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Acne Causes and Our Stepwise Approach to Its Management

Acne Causes and Our Stepwise Approach to Its Management

Date : Thu, 12 Sep 2019

What is Acne?

Acne is a skin condition characterised by painful spots on the surface of the skin, most commonly affecting the face, chest and back. It is a common condition that affects most people at some point in their lives. Acne spots vary in nature and can present themselves differently in different people. There are 6 types of spots that a person with acne may be affected with including:

Whiteheads – Small white spots like blackheads

Blackheads – Small black spots

Papules – Red spots which may feel tender or sore

Pustules – Like papules but contain pus in the centre giving them a white appearance

Nodules – Much larger than typical acne spots, painful and tender and can penetrate deeper into the skin

Cysts – Largest and most severe type of acne characterised by large tender lumps (like boils) that can be quite painful and pose the highest risk in terms of scarring. 

What causes Acne?

Our skin contains tiny pores through which hair grows known as follicles. Acne is caused when these pores become blocked. Within these pores are sebaceous glands, whose primary role is to secrete an oily substance called sebum which helps lubricate the hair as is grows out of the follicle. When these glands overproduce sebum, it can lead to a build-up of dirt, dead skin and bacteria that normally live harmlessly on the skin. This leads to blockage of the pores and subsequent spot formation.

There are numerous factors which can affect this spot forming process leading to worsening of acne. Some of these factors are:

·        Testosterone – A natural sex hormone which rises during puberty. It is thought that testosterone stimulates the sebaceous glands leading to overproduction of sebum. Therefore,teenagers going through puberty notice that their skin becomes oilier. The over production of sebum increase acne outbreaks.

·        Menstrual cycle – Again due to changes in hormones, some women note they have flare up of acne just before their periods.

·        PCOS (polycystic ovary syndrome) – This condition occurs due to formation of small cysts on the ovaries. This can result in weight gain, hirsutism (hair growth) and acne.

·        Hereditary – Acne can be more prevalent in families that have a history of acne. If both parents suffer from acne, it is likely children will also suffer.

·        Cosmetics – Less of a problem now, due to testing and research.

·        Medications– Such as Hormones, Contraceptive pills and epilepsy medication.

·        Wearing Hats/Headbands – Can increase blockage of pores and increase breakouts.

·        Smoking


There are a lot of myths around what causes acne, the following are some of these which have no evidence to support their claim:

·        Acne is caused due to poor diet/chocolate

·        Acne is caused due to poor hygiene and dirty skin

·        Acne is influenced by sexual activity

·        UV lamps and sunbeds help improve acne

·        Squeezing spots is the best way to help acne

·        Acne is contagious


How you can help yourself

There are many things you can do to help control your acne. While they may not completely prevent you from getting spots, they may provide better control and lower the risk of scarring. The following are some steps you can do:

·        Do not over wash the skin – whilst it is correct that acne occurs due to a build-up of dirt and oil in pores, over washing doesn’t help and can make it worse! Frequent washing can cause dry the skin leading to more irritation and more oil production which is one of the factors causing spots.

·        Use lukewarm water to wash – using extremes of water temperatures to wash can make acne worse.

·        Use mild soaps or cleansers – using harsh soaps and cleansers can irritate the skin as well as cause over drying.

·        Avoid touching the acne affected areas as this can transfer more dirt and bacteria onto the face.

·        DO NOT SQUEEZE SPOTS – this is possibly the worst thing you could do. Not only doesn’t it increase the chances of pushing the acne deeper into the skin but it increases the risk of scarring. Acne eventually goes but scars can be permanent!

·        Avoid using too much make up and cosmeticsas these can block pores and lead to spots. Avoid using too much and try to buy products that are described as non – comedogenic (less likely to clog up pores in the skin)

Treatment of Acne and using a stepwise approach

There are many products to help manage acne, each with their own pros and cons and some working better for some people than others. It is important to remember that all acne treatments can take up to 6-8 weeks to start having a noticeable difference to your skin. Unfortunately, there is no quick fix to acne, but with persistence and patience, you can see a marked improvement in your skin with some people having complete resolution of their acne.

We usually advise trialling simple topical preparations that contain Benzyl Peroxide that can be bought over the counter, such as Acnecide, and then moving up to combination topical preparations containing antibiotics or retinoids.

We do not advise using oral antibiotics until all topical preparation have been tried, due to the possibility of experiencing more troublesome side effects. You should never use oral antibiotics by themselves as this increases the risk of antibiotic resistance. This can be reduced by using a topical preparation containing benzyl peroxide and or a retinoid. You should not use oral antibiotics and topical preparations containing antibiotics together.

We advise the stepwise approach below to managing your acne.


Benzyl Peroxide topical treatment

  • Acnecide (Benzyl peroxide) works in 3 ways:

1.      It kills bacteria

2.      Reduces inflammation

3.      Helps dry and unblock pores

If you see no difference in your skin after 6-8 weeks you should stop and move to step 2.



Topical Antibiotic OR Topical Retinoid

  • Zineryt (Topical Antibiotic) contains the active ingredient, Erythromycin which belongs to a group of antibiotics called macrolides. It helps to eliminate acne forming bacteria on the skin, thereby reducing spots and inflammation. It comes as roll on, which can be particularly handy if your acne is affecting large areas such as the chest or back. For more information, please read the patient information leaflet here.


  • Differin (Topical Retinoid) contains the active ingredient adapalene. Retinoids work by unclogging the pores of the skin and preventing build-up of dead skin cells and oil which can lead to bacterial growth and acne. They are derivatives of vitamin A and can be applied topically or taken orally (under specialist supervision only). For more information, please read the patient information leaflet here.

We advise to try one of the above for 6-8 weeks and if you do not see any benefit, to switch to the other preparation and try for 6-8 weeks. If both fail, you can stop using the preparation and move onto step 3.



Combination topical preparation

There are 2 combination preparations we supply for acne:

  • Duac (Antibiotic + Benzyl Peroxide) contains the antibiotic clindamycin and benzyl peroxide in 2 different strengths (3% and 5%). It has a dual action, fighting bacteria on the skin which can lead to acne as well as helping to unblock pores. For more information click here.


  • Epiduo (Retinoid + Benzyl Peroxide) contains the retinoid adapalene and benzoyl peroxide. It also has a dual action, fighting bacteria on the skin as well as unblocking pores. For more information click here.

As with STEP 2, we recommend using one for 6-8 weeks and switching to the other if you do not see any benefit.



Oral Antibiotic

  • Lymecycline (Brand name Tetralysal) is a tetracycline type antibiotic commonly used to treat acne. It works by reducing acne forming bacteria found on the skin. It comes in a capsule form and is taken once a day for up to 3 months. After 3 months, the treatment should be stopped as continuous use beyond this period can lead to antibiotic resistance. To learn more about antibiotic resistance and its risks please click here

Step 4 should always be used in combination with a topical treatment, such as benzyl peroxide (Acnecide), adapalene (Differin Cream/Gel) or both (Epiduo) as this helps prevent the development of resistant bacteria. It should NOT be used with any other antibiotic containing preparation (Zineryt & Duac).


Most acne treatments can’t be purchased over the counter and require a prescription from an appropriate practitioner. At Ask A Pharmacist, we can save you time and money, by providing prescription treatments, delivered direct to your door without leaving the comfort of your home or office. Simply choose your product, answer a simple questionnaire and pay for your item(s). Our prescribers will issue a prescription for your item and pass onto our dispensary team for dispatch. This all happens in house, which helps keep our prices very competitive and ensures a speedy delivery to our customers.