booklet

In this booklet you will find:
•
•
•
•
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Information on the various types of acne
Lifestyle advice for acne sufferers
Treatment options to assist with managing acne
Expert feedback and compelling real-life stories
Tips on where to get help
Science For A Better Life
Bayer Australia Limited
875 Pacific Highway
Pymble NSW 2073 Australia
Ph: 02 9391 6000
ABN 22 000 138 714
L.AU.WH.05.2012.0251
This booklet has been developed by All About Acne
and Bayer Australia Limited
All About Acne
Foreword
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Co-chair, All About Acne
Contents
Chapter 1.
All About A
cne What is acn
e and how
is it caused?
Who gets a
cne? Types of acn
e
1
1
2
2
Chapter 2.
Acne and Y
our Life Acne’s impa
ct on your q
9
uality of life
Lifestyle advi
ce for acne
9
sufferers Chapter 3.
10
Treatment
Options fo
Skin cleanse
r
A
cne rs 15
Topical thera
pies 15
Antibiotics 16
Retinoids 18
Combined O
ral Contrace
18
ptive Pill Natural rem
edies 20
Treatments
for scarring
21
Chapter 4.
2
1
What do y
ou need to
about you
know
r acne Acne FAQs
23
The role of
the dermato
23
logist in acn
Useful sites
e treatment
for more info
27
rmation Chapter 5.
28
Where to g
et help General Pra
ctitioners (G
29
Ps) Specialists
29
Pharmacists
32
32
1
"Research shows that in the
later years, hormones play a
bigger part in causing acne.
Stress and diet can also be
factors in worsening acne in 20
to 40 year olds."
All about acne
What is acne and how is it caused?
Acne is a common skin disorder
distinguished by whiteheads, blackheads
and pus-filled spots on the face, neck,
back and chest. The condition may
appear for short spans of time in some
adolescents, although it can persist for
years in others. In fact, acne might only
develop for the first time in some people
in their late 20s or early 30s.
Hair
Skin surface
Sebum
Follicle
Sebaceous gland
Acne usually rears its red head at
puberty when an increase in sex
hormones, some of which are called
androgens, results in a surge in oil
production. This spike in oil production
causes blockages in the skin’s pores
leading to blackheads and whiteheads.
The oil produced by the sebaceous
glands is called sebum. It is meant to
help keep the skin supple and healthy.
This oil usually drains naturally to the
surface of the skin, although when it
becomes blocked at the opening of
the oil gland, the sebum builds up
allowing bacteria to multiply. This causes
inflammation which is seen as redness,
swelling and tender pimples.
Some areas of the body, particularly the
face, are more prone to acne because
they have a higher concentration of oil
glands than other parts of the body.
DID YOU KNOW...?
Whilst a lot of women (62%)
consider their acne to be mild,
Gen Y women were more
likely to consider their acne as
moderate (40%) compared to
older women from Gen X (27%)
1
The main acne bacterium (known as
Propionibacterium acnes) exists on
everyone’s skin, however it doesn’t
usually cause problems, except for those
prone to acne. When oil builds up, the
bacteria have the perfect conditions to
multiply and trigger inflammation.
Dr Mei Tam, Dermatologist, VIC
Who gets acne?
Eighty-five per cent of Australians
develop acne at some stage in their
life, with five per cent experiencing very
serious forms of the condition. People
suffering persistent acne may experience
both physical and emotional effects.
Teenage boys and young men have
higher levels of androgens than women
do. Because of this, they are more prone
to acne during puberty and it is likely
to be more severe. Acne in men usually
settles during their early 20s.
Females, unfortunately, are more likely
to suffer from ongoing acne. In some
instances, women can develop acne for
the first time after puberty. Acne can run
in the family, though in most instances its
occurrence is sporadic.
Types of acne
There are various types of acne. All
are defined according to the severity
of the condition as well as when the
acne occurs.
There are non-inflammatory acne
(whiteheads and blackheads) and
inflammatory acne (papules
and pustules).
Non-inflammatory acne
Whiteheads, named
for the white spot
they form on the
skin’s surface, appear
when trapped oil
remains below the
surface of the skin.
Whiteheads may be
so small that they
are invisible to the
naked eye.
Whiteheads
A blackhead
Blackheads
occurs when the
pore opens to the surface and the
sebum, containing the skin pigment
melanin, oxidises and turns a brown/
black colour. Many people think
blackheads are dark in colour because
they contain dirt, which is not true.
Blackheads cannot be washed away.
The oil that becomes blocked in pores
takes quite some time to drain to the
surface of the skin and because of this,
blackheads can be quite persistent.
