A-Z

Acne (young people)

What causes acne?

The medical explanation for acne is that it is caused when skin pores/follicles become blocked. This doesn’t mean that the person with acne is ‘dirty’, as the source of blocked pores can come from inside the body (when the sebaceous glands produce too much oil). A spot (of which there are different types) develops when the blocked pore is infected by the normal bacteria living on the skin. Acne often affects the face because there are lots of sebaceous glands located there. Some people tried to reduce the chances of bacteria getting into the blocked pore by doing things like frequently washing their pillowcases and keeping hair off their face. Other things, such as dried skin flakes, can add to blocking pores. Marga thought the eczema she had in winter also contributed to her acne becoming more severe.
 

Dr McPherson talks about what happens in skin with acne.

Dr McPherson talks about what happens in skin with acne.

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Okay. So we're just going to talk about acne [sketching]. So that's a close-up of the skin. That's your hair coming out of a hair follicle. And this is a sebaceous gland, which produces something called sebum into the surrounding area. So in acne you've got more sebum. And then you get kind of hyperkeratosis, and that sort of plugs up this pore, which is what you see as a pore in the skin. And then you can get bacteria and inflammation, and you can get pus and pustules. So there's different types of acne lesions. There’s the comedones, which are kind of we know as whiteheads and blackheads. And then you can get the pustules. And then obviously all of these can then lead to, in some cases, marks or scarring. Which is why we particularly want to, you know, treat acne, before you get any scarring. 
There can be different reasons for developing acne (i.e. when the sebaceous glands in their skin start to over-produce oil), such as changes in hormones during puberty. Some people find their acne continued after puberty and into adulthood, but the principle (that the pores become blocked) is the same.
 

Deborah talks about how her acne has changed over time.

Deborah talks about how her acne has changed over time.

Age at interview: 25
Sex: Female
Age at diagnosis: 12
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Would you be able to say a bit more about those differences between sort of teen acne and then adult acne?

Yeah. Yeah, absolutely. I've always had oily skin, with my acne. But while I was a teenager it was incredibly oily. My skin's sort of normalised more from that now. But I've found as I've become less oily skin, I've got larger pores. Which now is my main problem with acne, because the larger pores are more prone to it, rather than it being the oily skin. So now I'm more focused on getting the right moisturisers, getting - staying hydrated, drinking lots of water, things like that. Whereas when I was a teenager it was all just oil control. Which make-ups can I use, which things can I take to sixth form to wash my face with at lunch, or you know, you can buy those little towel bits of paper that soak up all the oil and things. So I think it definitely has changed quite a bit. I mean, even before, when I first got my breakouts - I can't even remember what my skin was like then. I was 12, you know? I think my skin was just changing so often. I do have quite sensitive skin as well, I've always had that. So that's sort of been an added complexity to all of it, because you can't just throw lots of chemicals at my skin without it reacting badly. So yeah, it's definitely different now than how it was before. 
Women sometimes have acne flare-ups around their menstrual cycle (periods) and when trying out a new hormonal contraceptive in a pill or implant. Abbie no longer has acne after taking isotretinoin (e.g. Roaccutane), but she worries that it might return when she gets some spots around her period. Some women, like Marga, found that taking the combined contraceptive pill helped ‘balance’ their hormones.
 

Naomi’s acne returned when she tried the implant (hormonal contraceptive). She had recently stopped taking isotretinoin (Roaccutane) and so didn’t want the contraceptive pill.

Naomi’s acne returned when she tried the implant (hormonal contraceptive). She had recently stopped taking isotretinoin (Roaccutane) and so didn’t want the contraceptive pill.

Age at interview: 22
Sex: Female
Age at diagnosis: 9
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And what about when sort of before you went on the third treatment of Roaccutane (isotretinoin), when it resurfaced, when you had the implant?

Yeah, yeah that was really awful because I’d only sort of a few months before I finished the previous one and I didn’t want to be taking a pill anymore every day because having taken so much medication all my life I just, I thought, you know, I want to be able to get up in the morning and not have to remember to take a pill, not that I forgot but I just, for me it was just another form of medication and I didn’t want that anymore. And so, you know, I went to the GP and they said, you know, “Try this implant” and initially I thought ‘oh well, I’d rather have a coil because they don’t have hormones in’ and like . But when I went to the like sexual health clinic place they were like, “Oh, don’t worry, like we can, we can just put this implant in, it’s really easy and it’s like much less painful than a coil.” and, you know, “If you have any problems, we can just take it out and it’ll be fine” and I think I should have stuck to my guns and said, “No,” but I was like, “Yeah, you know, I might as well.” And so they put it in and within a couple of weeks my skin was just ruined and so I, I was like well maybe I should just wait a bit ‘cos it might improve but it just didn’t get better. So I went back to the clinic place and said, “Please just take this out, I don’t want it here.” and obviously that whole process like took time as well because I had to wait to see if it improved then I had to phone and make an appointment and they didn’t have one for like four weeks. And yeah so then I had that taken out and then I was hoping that that would make things better but it just never really, like I waited for a few months and nothing happened and that was when I was just, I was so upset I just thought like ‘I just want to go private because I can’t face waiting again’.

 

Marga takes the combined pill to help with her acne. Although there is no clear link between diet and acne, she thinks dairy is a dietary trigger of hers and wonders about hormonal links to this.

Marga takes the combined pill to help with her acne. Although there is no clear link between diet and acne, she thinks dairy is a dietary trigger of hers and wonders about hormonal links to this.

Age at interview: 24
Sex: Female
Age at diagnosis: 18
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Did they talk about things like causes and triggers and the sort of medical side of it?

Yes, they went through the fact that it was probably hormonal which is why I was on the Yasmin, and yeah, they basically went sort of outlined the fact that my hormones are probably up and down, and things like that and they said eventually it will level out – which I guess gave me confidence because I knew that this isn't forever, and like it's just because my hormones are quite fluctuating at the moment. Interestingly though, I've-, basically I've given up dairy. This is, they, the doctors didn’t mention anything like this, but I heard from a friend that dairy can actually be a trigger of acne. I've given it up probably about two-, two and a half years now. I still eat it from time to time, so I'll still eat cheese on pizza for example but I switched to soya milk; I don’t drink milk. And that’s been amazing as well for my skin, which is obviously something that the doctor hasn’t really mentioned to me at all. But my skin has got so-, also I've noticed a significant improvement for example when I went off the Lymecycline and had that about six month period, nine month period where I wasn’t on anything apart from the benzoyl peroxide. Even before that, actually before I went on Lymecycline I also had given up dairy and it really, really helped. Because I notice when I now then have cheese I'll, you know, maybe like two or three days in a row, I'll-, I can guarantee that I'll get a few spots which is, you know, I haven’t really mentioned that to my doctor; I don’t know whether I feel a bit stupid saying it because they’ve never mentioned to me that food can be a trigger. So that’s, yeah, that’s another thing that dietary that I've changed as well which I feel like as well helps with that control element cos I feel like, you know, I know that that’s bad for my skin; I wonder whether it's the cow hormones or something in the, in the milk. 
Sometimes acne is related to another health condition which causes changes in hormones and can have other symptoms too, such as polycystic ovary syndrome.

Some people thought there was a genetic factor to their acne as they knew of others in their family (parents, siblings) who had had similar experiences to their own.
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