Treating Acne: Methods, Risks, and the Accutane Controversy

What Is Acne and What Causes It?

According to the National Health Service (NHS) Direct Online Health Encyclopaedia, acne affects a person's hair follicles and the sebaceous glands in the skin, "which secrete an oily substance called sebum" — a fatty lubricant material. The places on the body most commonly afflicted with acne are the face, arms, back, and chest.

Acne usually begins to affect a person's skin around the time of puberty, the NHS explains, though it can also begin in adulthood. Only 20% of people in the UK go through life acne-free; for those not so fortunate, the onslaught can happen generally between the ages of 11 and 30.

Why does acne appear on the skin around the time a person reaches puberty? The NHS Direct Online Health Encyclopaedia's "Acne Introduction" section explains that changes to a person's hormone levels create a condition in the sebaceous glands that produces excess amounts of sebum. The sebum, together with dead skin cells, "blocks the hair follicles, which enables the formation of spots ranging from blackheads to painful red nodules," the NHS reports.

The NHS Direct Online Health Encyclopaedia's "Acne Causes" page adds that the increased hormone level is actually the presence of the hormone testosterone, which — as some may not realize — is present in both boys and girls. Testosterone triggers the rapid division of skin cells, resulting in a blocking of the hair follicles. This is a slightly different explanation from the "Acne Introduction" page, which did not mention testosterone as a contributing factor. The "Acne Causes" page further explains that changes in skin acid levels during puberty also "encourage the growth of bacterium," which becomes trapped in hair follicles.

When acid is trapped in hair follicles, the resulting pimple is more severe — a "deeper infection" in the form of pustules and nodules. The "Acne Introduction" page explains that "acne usually corrects itself over time," so a person could technically choose not to treat it; "in most cases it should get better without treatment," the NHS reports. However, for some individuals, allowing the acne to go untreated "may take years" and "can potentially cause permanent scarring." Hence, the NHS recommends treatment.

The "Acne Causes" page offers additional information on causes of acne: (1) it may be genetically passed on through family trees; (2) stress causes existing acne to worsen; (3) girls may experience increased acne breakouts during menstruation; (4) some drugs — including corticosteroids, anti-epileptic medicines, and oral contraceptives — may aggravate acne; and (5) exposure to dangerous chemicals called dioxins may cause a rare form of acne called chloracne.

Heavy intake of chocolate and greasy fried foods does not cause acne, the NHS states. However, failure to wash one's face, especially during puberty and the teenage years, can indeed help acne blemishes take hold. The NHS "Acne Prevention" page notes that acne "is not infectious" and is not caused "by poor hygiene," though washing one's face and removing make-up before going to bed are helpful preventative measures.

Traditional Treatments for Acne

The NHS website includes a link to "Wellingborough LHG Acne Treatment Advice," which provides treatment information for mild, moderate, and severe acne. For "mild acne" — defined as open and closed comedones along with several small papules and pustules — topical Adapalene (Differin) gel or cream, Isotrexin or Retin A gels, and/or Benzoyl peroxide 2.5–5% gel are recommended. For "moderate acne," characterized by numerous comedones, small inflammatory papules, and numerous pustules, both oral and topical remedies are recommended: topical treatments (Zineryt, Zindaclin, Benzamycin) and antibiotics (Oxytetracycline, Lymecycline, Erythromycin, Minocycline, Doxycycline, and Trimethoprim).

In the case of "severe acne" — numerous comedones, deeper papules and pustules, deep and large lesions, and nodules, cysts, or abscesses — the Wellingborough LHG advice is to use systemic and topical treatment similar to that for moderate acne, plus immediate referral for Roaccutane, with a blood test at the time of referral. Severe acne cases also require systemic antibiotic therapy for 3 to 36 months.

The Acne-Rosacea.co.uk website takes acne severity to an additional level: "very severe acne" requires urgent referral to a hospital specialist for mega-dose antibiotics and possibly oral isotretinoin.