A whitehead or blackhead can heal by
releasing its contents to the surface of
the skin. When this doesn’t happen, the
pore’s wall ruptures which may result in
inflammatory acne.
2
Inflammatory acne
When the wall of a blocked pore ruptures, the broken wall
allows white blood cells to enter the pore and this causes
inflammation.
A few days later, once the white blood cells have made
their way to the surface of the skin, a spot appears. This is
commonly referred to as a pimple or a zit.
Pimple
Inflamed acne lesions can sometimes collapse as a result of
the follicle breaking along the bottom. When this happens,
the surrounding skin becomes inflamed, sometimes engulfing
neighbouring follicles. This is called a nodule.
When very severe inflammation occurs, the result is a very
large, pus filled pore. These lesions are referred to as cysts.
"A common myth is that
patients see their acne as a
product of dirt. Patients try
to wash the 'dirt' out, which
leads to drying of the skin.
The skin then compensates
by producing more oil."
Dr Mei Tam, Dermatologist, VIC
Mild acne
Mild acne does not cover large areas of the face or body and
is limited mainly to whiteheads and blackheads. This type of
acne may be controlled with regular, appropriate skin care.
Treatment for mild acne includes products that are available
without a prescription from supermarkets and pharmacies.
3
Nodule
Cyst
DID YOU KNOW...?
Eight out of ten (82%) women
who have experienced acne in
the past five years stated that
their period aggravated the
condition. Some women also
believed emotional stress (67%),
work-related stress (34%) and an
unclean face (36%) contributed
to the worsening of their acne
condition.
4
"To camouflage acne, dermatologists
suggest patients use make-up that
is oil-free and non-comedogenic.
Mineral makeups often do a good job
because they are lighter on the skin
and also offer coverage."
Dr Mei Tam, Dermatologist, VIC
Moderate acne
Unlike mild acne,
moderate acne is more
widespread across
the face and body.
It is characterised by
inflammatory lesions
(papules and pustules). Moderate acne
breakouts can be persistent and should
be treated early to avoid the possibility of
permanent scarring.
If over-the-counter products are not
improving your acne, you should visit
your doctor to discuss different treatment
options or for a referral to a dermatologist.
Severe acne
Severe acne is mainly
characterised by
large, deep, solid and
painful lumps or cysts.
Severe acne breakouts
cover large areas of
the face and body, lasting for a long time.
They often don’t subside for months or
even years.
Typically, severe cystic acne does not
respond to over-the-counter skin
treatments from pharmacies and
supermarkets. Instead, anyone with
5
severe acne should see their doctor for
a referral to a dermatologist who will
conduct a full assessment and make
further recommendations.
Severe acne can prevent people from
doing many things they enjoy because
of concerns about their appearance and
the opinions of others. It may affect
self-confidence and some people will
experience anxiety and depression.
Severe acne in particular may lead to
scarring if left untreated.
Androgenic hormones, including
androstenedione and testosterone, have
male-like effects on the female body.
While androgenic hormones help maintain
muscle and stimulate the libido, they also
increase oil production in the skin.
Hormonal acne can range from mild
cases before your periods, especially if
you are stressed, to more severe cases
which appear at any time during the
menstrual cycle.
Women who have polycystic ovary
syndrome (PCOS), a common
reproductive syndrome, are likely to
battle with hormonal acne more than
others, especially at times of stress,
illness, weight gain, and pregnancy.
Pregnancy acne
Women who are prone to outbreaks of
hormonal acne may find that they have
flares of acne during the first trimester
(three months) of their pregnancy.
Usually those who do experience
acne during their pregnancy find that
it improves and may even disappear
towards their last trimester.
Breastfeeding can often keep
outbreaks of acne at bay. Women
who suffer persistent acne may
notice that their acne is progressively
less severe or that it disappears with
subsequent pregnancies.
Hormonal acne
Hormonal acne is thought to result from
the interplay of sex hormones, other
hormones and chemical substances
produced by the body in times of stress
or illness. It is common for hormonal
acne to begin in the 20s, or even early
30s, and can affect individuals who were
blemish free during their teenage years.
It is important to note that hormonal
acne differs from teenage acne. Teenage
acne is usually more severe in the oily
T-zone of the face, whereas hormonal
acne is more prominent on the jaw line,
chin, lower face and neck as these areas
are sensitive and easily irritated.
DID YOU KNOW...?
The most prominent area
for acne to appear is on the
face, with 98% of the women
surveyed saying they had
experienced acne on their face,
followed by 51% on the back,
35% on the chest and 32% on
the neck.
