Acne Patient Information Leaflet

What is Acne?

• Acne is the common cause of spots for people in their teens to their mid twenties, but older people may be affected.
• Acne usually occurs mainly on the face, it may also affect the back and chest area.
• Acne may vary from mild to severe.
• If severe it may lead to scarring so early treatment is recommended.

What are the causes of Acne?

• Normal skin has sebaceous glands which produce natural oils.
• During puberty production of these oils increases.
• This causes blockage of the sebaceous glands. The trapped oils in the glands allow bacteria known as Propionibacterium acnes to multiply.
• This in turn results in an immune reaction and inflammation of the skin.
• Acne may be associated with other medical conditions such as polycystic ovaries
• Some medications may make acne worse such as progesterone only contraceptives, steroid creams used in eczema, anabolic steroids and some antiepileptic medications.

What are the types of Acne?

There are two main types of acne lesion- non-inflammatory and inflammatory. Many people have a mixture of these. Different treatments may help one type more than another- some treatments help both.

Non-inflammatory lesions:

• Whiteheads or “closed comedones”– these are closed, oil-plugged pores.
• Blackheads or “open comedones” -these are open plugged pores — the oil turns brown when it is exposed to air.

Inflammatory lesions:

• Papules- these are small, sore red bumps
• Pustules- these are also known as pimples, and are papules containing pus
• Nodules- these are large, solid, painful lumps under the skin
• Cysts- these are large, painful, pus-filled lumps under the surface of the skin

Severity:

• Mild Acne- usually consists of ‘whiteheads’ and blackheads’- (picture)
• Moderate acne- usually consists of pimples or papules in addition to whiteheads and blackheads- (picture)
• Severe acne- usually consists of more severe inflammation with the presence of spots filled with pus (pustules), which may form nodules and cysts. This may result in scarring or post-inflammatory pigmentation)

What are the treatments available for acne?

• Treatment depends on the type and severity of your acne.
• The aim of treatment is to clear the acne and to prevent scarring.
• Treatments are either topical creams or gels (applied to the skin), or oral tablets.
• Treatments can take up to 8 weeks to provide full benefit.
• Once your acne has cleared it’s recommended you stop treatment.
• It is not uncommon for symptoms to flare up again in which case you may need to restart treatment.
• Sometimes you may need to continue with treatment long term, on the advice of your doctor.

Daily skin care tips for acne

• Wash as you would normally using mild soap and lukewarm water.
• Antiseptic washes may be of some benefit.
• Do not use ointments or oil rich creams as they may clog the skin pores. A water based moisturiser is probably best.

Topical treatments

Benzoyl peroxide

• This is a very common topical treatment especially in mild-moderate acne.
• It works by killing the bacteria Propionibacterium acnes, reducing inflammation and helping to unplug blocked pores.
• It comes in various strengths (2.5%-10%) and is available over the counter at the pharmacy.
• It is usually applied once or twice daily.
• The most common side effect is that of initial skin irritation- usually the skin develops tolerance after a week or so- using a lower concentration may be beneficial if this is a particular problem.
• Benzoyl peroxide may be combined with antibiotics to provide ‘dual action therapy’.’

Azelaic acid

• Azelaic acid is an alternative that mainly works by unplugging blocked pores.
• It usually causes less skin irritation than benzoyl peroxide.
• Treatment is only licensed for up 6 months.

Topical Retinoids

• Topical retinoids are a group of medications that work by unplugging blocked pores and reducing inflammation.
• The most common side effects are skin irritation (including dryness, redness and peeling).
• Topical retinoids also increase sensitivity to sunlight,therefore sun protection is advised.
• Various strengths are available.
• Appropriate contraception must be used during treatment and fully discussed with your regular doctor.
• Topical retinoids are not used in those who are pregnant or intending to conceive as there is a risk of harm to unborn babies.

Topical antibiotics

• Topical antibiotics work by reducing inflammation and the number of bacteria.
• They usually cause less skin irritation than benzoyl peroxide or retinoids.
• Topical antibiotics may be combined with either Benzoyl peroxide or topical retinoids which usually work better than either medication alone.

Oral medications

Antibiotics

• Oral antibiotics work by reducing inflammation and the number of bacteria.
• They do not unclog the pores so you may be advised to use a topical treatment such as benzoyl peroxide at the same time.
• Topical treatment may also reduce the risk of bacteria becoming resistant to your oral antibiotic.

Oral Contraceptive Pill

• The contraceptive pill may help women with their Acne particularly if it seems to be related to hormonal changes.
• Not all women may be suitable for this type of treatment and should only be started on the advice of a doctor.

Oral Retinoids

• Oral retinoids (such as Roaccutane) are extremely effective for more severe cases of Acne
• They work by reducing the amount of oil made by the sebaceous glands of the skin.
• This type of treatment should only be started by a dermatologist because there are potentially serious side-effects.
• If you have tried other treatments and they have not been effective or if you feel you have severe Acne then it may be worth seeing a dermatologist for an opinion.
• Qoctor can provide a referral to see a dermatologist for acne (link).

Repeat prescriptions for Acne treatment are available at www.qoctor.com.au should you fulfil the criteria for prescribing.

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