Acne Treatment

What is acne?

Acne, also known as acne vulgaris, is a common skin problem which usually affects the face but can also affect the trunk (tummy), chest and back.

Acne is a condition that causes spots (pimples), whiteheads, blackheads, and cysts. These happen when the pores (small holes) in your skin are blocked by overactive oil (sebaceous) glands.

You might also get spots if bacteria or dead skin enter these pores, which leads to soreness, redness and swelling.

During puberty, hormones trigger our oil glands, which is why we’re more likely to experience acne during our teenage years. In fact, acne is most common in teenagers between the ages of 13-16 years old, but it is also becoming more common in adults with 1% of men and 5% of women also affected.

Several factors contribute to acne such as:

• Overgrowth of keratinocytes which are cells in the outer layer of the skin. They seal the follicles and form comedones, or spots.
• Increased sebum (oil) production clogs the pores.
• Overgrowth of certain bacteria in the pores triggers an immune response.
• Inflammation occurs as a result of the immune response.

Although we do not understand the exact way these all contribute to spotty skin, they can all play a role in acne development.

What is cystic acne?

Cystic acne is a type of severe acne that appears in the formation of pus-filled cysts deep within the skin, resulting in painful and often sizable spots.

See a dermatologist to reduce the chance of skin scarring and infection.

Treatment options may include oral antibiotics and prescription-strength creams to help clear the skin.

What are the different types of acne?

We class acne severity as mild, moderate, or severe based on the number of comedones, cysts and inflamed areas there are.

Mild - Mostly whiteheads and blackheads, with maybe a few small red papules and pustules.

Moderate - Involves more blackheads and whiteheads than mild acne, along with quite a few papules and pustules.

Severe - Usually more large, painful papules, pustules, nodules, or cysts, often leading to acne scars on the skin.

What causes acne?

There are many causes of acne. The most common is teenage acne, but what are the other causes?

Infant: Seen in infants up to one year, it should resolve in a few months without any treatment neede. See a doctor if it persists beyond that age.

Hormones: Hormones, particularly testosterone, increase sebum production, leading to clogged pores and cyclical breakouts. This is often linked to the menstrual cycle in females.

Menopause: Hormonal changes during perimenopause and post-menopause, particularly the decrease in oestrogen levels, can result in acne later in life.

Puberty: Increased levels of sex hormones during puberty stimulate sebaceous (oil) glands, leading to oilier skin and an increased risk of breakouts.

Adult: Factors such as sunlight exposure, stress, smoking, poor sleep, dietary choices, and certain cosmetics can contribute to adult acne.

Stress: Higher stress levels release hormones that increase oil production and testosterone, worsening acne.

Smoking: Cigarette smoke alters sebum composition, leading to overgrowth of skin cells and comedone formation.

Cosmetics: Oil-based cosmetics can clog pores and trigger acne, look for products that are “non-comodogenic” (this means they shouldn’t clog your pores).

Pregnancy: Acne may improve in the first trimester but worsen in the third due to hormonal changes. Ask us about safe treatment options during pregnancy.

Endocrine causes: Conditions like polycystic ovarian syndrome (PCOS) and hormone-secreting tumours can lead to acne. Consult a doctor if acne persists despite conventional treatment or if other symptoms of excess testosterone are present.

Does diet affect acne?

Yes, the food you eat can impact acne. Some foods are beneficial, while others can encourage acne breakouts.

Carbohydrates: Foods with a high glycemic index are starchy foods such as white bread, pasta, and potatoes. These cause a surge in our blood sugar and the release of insulin and IGF1.

Insulin affects the growth of sebaceous (oil) glands and acts directly on the adrenal glands and reproductive organs to trigger testosterone production. Sugary foods such as chocolate also have this effect.

Dairy: Milk contains amino acids that when combined with carbohydrates stimulate insulin production. In addition, milk contains hormones such as progesterone and androgens that can increase sebum production. In studies, milk and whey proteins have been linked to acne flare-ups.

Omega 3: Studies support that Omega 3 fatty acids and Y linolenic acid work to reduce acne lesions by having an anti-inflammatory effect and reducing the effects of IGF1.