6
Myth busters
Myth 1: Acne is caused
by bad hygiene
Acne occurs when pores
in the skin become
blocked with the skin’s
natural oils. While acne
is not caused by poor
hygiene, maintaining
clean skin may help
control the condition.
Myth 2: Blackheads are
just dirt; you can wash
acne away
Blackheads are caused
when the skin’s natural oil
reaches the skin’s surface
and oxidises. They are not
caused by dirt and cannot
be washed away. In fact,
too much scrubbing will
further irritate your skin.
Myth 3: Picking and
squeezing pimples
is okay
Picking and squeezing
pimples will visibly
worsen your acne by
causing increased and
deeper inflammation,
bringing with it the risk of
permanent scarring.
7
Myth 4: Makeup and
moisturisers won’t make
acne any worse
Myth 7: Sunlight,
sunbaking and solariums
will improve my acne
Oil-based make-up and
some moisturisers can
worsen acne. Choose
products that are oil-free/
non-comedogenic (won’t
block pores). Siliconebased foundation is also
a better option for those
prone to acne. Heavy
make-up use requires
proper cleansing to
reduce the chance of acne
breakouts.
While some people do
notice some improvement
in their acne in summer,
overall this is not true.
Sun exposure can cause
inflamed acne to turn
dark brown, in addition
to potentially causing
premature wrinkling, skin
growths, skin cancers and
other signs of aging skin.
Myth 5: Too little or
too much sex can make
acne worse
It is always a good idea to
clean your face thoroughly
after hot sweaty activities,
however acne is not
caused by sweat.
There is no connection
between acne and the
frequency of sex.
Myth 6: Using lots
of over-the-counter
acne treatments
containing benzoyl
peroxide and salicylic
acid will improve acne
This is not true. In fact,
using too much of these
acne treatments can
worsen your acne as it
causes dryness, irritation
and blemishes.
Myth 8: Sweat from
exercise causes acne
someone else’s or your
own skin will not increase
the chances of developing
a pimple.
Myth 11: Acne outbreaks
cannot be blamed on a
woman’s period
This is false; many women
notice a worsening of
their acne shortly before
their period. This can be
attributed to changes
in female sex hormones
which contribute to the
blockage and inflammation
of the skin’s pores.
Myth 12: Acne is not
hereditary
Myth 9: Acne is caused
by allergies
Studies have shown that
those with a history of
acne in their family are
more likely to develop
acne themselves.
There is no scientific
research to suggest a
connection between
allergies and acne.
Myth 13: Prescribed
medications won’t make
acne worse
Myth 10: Acne is
contagious
Acne is not contagious;
it cannot be ‘caught’ or
passed from one person
to another. Touching a
pimple and then touching
Some prescription
medication may trigger
or aggravate acne. Your
doctor or pharmacist
can advise you on which
medications may affect
your acne.
8
2
Acne and your life
Acne’s impact on your quality of life
We live in a world that places strong emphasis on appearance, so it comes as no surprise
that acne may cause embarrassment and self-consciousness. When acne sufferers were
asked what affected them most about their condition, appearance was a common
concern! In some studies acne has been noted to lead to social withdrawal. In some
patients, this is to the extent that they feel uncomfortable in public situations, particularly
when meeting new people and socialising with members of the opposite sex. The good
news is that when acne improves, usually these feelings of anxiety and depression lessen
and confidence grows.
Acne and depression
Depression is common in young adults
and adolescents, with up to one in four
females and one in six males suffering
depression at some time in their lives.
Studies have linked acne as a cause
of depression.
Young men are at increased risk of
depression and are more commonly
affected by severe acne scarring.
However, social researchers have
found that women with acne find the
condition more embarrassing than their
male counterparts.
Those with acne report that emotional
stress can exacerbate their acne.
Sufferers may also develop emotional
problems such as social phobias, low
self-esteem or depression as a result of
their skin condition.
Friends and family of acne sufferers can
help by keeping an eye out for poor
coping ability and signs of depression,
9
and encourage the person to seek
medical advice if concerned.
Remember, if you are feeling
down, you can access excellent
services and helplines to answer
your questions or get advice.
Some support lines for people
suffering depression include:
Beyond Blue – 1300 224 636
Lifeline – 13 11 14
Sane – 1800 187 263
Anyone who thinks he/she might
be suffering from depression
should speak to a healthcare
professional for advice and help.
Acne’s relationship
with stress
Lifestyle advice for
acne sufferers
Research has shown links between high
stress levels and the severity of acne, as
well as completely new outbreaks.
Diet
A number of mechanisms have been
suggested to explain why increased
stress levels may aggravate acne.
