars. This may be due to increased sweating and friction under tight clothing. Recently is the ‘maskne’ made common by frequent face mask use.
- Some medicines can make acne worse. Do not stop a prescribed medicine if you suspect it is making your acne worse but tell your doctor. An alternative may be an option.
- Some contraceptive pills make acne worse; others can make it better. (Generally the ‘progesterone only’ contraceptives can make acne worse: like the mini-pill or the contraceptive injection or depot in the arm).
- Anabolic steroids (which some bodybuilders take illegally) can make acne worse.
- Whilst there is no clear scientific evidence backing up diet as a cause of acne it has been reported by acne sufferers that some specific foods eiher trigger their acne or make it worse.
Skincare for people with acne
- Use a non-alkaline (this could be pH neutral or slightly acidic) skin cleansing product twice a day – if in doubt, your pharmacist can advise.
- If using skincare products such as moisturisers, avoid oil-based products as these may clog the holes of the skin (pores).
- If you wear make-up, you should also avoid oil-based make-up and should remove make-up at the end of every day.
- Some topical acne treatments may dry the skin. If this occurs, use a fragrance-free, water-based moisturising cream.
Treatment for acne depends on how severe it is and it can take several months to see improvement so persistence is key.
Over the counter creams or gels, eg Benzoyl peroxide and Azelaic acid from your local Pharmacist can help with mild acne.
Prescription medicines from your Doctor that can be used to treat acne include:
- Topical Retinoids
- Topical Antibiotics
- Antibiotic tablets
- In women, the Combined oral contraceptive pill.
There are some other more specialised forms of Dermatologist treatments eg oral tretinoin for the more severe forms of acne that causes scarring and can result in psychological distress and depression.
Cosmetic treatment is also available either over the counter in the cosmetic section or with a specialist beauty therapist or cosmetic Doctors or practitioners.
Psychological Effects Of Acne.
“There is no single disease which causes more psychic trauma, more maladjustment between parents and children, more general insecurity and feelings of inferiority and greater sums of psychic suffering than does acne vulgaris.”
Adolescents are psychologically vulnerable, they are sensitive to modifications in their bodies and appearance. Acne commonly affects young people at a time when they are undergoing maximum psychological, social and physical change. Studies have revealed the burden of acne to diminish adolescents’ quality of life (QoL) and to impact their global self-esteem. Between 30%-50% of adolescents experience psychological difficulties associated with their acne, and although the interaction is complex it can be associated with developmental issues of body image, socialization and sexuality.
It has been suggested that patients with moderate-to-severe acne suffer from poor body image, low self-esteem and experience social isolation and constriction of activities. As part of the emotional impact, increased levels of anxiety, anger, depression and frustration are also observed in patients with acne. Additionally, suicidal ideation and suicide attempts related to the negative psychosocial impacts of acne have also been documented and can affect the social, vocational and academic performance of teenagers. Some patients are severely affected and require more than acne therapy alone.
For the above reasons it is important that our teenagers are understood and supported whilst they go through this phase in their lives and also to seek medical help for the physical effects of their acne as well as the psychological effects by consulting with a doctor early enough.
Acne Vulgaris: The Psychosocial & Psychological Burden Of Illness, Richard G. Fried, Sept 2103, Dermatology Learning Network
Dermatology Learning Network, NHS UK. Patient.co.uk
ALSP FROM DR ADEOLA;