Vegan diet: There is little evidence from studies that a vegan or vegetarian diet is beneficial in preventing or treating acne.

Probiotics: There is growing evidence that probiotics may improve acne by having an anti-inflammatory effect and reducing insulin levels.

How to prevent acne

These tips can help you manage and prevent acne:

1. Avoid touching your face too much - this can transfer bacteria or dirt that can clog pores.
2. Reduce your stress levels as stress can worsen acne.
3. Wash your face regularly, morning and night.
4. If your hair is oily, wash it more often as the oil can transfer from your hair to your face.
5. Avoid touching your spots as you may transfer bacteria which will cause more spots.
6. Use products right for your skin type, like avoiding oily skincare products.
7. Exfoliate your skin while washing it to remove the dead skin cells - do not use scrubs on your face, these will damage this delicate skin.

How to get rid of acne

Discuss your condition with a doctor or dermatologist. They will be able to advise you of the next steps and your suitability for prescription-strength treatments.

Treating acne

Sometimes acne doesn’t resolve with a thorough skincare routine and adopting a healthier lifestyle.

Oxford Online Pharmacy may have something to help you, from prescription strength to over-the-counter acne medications.

Find below a list of the available acne treatments and how they differ from one another so you can determine the best treatment for you:

Topical acne treatments

Oral antibiotic acne treatments

Over-the-counter treatments

Getting in touch

If you have any more questions about acne, its causes and treatment, speak to one of our pharmacy team today. You can also find more detailed information about each treatment type on the product pages or in the patient information leaflets.

If you have looked through our treatments and are still unsure, contact a member of our trained healthcare team for friendly, unbiased advice.

Acne FAQ’s

How long should I use acne treatments for?

This depends on the severity of the acne and the treatment in question. Generally, topical treatments applied to the skin should be used for at least 8-12 weeks before you assess the effects. The effectiveness of oral antibiotics should also be assessed after 12 weeks.

What happens if my skin reacts to the treatment?

If it’s a cream or gel, reduce the number of times you apply. For example, if you use it twice a day reduce it to once a day, or if you use it once a day use it alternate days or 3 times per week.

When starting with retinoids, you can apply a thin layer of moisturiser first, then the retinoid. Leave it to dry for 10 minutes then apply your moisturiser. This process is sometimes called “retinoid sandwiching”.

It is also a good idea to apply retinoids at night and wash them off the next morning. Let your skin dry before getting into bed to save the treatment from rubbing off on your pillow.

If the reaction is severe, stop treatment for a few days and use a non-oily moisturiser until it settles. If you have reacted to an oral antibiotic, seek medical advice from your GP.

What sort of diet might help with acne?

Some people see an improvement in acne when they follow a low GI diet i.e., reduce carbohydrate and sugar intake, as well as dairy. It's best to eat plenty of fresh fruits, vegetables, and legumes. Drink plenty of water and eat fish high in omega-3 oils such as herring, mackerel, salmon or tuna. There are also plenty of vegetarian sources such as chia seeds, flaxseeds, and edamame.

What skincare regime should I use?

Harsh exfoliators and repeated washing damage the skin barrier and are not recommended. It's best to use a gentle cleanser with a PH of around 5.5 (higher PH products may cause skin barrier dysfunction). Use oil-free make-up and an oil-free sunscreen is essential to prevent skin damage and flare-ups.

Does lack of sleep cause acne?

It’s possible. Poor sleep can increase stress levels and release the stress hormone CRH from the hypothalamus of the brain. CRH increases sebum production and stimulates testosterone release resulting in an oilier complexion which can trigger acne.

What does stress acne look like?

The appearance will be like typical acne – open and closed comedones, redness, inflammation leading to sometimes cysts and scarring. However, the cause will be more obvious, like a stressful life event, e.g. starting a new job or sitting for exams.

References:

NHS, Acne diagnosis

NHS, Acne treatment

National Eczema Association, warnings for topical steroids

American Academy of Dermatology, Acne diet

Health line, Stress acne