Some reports focus on chemical
reactions and changing levels of
hormones in the body. In times of
emotional stress, hormones called
androgens and glucocorticoids are
released. These hormones increase oil
production by the skin and can make
acne worse. Also, a corticotropinreleasing hormone, which is used
by the body to coordinate the stress
response, increases the conversion of
androgens to testosterone, which will
have an effect on acne.
Not all theories are related to
hormonal activity. Some scientists
believe that stress causes the skin to
release a substance which produces
inflammation. Others say stress can slow
wound healing by up to 40 per cent,
which could explain why acne lesions
are slower to repair in times of stress.
It is difficult to eliminate stress
from everyday life, but by learning to
manage stress, you can reduce the
impact it has on your physical and
emotional wellbeing.
The relationship between diet and acne
is a controversial subject and many
myths exist on the topic. Some of these
suggest chocolate, soft drinks and other
junk foods can possibly aggravate acne.
A healthy, balanced diet might assist
with acne improvement in some people,
but it is not a cure for acne.
There is now evidence supporting the
benefits of a low GI (glycaemic index)
diet to help achieve better skin. A low
GI diet is one which includes plenty of
protein-rich foods, such as nuts, fish,
lamb, beef and legumes, in addition to
a variety of fruits and vegetables. These
low GI foods are recommended because
they improve insulin metabolism and
may improve the symptoms of acne.
Insulin is an important hormone in the
body because it has a controlling effect
on all of our other hormones, including
androgens. It is believed fluctuations
in hormonal levels, particularly these
androgens, will cause acne breakouts.
Insulin also impacts on growth hormones
and it is suggested that because of this,
insulin may be related to acne formation
at a cellular level.
10
Weight
DID YOU KNOW...?
The vast majority (96%) of female
acne sufferers felt that their acne
had adversely affected their
self-confidence, with half of all
Gen Y women (50%) stating that
their acne had stopped them
from going out.
There is no reason why you can’t treat
yourself to high GI foods, although they
should be eaten in moderation. A diet of
high GI foods, which includes processed
and refined foods (white bread, sweets
and biscuits) causes a rapid increase in
blood sugar levels. This increase in sugar
levels triggers the production of insulin
and may lead to worsening of acne.
While there are many reasons to eat
a balanced diet, medical treatments
may still be necessary for improving
moderate to severe acne and a general
practitioner or dermatologist is best
placed to assist with this.
The likelihood of developing acne may be
reduced by maintaining an appropriate
healthy body weight. This may also help
reduce the severity of acne. Weight is
essentially determined by the balance
of kilojoule intake from food and the
amount of energy used each day; if more
kilojoules (4.184 kilojoules = 1 Calorie) are
consumed than expended, you will gain
weight as the excess kilojoules are stored
as body fat.
While it is important to have some fat,
too much of it can interfere with your
overall health. For females, fat converts
good hormones – oestrogens – into other
hormones, which have similar effects as
testosterone. These hormonal changes will
contribute to acne.
This doesn’t mean only overweight
people have acne; rather, maintaining
a healthy weight will minimise your
chance of developing the condition and
reducing its severity. Acne sufferers will
be pleased to learn that even modest
weight loss may bring improvements in
your skin.
General Lifestyle
A number of factors in everyday life
may have an impact on acne including
exercise, time spent outdoors, smoking
and alcohol.
11
Exercise
Sun
Daily exercise is important to overall
health and wellbeing, including
healthy skin.
Appropriate sun protection is highly
important for all Australians, particularly
those who are being treated for acne.
For those who are acne prone, look for
products labelled ‘non-comedogenic’.
These products are lighter and spread
more easily on the skin so they will not
clog pores, which may contribute to the
worsening of acne.
Moderate exercise might help reduce
acne in a number of ways. This can be
by lowering stress levels, which have an
impact on the body’s hormones that are
responsible for acne, such as insulin or
the growth hormone corticotropin.
Also, exercise promotes circulation,
which helps remove toxins from
the body, which would otherwise
aggravate acne.
Cosmetics
The excessive use of make-up, coverup or other techniques to reduce the
CASE STUDY
Age: 34
Sex: Female
Occupation: Police woman
I have had acne as long as I can remember. I have tried numerous
products – oral antibiotics prescribed by my GP, products that I bought
off the internet, over-the-counter chemist products, treatments that
my friends and pharmacists recommended – none of these made a
difference. I am now taking an oral retinoid, which is intense but the
benefits make it worthwhile. My acne is not under control yet but is very
much improved and for this, I am grateful. My advice to acne sufferers
is to seek professional advice. I have got satisfaction from seeing my GP
and a lot of satisfaction from my dermatologist.
