Acne

While spots commonly appear during teenage years they can affect individuals of all ages and some people present for the first time in their 30s or 40s. At any age if spots affect confidence and or self esteem, they should not be ignored.

A subgroup of women with polycystic ovarian syndrome may have poorly controlled acne which is often more severe than in women who do not suffer with this condition.

Acne may be comedonal (blackhead and whiteheads) or may be more severe with inflamed red or pus-filled lesions (papules and pustules). More severe acne carries a risk of scarring and should be treated early.

Spots occur due to a combination of factors:

Hormones - namely the male hormone testosterone, which is also found in women, stimulates the production of sebum and oil.
Cutibacterium acnes (previously called propionibacterium acnes). The acne bacteria, multiplies in the oil which results in inflammation. If pores are blocked e.g with dirt, oil-based creams or makeup, inflammation occurs resulting in the development of red spots which are often tender and sore.
Sebum and keratin (dead skin cells) block skin pores causing comedones

Aggravating factors include:

Humidity
Oil-based cosmetics
Certain foods
Stress
Medications e.g some forms of the oral contraceptive pill, steroid creams and tablets.

There has been much scientific debate regarding the role of certain foods, for example chocolate and it's role in triggering acne
Diets high in sugar and processed foods may trigger acne by altering the gut microbiome and increasing inflammation

Stress increases the hormone cortisol which, like testosterone, stimulates the sebaceous or oil-producing glands.

Treatment is aimed at the three main causes:

Reduce sebum production

Hormonal manipulation with the oral contraceptive pill Yasmin, Dianette
Retinoids (Vitamin A treatments) which may be applied topically (ie on the skin) or taken as tablets ie Isotretinoin
Anti androgens taken orally eg Spironolactone or a "first in class" topical androgen receptor inhibitor cream, Clascoterone

Reduce bacteria

Antibiotics e.g Lymecycline
Zinc, niacin and salicylic acid-containing products
Benzoyl peroxide

Reduce blocked pores

Salicylic acid containing products
Topical retinoids eg adapalene, tretinoin

The occasional spot may be treated with products available over the counter but when spots are more persistent then it is advisable to treat more aggressively with one or a combination of treatments which may be prescribed.

Dr Jones will be happy to advise which treatment or combination of treatments, is most appropriate for you.