Acne

Acne is a common skin condition that happens when the hair follicles (pores on your skin) get plugged with oil and dead skin, causing pimples and spots.

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What causes acne

Acne is caused by a combination of things.

  • Your hormones make the oil-producing glands (sebaceous glands) in your skin produce too much oil (sebum).
  • Dead skin cells are not shed properly and they plug your pores.
  • The excess oil can increase the number of bugs (bacteria) on your skin.

These things together can cause inflammation, leading to red, pus-filled spots.

Several things can contribute to acne, including:

  • changes in sex hormones around puberty
  • changes in female hormones related to periods, pregnancy, stopping or starting oral contraceptives and polycystic ovary syndrome (PCOS)
  • a family history of acne.

Your diet may contribute to your acne or make it worse, particularly if you have a lot of:

  • cow's milk
  • refined carbohydrates such as white bread and white rice
  • potatoes
  • sugary drinks and foods.

Symptoms of acne

You can get acne at any age, but it is most common in rangatahi due to their changing hormone levels.

Acne nearly always affects the face but can be on your neck, back and chest. It can range from being mild (a few spots) to severe (many spots that may leave marks or scars on your skin).

Types of spots include:

  • whiteheads (closed plugged pores)
  • blackheads (open plugged pores)
  • small red, tender bumps (papules)
  • pus-filled pimples (pustules) — they have a white tip in the centre
  • large, hard, painful lumps under the skin (nodules)
  • painful, pus-filled lumps under the skin (cysts) — these can look similar to boils.

Self care for acne

  • Do not pick your skin or squeeze your pimples. This will only make things worse and could lead to scarring.
  • Keep your skin clean with a gentle, non-abrasive cleanser.
  • Shampoo your hair regularly and keep your hair off your face.
  • Avoid the sun and tanning beds as tanning damages your skin and can make your acne worse.
  • Look for make-up brands designed for acne-prone skin or labelled 'non-comedogenic'. Always remove your make-up before going to sleep.
  • Be careful when you shave your beard area — use light pressure and make sure your blade is sharp.
  • Eat healthy and nutritious foods and have regular meals.

Eating well for good health

Acne can cause a lot of distress and affect your mood and self-esteem. See your healthcare provider or speak to someone you trust if you have any of these feelings.

Treatments for acne

While there is no cure for acne, there are several treatments available. Along with self-care, they can be very effective at stopping new spots from developing. They can also reduce scarring.

Most treatments work by cleaning your skin and drying up excess oil (sebum). They also reduce germs (bacteria) and inflammation.

You need to try an acne treatment for 3 months or more to see if there is any improvement.

Before starting any acne treatment, talk to your GP, pharmacist or other healthcare provider. They will advise whether a product is right for you.

Topical (rub on) treatments

Topical treatments are ones you put on your skin, rather than medicines you swallow. They include creams and gels. Some creams you can buy from the supermarket or pharmacy. But you will need a prescription for the stronger creams.

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Benzoyl peroxide works as an antiseptic to reduce germs on your skin. This can reduce inflammation and prevent pores from blocking. Brands include Benzac AC, PanOxyl, Clearasil Ultra, Clean and Clear Cleanser.

Treatments come in 3 strengths. You can buy 2.5% and 5% benzoyl peroxide from the supermarket or pharmacy without a prescription. To buy the strongest preparation (10%), you need to go to a pharmacy. It is best to start with a lower strength, especially if you have pale skin.

Benzoyl peroxide — Healthifyexternal link

Azelaic acid treatments are gentler on your skin than benzoyl peroxide. You can use them for more widespread acne. They work by getting rid of bacteria and dead skin.

You can buy some azelaic acid treatments from the pharmacy without a prescription. Brands include Skinoren and Azclear.

Topical antibiotics cut down the bacteria on your skin that can infect blocked pores. You will need a prescription for a topical antibiotic. The most prescribed is clindamycin cream. Sometimes the clindamycin cream also contains benzoyl peroxide.

If it does not, your healthcare provider will tell you to use the topical antibiotic with a benzoyl peroxide product or a topical retinoid.

Clindamycin —My medicinesexternal link

Topical retinoids are creams or gels that work by removing the dead skin from the top of your skin. This is called exfoliating. This helps reduce the number of new spots forming. It also prevents inflammatory (red and swollen) acne.

You can buy many products containing low-dose topical retinoids at a supermarket or pharmacy. Some higher-dose retinoids are available on prescription. Some are subsidised, which means they are cheaper.

Prescription brands include ReTrieve cream and Differin cream. Differin also comes as a gel.

You should apply topical retinoids at night. It is particularly important to avoid sun exposure when using them.

You should not use topical retinoids if you are pregnant. If you are of child-bearing age, you should use effective contraception.

Oral treatments

Oral treatments are medicines that you swallow such as pills or tablets.

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Oral antibiotic tablets called tetracyclines can be prescribed to treat acne. The most common is doxycycline.

The antibiotic erythromycin is used for children 12 years old and younger. It is also for pregnant women and other people who cannot take or do not respond to tetracyclines.

Doxycycline — My medicinesexternal link

Erythromycin — My medicinesexternal link

The low-dose combined oral contraceptive pill (the pill) can be used to treat women with mild acne.

Combined contraceptives contain both estrogen and progesterone. All combined oral contraceptives are effective for acne. But it may take up to 6 periods (menstrual cycles) for you to see an effect.

Combined oral contraceptiveexternal link

Progesterone-only contraceptives (mini-pills) such Noriday and Cerazette do not help with acne. They may even make it worse.

The anti-androgen (hormone blocking) medication, spironolactone can improve acne in women. It can also help with unwanted hair growth.

Spironolactone – My medicinesexternal link

Isotretinoin may be used to treat severe acne. This is a very effective treatment though it can have side effects in some people including:

  • dry skin and lips
  • headaches
  • muscle aches
  • change in mood.

If you are worried about any of these talk to your healthcare provider. The side effects will usually go away when you stop the medication.

It is particularly important to avoid sun exposure when using isotretinoin.  

You must not use isotretinoin if you are pregnant. If you are of child-bearing age, you should use effective contraception.

Isotretinoin — DermNetexternal link