12
visibility of acne lesions can be a doubleedge sword. It may camouflage the
acne but the wrong type of cosmetics
will block pores. Again, look for ‘noncomedogenic products’. Mineral makeup is also an option for acne prone skin.
Being overly vigorous or using strong
cleansers to remove make-up can further
irritate skin and cause acne to become
inflamed. Gentle cleansing with gentle
products are recommended.
Some people with acne complain of
their skin being excessively oily or greasy,
in these cases, it is advisable not to use
a moisturiser.
Smoking
Clinical experience suggests there is a
relationship between smoking and acne.
A recent study found there was a higher
incidence of adult acne in those who
smoked versus those who did not.
Smoking has been found to cause harm
to the skin by constricting the outer
skin’s blood vessels. It also severely
impairs collagen production, leading
to wrinkling and premature aging.
Smoking also stimulates inflammatory
reactions in the body resulting in poor
wound healing and reduced repair of
inflammatory acne lesions.
13
DID YOU KNOW...?
Acne was shown to be linked to
embarrassment and decreased
self-confidence, with 96%
reporting that acne had an
effect on these two selfperceptions. Furthermore, one
in five (21%) women described
their embarrassment caused
by acne as 'extreme' and 17%
described the effect on their
self-esteem as 'extreme'. All in
all, 92% of women surveyed
reported acne as having an
impact on their lives.
Alcohol
Research into the effects of alcohol
show a trend towards alcohol affecting
hormone balances. Excessive alcohol
consumption also leads to increased
weight. This is worth noting as hormonal
fluctuations caused by weight gain in
females are an important factor in acne
development.
14
3
Treatment options
There are many safe and effective treatment options available for women who suffer
from acne, ranging from topical treatments to a multitude of oral medications. This
booklet will cover some acne treatment options; however you will need to speak with
your GP or dermatologist to identify the best treatment option for you.
Skin cleansers
While acne is not caused by poor
hygiene, maintaining clean and healthy
skin may help control the condition.
Mild ‘soap free’ facial cleansers, which
are acid and/or pH balanced and free of
alcohol and abrasives, can be used as
part of your skin care routine.
For women with oily skin, cleansers that
are easily rinsed off the surface of the
skin are recommended.
Women with combination, dry,
sensitive or easily irritated skin, or
women using topical medication
for their acne should use liquid
cleansers that are “gentle, oil-free plus
moisturising”. More highly moisturised
cleansers should generally be avoided.
Specially formulated cleansers, specifically
those with salicylic acid, are particularly
good for acne sufferers. They work by
helping to unblock pores by targeting
sebum. The salicylic acid dissolves,
removes and prevents the substances that
block the pores. Because of this, salicylic
acid helps speed up the clearing of
pimples and also helps improve the skin’s
condition in the long-term.
Mild acne sufferers may not need
anything more than a cleanser for the
everyday control of their acne. However,
it is important to remember to speak
with your doctor before combining this
with prescription topical treatments.
Some people use toners after cleansing,
however they can irritate the skin and
therefore are not always recommended.
"Dermatologists generally recommend two
over-the-counter treatments: peeling agents for
people who suffer from rough and bumpy skin,
and treatments that are benzoyl peroxide based.
These treatments have been shown to be the
most effective over-the-counter options for milder
forms of acne."
Topical therapies
Topical treatments are usually the
first choice for those suffering mild
to moderate acne. These treatments
include agents such as benzoyl peroxide,
antibiotics, retinoids, azelaic acids and
keratolytics. Combination therapies
are also available and include benzoyl
peroxide and a retinoid or benzoyl
peroxide and an antibiotic.
Some of these products can be
purchased over the counter, while
others will require a prescription from a
medical professional.
Topical creams are best applied after
cleansing, once your skin has dried. This
is because topical treatments may cause
irritation if applied to moist skin. Unless
otherwise specified by your healthcare
professional, creams/gels and lotions
should be applied to the entire area of
your face where acne usually develops.
These treatments may help prevent new
pimples from forming, in addition to
treating those that have already appeared.
When applying topical treatments, it is
important to take care around sensitive
areas, including the skin around the
eyes, lips and nostrils. Also, you should
make sure to follow all instructions
for applying these treatments in order
to maximise their effect. For example,
some treatments should be used
sparingly. Applying more than the
DID YOU KNOW...?
Over three-quarters of female
acne sufferers (77%) are
aware of benefits of the oral
contraceptive pill in treating
acne and the majority of these
women (65%) were informed of
this benefit by their GPs.
In addition, 75% of women
who were prescribed the oral
contraceptive pill specifically
for the treatment of their
acne reported the treatment
as ‘moderately to extremely
effective’.
recommended amount will not help
your skin improve any faster, in fact, it
may lead to irritation and make your
acne worse.
