Saturday 19 October 2019

Dear Dr Nina: I'm worried my daughter will have bad acne like me

Acne is most common between the age of 14 and 17 in girls
Acne is most common between the age of 14 and 17 in girls

Nina Byrnes

Question: I have an 11-year-old daughter and I am worried that she will suffer from the same dreadful acne that plagued me as a teen. I am now in my late 40s and had acne from the age of 12 until into my late teens. I tried everything at the time - antibiotics, the pill, topical treatments - and nothing made a significant difference. It destroyed my confidence and I am afraid that my daughter will go through the same, as she seems to have the same skin as I do. Are the treatments better these days? How do GPs handle acne now?

Dr Nina replies:  Acne is most common between the age of 14 and 17 in girls and 16 and 19 in boys. It disappears in most adults into their 20s, but persists beyond the age of 25 in 5pc of women and 1pc of men.

Acne can run in families. Stress can play a role. The exact mechanism is not known. Bacteria in the pores can make the situation worse, but acne is not a condition of poor hygiene. It is not true that greasy food and chocolate can cause acne, but it is well known that a diet high in unrefined carbohydrates (ie. sugar) can make acne worse. Conversely, a low glycaemic-index diet (ie. one high in fruits vegetables and fibre) can help improve the situation.

The increase in the male hormone testosterone during puberty causes an increase in sebum secretion and, therefore, makes congestion more likely. Women who have conditions associated with higher male hormone levels, such as polycystic ovarian syndrome, have a higher incidence of acne.

Treatment is often recommended based on how severe the acne is. If there are a few inflamed pimples, but mainly blocked pores with small blackheads and whiteheads, then starting with a cream or lotion that is applied to the skin may be advised.

Combination products are often advised. The best of these are those that contain benzoyl peroxide. This substance helps clear the keratin plugs and also helps reduce bacteria in the skin.

Another prescription medication applied to the skin is Retin A. This is a vitamin A-based product and it causes an irritant effect to the skin that dries out the upper layers, reducing the chance of keratin plugging and inflammation.

The next step is often a prescription for an antibiotic that is applied to the skin or taken daily by mouth. These are effective in about 70pc of people, but may take several weeks to work. The normal course is three to six months. It is unlikely that lotions or creams alone will work for more extensive acne.

In women,the contraceptive pill can be a very effective way of controlling skin changes. These pills reduce the circulating levels of testosterone in blood. The pill can take three months to have an effect, but skin may continue to improve over the next six months. For those with severe, unresponsive acne, treatment with a prescription drug called Roaccutane can be transforming.

More recently, skin treatments such as dermabrasion, light therapy and laser are becoming more popular for acne and can be especially helpful in reducing scarring.

Active acne increases the risk of facial scarring and causes distress to many of those afflicted. The goal of acne treatment now is to start treatment early. Teenagers should not be left to "grow out of it" as scarring can be permanent.

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