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Acne is one of the most common skin diseases, it develops in teenagers and in most cases spontaneously resolves around the age of 25 years. When sebaceous (talc) gland follicles are infected this causes blackheads or whiteheads (comodones). There are 3 sorts of acne

  • Mild acne
    • Most common in teenagers (boys and girls)
    • Spread across the face
    • Mix of whiteheads, blackheads and no pustules (signs of inflammation/infection)
  • Moderate to severe (acne vulgaris)
    • Most common in females
    • Spread over the face
    • Mix of whiteheads, blackheads some pustules
  • Severe (acne conglobata)
    • Most commonly seen in males
    • Spread across the back, neck and chest
    • Mix of whiteheads, blackheads, more pustules, cysts or scars

There are 4 factors that play a role in acne development

  1. Shedding of skin cells in the follicle gland tract
  2. Increased production of talc from sebaceous glands
  3. Infection by P. acnes bacteria
  4. Immune and infection response

Many believe that acne is caused or made worse by a number of factors, but there is little evidence to prove this. For instance smoking, use of cosmetics, certain types of food (chocolate, dairy products, meat, fatty meals).

There is evidence that the following factors do play a role in acne

  1. Use of corticosteroids
  2. Plucking at or squeezing pimples
  3. Use of chlorinated lotions/products
  4. Genetic
  5. Endocrine disturbances for instance in polycystic ovarial syndrome or Cushing’s syndrome

The GP will ask about

  1. The number of months or years acne has been visible
  2. The location of acne on the body
  3. What measures have been taken to treat it
  4. If there are other family members affected
  5. If you are psychologically effect by acne
  6. Your expectations on treatment

General advice by the GP will consist of

  • Over the counter use of benzoylperoxide is very effective
  • avoid plucking at or squeezing the acne pimpels as this leads to infection and worsens the lesions
  • avoid diet or cosmetic changes as this will not have an effect on acne
  • no need to sunbathe as sunlight has little to no effect on acne
  • recommend use of contraceptive pill in women as this can reduce acne

Management with prescription drugs by the GP will focus on the formation of new acne lesions. The effect of treatment is visible after about 6 to 8 weeks. It is important to advice on patience when using one or more of these drugs.

  • Benzyl peroxide gel 5% to be applied to the face every evening for a minimum of 6 weeks. Skin irritation and discolouration are possible side effects. If side effects are not well tolerated, consider application every other evening.
  • Retinoid lotion are also safe to use, however with side effects of skin irritation, shedding, redness, dryness burning sensation and increased sensitivity to sunlight. Should not be used if pregnant and need to take appropriate contraception
    • Adapalene gel 0.1% to be applied on skin every day for minimum of 6 weeks
    • Tretinoin lotion or cream 0.02% or 0.05% to be applied on the skin every evening for a minimum of 6 weeks
  • Antibiotic lotion are effective in treating the infectious component of acne lesions. Always combine antibiotic lotions with either benzyl peroxide or a retinoid lotion. All antibiotic treatments should be given for a minimum of 6 weeks and a maximum of 3 months,
    • Doxycycline 100 mg one tablet every day. On the first day give two tablets and then continue with one tablet. Advise on the risk of sensitivity to sunlight and recommend the use of sun factor. Do not take if pregnant
      • If gastrointestinal side effects occur then prescribe Doxycycline 40mg (slow release) one tablet every day.
    • Tetracycline 250mg one tablet twice a day (morning and evening) one hour before or 2 hours after a meal. Do not ingest this right before going to bed, during pregnancy or if breastfeeding.
    • Erythromycine 250 mg one tablet twice a day (morning and evening). This is the safest antibiotic to take during pregnancy

Isotretinoin tablets are very effective in case of severe acne. If this form is chosen there is no. need to combine it with local ointments or gel treatment as above. However because of severe side-effects of the foetus it is not recommended or prescribed in women of child-bearing age. If isotretinoin is prescribed, women will need to sign a form and agree to undergo treatment to prevent them from being pregnant during and 1 month after treatment. This implies that women will need to have pregnancy tests every 4 weeks, take oral contraceptives pill and use barrier contraceptive like a condom during sexual activity. It is also important to assess mental health if on this drug due to side effects as depression. This type of treatment ist typically done by a dermatologist.

Acne is a skin disorder that can progress from mild to severe. Treatment is available and varies from local application of lotions to oral medication. The GP will be able to discuss all treatment options and precautions necessary to avoid serious side effects.