Treatments will usually take time to have
an effect on your acne. You should see
improvements along the way but it is
important to allow enough time for
them to take maximum effect before
deciding if the treatment is appropriate
for you.
Prof Kurt Gebauer, Dermatologist, WA
15
16
Antibiotics
Antibiotics have long been prescribed
for inflammatory acne. In addition to
helping to reduce the bacteria on the
skin’s surface and in follicles, antibiotics
have an anti-inflammatory action to
reduce the swelling, pain and redness
of inflammatory acne.
Antibiotic gels and lotions may have
limited side effects compared to
oral antibiotics, however they do
take longer to be effective. Topical
antibiotics should be applied directly
onto the affected skin.
A variety of antibiotics are currently
available and your GP or dermatologist
will prescribe the best option for you.
Your doctor may choose to change
your prescription if an antibiotic proves
ineffective, however this will only
become clear after a trial of four to
six weeks.
In many cases, antibiotics are effective.
You should be seeing an improvement
within eight to twelve weeks. If this
is not the case, it’s time to speak with
your doctor.
Your pharmacist can also provide helpful
tips if needed, such as advice on when
is the best time to take your antibiotic
and whether it should be taken with or
without food.
DID YOU KNOW...?
An oral retinoid prescribed by dermatologists was described as having
'moderate to high effectiveness' by 9 in 10 (89%) of the users.
17
Retinoids
Retinoids are vitamin A derivatives
that are prescribed as either topical
or oral formulations. They are effective
at both unblocking acne pores as well
as preventing the development of
new pimples.
Retinoid gels and creams help suppress
mild to moderate acne. They can be
combined with an antibiotic in the
early stages of use to speed up the
improvement and control of acne.
The combination of topical retinoids
and an antibiotic can minimise acne
causing bacteria and thus help reduce
inflammation. Additionally, the
combinations can help prevent problems
with irritation, which may affect 10-20
per cent of people in the early stages of
their topical retinoid use.
Women using hormonal treatments
such as the oral contraceptive pill
to manage their acne are advised to
combine this with topical retinoid
treatment to provide better long-term
acne control. Topical retinoids can be
used for several years as maintenance.
These topical retinoid treatments
unblock pores to prevent further
blockages, decrease oil production and
also soothe the redness of inflamed
acne. They also make the oil glands less
hospitable to acne causing bacteria.
Oral retinoid treatments are the most
potent treatment for severe acne as they
deal with all the known causes of severe
cystic acne. Up to 85 per cent of people
with severe cystic acne experience longterm remissions from the use of an oral
retinoid. A single course of treatment,
which usually takes five to six months,
is typically sufficient to help clear acne.
18
A small number of sufferers may have a
recurrence of less severe acne, normally
following a prolonged gap after their
previous episode. Depending on the
severity of this recurrence, another
course of oral retinoids or milder
therapies can be used.
experience additional acne flare ups,
therefore antibiotics may be prescribed
at the same time to prevent this from
happening. Retinoids also increase
sensitivity to sun, water and wind, so
precautions should be taken to protect
yourself from the elements.
Retinoids work by reducing the size
of the sebaceous glands and their
production of oil. Common side effects
include dryness, scaliness or irritation
of the skin. Simple precautions can be
taken to minimise the risk or extent
of these side effects. Also, in the early
stages of treatment, patients may
Combined Oral
Contraceptive Pill
In addition to contraceptive benefits,
the combined oral contraceptive pill (or
the Pill) may help treat acne by blocking
the stimulatory effect that androgens
(male hormones) have on oil glands.
CASE STUDY
Age: 34
Sex: Female
Occupation: HR Business Partner in the fashion retail industry
I have suffered with skin problems for many years. Last year I decided
I didn't want to put up with it any longer. I was tired of rejecting
offers to go out socially whenever I had a bad breakout. Before I was
referred to a dermatologist, I used a number of 'off the shelf' options,
but they provided no improvement. After visiting my dermatologists,
I was provided with other treatment options, which included an oral
contraceptive pill and two topical creams, one of which is a benzoyl
peroxide based cream. It has been five months since I started treatment,
and it is making a world of difference not only my skin, but the
confidence I have in myself. I would recommend anyone suffering from
skin problems to speak to their GP.
19
Lowered levels of stimulation decrease
sebum and oil production.
Some pill formulations containing low
doses of oestrogen, referred to as low
dose pills, are indicated for mild to
moderate acne. These types of the Pill
work by inhibiting ovulation, which in
turn alters the levels of sex hormones in
your body.
