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Acne

Information about the skin condition acne and guidance on the support available through Changing Faces and other organisations.

What is acne?

Acne is a common skin condition which causes spots, oiliness and sometimes hot or painful skin.

It affects most people at some stage in their lives. It is often linked to hormone changes during puberty, with about 95% of those aged 11 to 30 affected at some point. In girls, it is most common between the ages of 14 and 17, with boys most often affected between the ages of 16 and 19. Symptoms usually disappear after a number of flare-ups, often in the mid-20s. About 3% of people have acne after the age of 35.

Whether you experience persistent acne or occasional flare-ups, you may feel self-conscious about the effect the condition has on your appearance. However, there is plenty of support available to help you manage these difficulties. On this page, we explain what acne is, acne symptoms and the acne support we can provide to help you manage the impacts it may have on your life.

Signs and symptoms

In most people, acne symptoms affect the face. More than half have acne symptoms on their back and about 15% on their chest.

There are six types of spots associated with acne:

  • Blackheads: Small black or yellowish lumps. Along with whiteheads, blackheads are a type of “comedone”.
  • Whiteheads: A type of comedone similar to blackheads, with a white tip. Whiteheads are firmer than blackheads and do not empty when squeezed.
  • Papules: Small red bumps, tender or sore.
  • Pustules: Similar to papules, but with a pus-filled white tip in the centre.
  • Nodules: Large, hard lumps, often painful, which build up beneath the skin surface.
  • Cysts: Large, pus-filled lumps which resemble boils.

Spots caused by acne, especially cysts, may cause permanent marks, scarring or discolouration. This can leave bumps or indents in the skin, or skin that is redder, darker or lighter than your natural skin tone. There are treatments and services which can lessen the permanent effects of acne.

Causes of the condition

Acne is linked to changes in hormone levels. Most commonly, this happens during puberty but it can occur at any age.

In people with acne, the glands are more sensitive even to normal levels of hormones. This causes the grease-producing glands next to hair follicles to make larger amounts of oil than usual. This in turn causes the skin bacterium Cutibacterium acnes (“C acnes”) to become more aggressive, leading to inflammation and the production of pus. Hormones also thicken the lining of the hair follicles. The excess oil and dead skin then block the pores, causing spots to form.

Hormonal changes linked to menstruation (periods) or pregnancy can cause acne in women.

Acne can also be brought on by medication taken for other health conditions, contraceptive pills or injections, and hormone-containing tablets taken by body-builders.

There is also some evidence that eating high glycaemic index (GI) foods can cause or aggravate acne. This includes sugary foods and drinks, white bread, potatoes and white rice.

Is acne genetic?

Acne tends to run in families. If both parents had or have it, it is more likely that you will have it too. However, many people with acne have no family history of the condition.

Types of acne

There are many types of acne. You can visit the DermNet NZ website to view a comprehensive list of the different types. Here are a few of the most common types of acne:

Acne vulgaris

Acne vulgaris is the “classic” and most common type of acne. It is characterised by comedones, papules, pustules and cysts.

Nodulocystic acne

This is a severe type of the condition affecting the face and upper body, which can leave scarring. It comes in various forms.

Acne fulminans

Acne fulminans is rare but it can be severe. It usually affects teenage boys and causes symptoms such as fever, malaise, appetite loss, joint pain and enlarged liver and spleen. It may be caused by an increase in androgens (a group of hormones) or an autoimmune response (the body attacking itself). It can also be caused by a hypersensitivity to the bacterium “C acnes” (discussed above) and some people may have a genetic tendency towards it. If you have it, it is important that you see a dermatologist straight away.

How is acne diagnosed?

Acne is easily diagnosed by a GP due to the appearance and distribution of spots.

Treatments for acne

Acne cannot be cured but many of the treatments available are highly effective.

There are five main treatments:

  • “Topical” treatments which are applied straight to the affected area. This is usually the first thing you will try.
  • Antibiotics taken by mouth may be prescribed if a topical treatment on its own doesn’t make your acne go away. You’ll usually carry on with the topical treatment as well.
  • Oral contraceptives containing the hormone blocker cyproterone acetate – which reduces the amount of oil produced – may help some women with acne.
  • If you have severe or persistent acne, you may be prescribed stronger medication by a consultant dermatologist. They will talk to you about the potential risks and benefits involved and help you decide whether it is the right treatment for you.
  • Light and laser therapy have mixed results against acne and tend to have a limited effect on severe acne.

You can find out more about these treatments on the NHS website.

If you have acne, you should also take self-care measures to avoid making your acne worse:

  • Do not pick or squeeze spots.
  • Do not wash spots more than twice per day.
  • Use an oil-free soap substitute to clean affected areas.
  • Avoid makeup and cosmetics if you can. Use water-based (“non-comedogenic”) products which are less likely to block the pores.

Acne and my appearance

You may feel self-conscious about the spots and redness caused by your acne, particularly as acne often affects the face.

You may notice people staring at you, and sometimes others may even pass comments or ask questions. Many people experience acne during their teenage years, a time when many of us start to feel more anxious about the way we look anyway.

What acne support can we offer?

There is plenty of support available if you are struggling with the impacts of living with acne.

Here at Changing Faces, we offer confidential, one-to-one social, emotional and psychological support for adults and young people through our counselling and wellbeing support service. Our trained wellbeing practitioners will work with you over a series of sessions, and many people find it helpful to talk through their thoughts, feelings and experiences.

We have a number of self-help guides to steer you through different aspects of life with a visible difference. This includes guides on coping with the mental health impacts of living with a visible difference like acne and practical tips to boost your self-confidence, as well advice on coping with school and work life and even social media.

You don’t have to hide your acne to fit into society’s expectations. However, if you decide that this is the right option for you, we may be able to help reduce the visible effects of acne or marks or scars left by acne through our Skin Camouflage Service. We cannot apply skin camouflage to skin that is infected, inflamed, or broken, so please contact the team to find out what we can do for you.

There are a number of ways we can support people with acne here at Changing Faces:

  • Online Community: An online forum moderated by Changing Faces staff, where you can talk to others with acne and other visible differences.
  • Peer Group Chat Service: An online support group of up to eight participants, taking place on Zoom or in a chatroom and facilitated by Changing Faces staff.
  • Workshops for children and young people and their parents: An opportunity to meet others and learn tools, tips and techniques for managing challenges with your visible difference.
  • Real stories: Read stories by other people living with skin conditions such as acne.

If you would like to use our services, please contact our Support and Information Line. As well as providing information and access to services, our friendly team can offer support calls for you to talk about the impact of acne on your life.

Other organisations

Guidance, support and advice is also available from other organisations. Please follow the links to their websites to learn more.

British Association of Dermatologists (BAD)

BAD specialises in the practice, teaching, training and research of dermatology (the branch of medicine dealing with the skin). They offer patient information on acne, general advice for people with skin conditions and opportunities to take part in research for skin conditions.

British Skin Foundation logo

British Skin Foundation

The British Skin Foundation provides patient information on skin conditions including acne. It also offers number of online forums for people with skin conditions to talk to other patients and medical experts, and opportunities to raise awareness of acne and its impacts by sharing your story.

Outlook logo

Outlook

A national, highly specialist psychological service based at North Bristol NHS Trust, supporting adults (16+) with appearance-related distress. They can provide face-to-face and remote support via NHS Attend AnyWhere. Please speak to your GP or healthcare professional to discuss a referral.

NHS

Please have a look at the NHS conditions page for official guidance on the main types of acne, treatments and things you can try to reduce symptoms, and information about when to see a GP. You will also find information about the current impact of coronavirus (COVID-19) on NHS services.