Acne

Extremely common, frequently under-treated, and the scarring it leaves is both physical and not.

What it is

Acne affects around 95% of people aged 11 to 30 to some degree. Being common is not the same as being trivial.

It happens when hair follicles block with oil and dead skin, bacteria multiply, and inflammation follows. Hormones drive it, which is why it starts at puberty and why it can persist or return in adult women.

Two things get it wrong repeatedly. It is not caused by poor hygiene, and scrubbing makes it worse. And it is not caused by chocolate or chips, though there is modest evidence about high-glycaemic diets.

The reason for treating it properly and early is scarring, which is permanent, and psychological harm, which studies place on a par with chronic physical illnesses.

Signs you might notice

Blackheads and whiteheads, on the face, chest and back.

Red inflamed spots, and deeper painful nodules or cysts in more severe acne.

Scarring: pitted, raised, or discoloured marks left behind.

Distress out of proportion to the visible severity, which should be taken at face value rather than argued with.

How it can affect day-to-day life

The mental health impact is the part most often dismissed. Acne is associated with significantly raised rates of depression, anxiety and suicidal thoughts in adolescents, and being told it is just spots compounds it.

Under-treatment is common. People are given a mild cream, told to persist, and never escalated, while the scarring accumulates.

Isotretinoin is highly effective for severe acne and requires careful monitoring, including pregnancy prevention and attention to mood. That monitoring is a reason for care, not a reason to withhold it.

Supporting someone well

Treat early and escalate. Any acne causing scarring or distress deserves proper treatment now, not in six months.

Give treatments 8 to 12 weeks before judging them, and expect an initial worsening with some.

Do not scrub, and do not use harsh products. Gentle cleansing twice a day.

Do not pick or squeeze. This causes the scarring that lasts.

Use non-comedogenic moisturiser and sunscreen, especially with retinoid treatments.

Take the distress seriously, in adolescents especially, and ask about mood.

Ask about dermatology referral for severe, scarring or treatment-resistant acne.

Where to get help

A GP or pharmacist can start treatment and refer to dermatology.

The British Association of Dermatologists publish patient information leaflets on every treatment.

Ask about mood at every review of severe acne, and particularly on isotretinoin.