Some formulations of the Pill include an
anti-androgenic progestogen that have
been proven to be effective in treating
moderate to severe acne. These Pills stop
androgens from binding to their receptors
resulting in less oil being produced and
acne being minimised. Your doctor will
determine if an anti-androgenic Pill is
appropriate for you.
It is worth remembering that the minipill
(also known as a progesterone-only pill)
and contraceptive implants are more
likely to worsen acne, because they
boost sebum production.
When taking the Pill for acne benefits,
there are a few things to remember:
DID YOU KNOW...?
Prescription topical creams and
antibiotics were rated as highly
effective, 11% and 12% respectively
by users of these treatment options.
• The Pill will need to be taken for at
least six months to get a good response
if it is being used as an acne treatment
• Some common side effects from
the Pill include nausea, vomiting,
abdominal pain, headaches or
migraines, breast tenderness/
enlargement, thrush and vaginitis
• You should continue with your normal
daily skin cleansing routine while using
the Pill
• You may notice a visible improvement
in your skin after taking the Pill
for eight to twelve weeks. Further
improvements can be seen from three
to twelve months
"Some patients don't understand why or how
acne treatments work and expect immediate
results. Acne treatments take time and it's
best that patients work with their GP or
dermatologist to find the most appropriate
treatment option for them."
Prof Kurt Gebauer, Dermatologist, WA
20
• The Pill can be taken for as long as an
acne treatment and contraception are
required. If acne does return with the
cessation of the Pill, it may not be as
severe and the likelihood of it returning
will reduce as you get older
• All combined oral contraceptive pills
carry an increased risk of developing
blood clots, depending on a number
of risk factors. Your doctor will assess
whether the Pill is appropriate for
you depending on whether you are
overweight, smoke, suffer migraines,
have epilepsy, have high blood pressure
and/or have a family history of breast
cancer. Make sure you ask your doctor
about the side effects of taking an oral
contraceptive.
• The Pill may also help to regulate
and lessen problems with your
menstrual cycle.
Natural remedies
21
A comparison between tea tree oil and
benzoyl peroxide lotion found the tea
tree oil was effective in reducing acne
and with few side effects, however it
took longer than benzoyl peroxide to
take effect.
Facials are often believed to have
therapeutic benefits, but they are not
a proven acne treatment. While facials
may provide some improvement for mild
acne, you should avoid facials if you are
using medicated acne creams as they
may contribute to irritation.
DID YOU KNOW...?
Self-selected pharmacy/
supermarket/department store/
beauty salon cleansers and
topical creams and lotions
are the most commonly used
treatment options for women
suffering from acne.
Treatments for scarring
Moderate to severe acne in which there
are papular/nodular lesions that have
caused damage to the surface and the
underlying layers of the skin may cause
scarring. Scarring can be reduced by
a variety of therapies including:
• Steroids (topical or injectable; not oral)
Research has been conducted into the
effects of Vitamin A and tea tree oil on
mild forms of acne. It is important to be
wary when using natural therapies as
variations exist between products. For
example, poorly purified or processed tea
tree oil can cause allergies or irritation.
nce scars have matured, skin
O
resurfacing and other lasers and nonlaser treatments can be used.
This may include:
A study has demonstrated that Vitamin
A in high doses can be an effective
treatment for acne, however most doctors
would not recommend this because of
the serious health risks associated with
excessive Vitamin A intake.
If you would like more information about
treatments to reduce scarring, speak with
your doctor.
• Injectable fillers or implants
• Surgery
22
4
What you need to know
A number of commonly asked questions are addressed in this booklet, but the
best way to get personal advice about your acne or the health of your skin, is to
speak with your doctor or dermatologist.
"If you are concerned about your acne, the best
person to see first is your GP. Ideally you would
have a great relationship with your doctor
and they will understand your problem from a
medical and social viewpoint."
Dr Jo-Ann See, Dermatologist, NSW
Acne FAQs
General acne questions
Who should I see if I am suffering
from acne?
Can acne be cleared immediately?
Because acne is a medical condition,
it is important to see a healthcare
professional. For mild acne, start by
seeing a pharmacist. If your acne is
not responding to an over-the-counter
treatment or you have moderate
to severe acne, see a GP who is
likely to commence topical and/or
systemic treatments. If your skin is
particularly problematic, a referral to a
dermatologist is appropriate.
No. The process for improving acne,
even in mild cases, takes time. You
should speak with your GP about what
treatment options are best for you.
Your GP might also refer you on to
a dermatologist.
Can acne be cured permanently?
Acne appears as a result of hormonal
changes, which affect the amount of
sebum produced by oil glands. Because
hormonal changes are unpredictable, it
is difficult to find a permanent cure for
acne. The good news is that any acne
can be improved with treatment.
DID YOU KNOW...?
Almost half of the women
(47%) surveyed said they spent
more than $100 a year on acne
treatments.
23
I have acne on my chest, back and
shoulders. What is the best treatment
for acne that is not on my face?
Treatment for acne on your body is the
same as treatment for acne on your
face. A dermatologist might supply you
with an alcohol-based lotion containing
salicylic acid, specifically designed for the
upper body. These treatment options
are more economical for treating larger
areas of the body than the face. For more
effective acne treatment of inflammatory
acne, systemic antibiotics can be used in
combinations with topical treatments.
After my acne clears, I am left with red/
dark marks. What are these marks and
how do I make them go away?
Over-the-counter therapies
for acne
The red marks that appear on your
skin once acne has cleared are called
erythematous macules. These marks
may get temporarily darker when
you exercise or when your skin gets
hot. The macule is not a scar and is
not permanent. It is the result of the
skin’s inflammation process and is far
more common in people with easily
tanned skin. The marks should fade
within a few months, though for some,
they may last for a number of years.
Nonetheless, the spots will always
disappear over time.
Will an acne treatment or facial wash
purchased over-the-counter be an
effective treatment for my acne?
Can people with acne suffer
from depression?
Studies have revealed acne can
contribute to depression, anxiety,
low self-esteem, low self-image and
decreased confidence. Treatments are
available which help control acne and
in turn psychological symptoms. If acne
is reducing your enjoyment of life, it is
important to speak with your GP.
Some over-the-counter acne treatments
contain benzoyl peroxide, salicylic
acid, alpha hydroxyl and azelaic acids.
Products with these active ingredients
are generally effective treatments for
mild acne. It is important to be gentle
when using these treatments, as
excessive scrubbing will cause irritation
and inflammation.
For more severe acne, speak with your GP
or dermatologist, as systemic therapies,
which are only available on prescription,
will improve this type of acne.
Are there inexpensive products that
can be purchased to help control my
mild acne?
There are many economical options
that are proven, effective treatments
and these can be purchased from
your pharmacist.
24
Using a cleanser containing salicylic acid
along with a light moisturiser is usually
sufficient. Some light moisturising gels
and creams include silicones, which
won’t affect your acne and protect your
skin from irritation. Remember, you
should select light moisturisers to follow
your facial cleanser, as heavier versions
may worsen your acne.
What should I do if the acne treatment
I am using causes my skin to become
irritated?
Some acne medications can cause
dryness or other minor skin irritations.
Usually, this will resolve itself as
your skin becomes accustomed to
the treatment you are using. In the
meantime, you can try to alleviate the
dryness by using a non-comedogenic
moisturiser, which won’t clog your
pores. If the irritation or dryness persists,
speak with your GP or pharmacist.
People using topical treatments for the
first time can be enthusiastic and may
over apply medication, so you may try
reducing the quantity and/or frequency
of application.
How long should I wait to see if my
over-the-counter product makes a
difference to my acne?
You should see notable improvements
within six to eight weeks and some
smaller improvements along the way.
Prescription treatments for acne
How severe should my acne be before I
go to see my doctor?
If your acne is interfering with your life
and causing you distress, you should see
your doctor.
Acne often will not only cause physical
discomfort or scarring, it also can
have an emotional effect on you. Early
intervention with a trip to the doctor
could help prevent these effects.­
I have been prescribed medication to
control my acne. How long will it take
for my medication to have an effect,
and how long should I remain on the
medication for?
When your doctor prescribes your
medication, they will also explain what
"When you see patients with acne and
you help improve their skin, you often
give them back their self-esteem, so
they feel much better about themselves.
This is extremely rewarding for me."
Dr Jo-Ann See, Dermatologist, NSW
25
you should expect from the treatment,
including how long you will need to take
your medication and when to expect an
improvement. It is important that you
follow the instructions that are included
with your medication and complete the
full course.
In some cases, acne appears to worsen
when a new medication is started. This
is usually due to natural variation with
flares and improvements in acne over
time. However, some improvement should
appear within eight to twelve weeks.
DID YOU KNOW...?
Only close to a quarter of women
who suffered from acne in the
past five years (24%) consulted a
health professional to guide their
treatment of the condition.
Why should I continue taking/applying
my medication even after my acne clears?
Even though your acne clears, due to
the chronic nature of acne it may be
necessary to continue your treatments for
some time after as maintenance.
Does the oral contraceptive pill help acne?
Some specific hormonal combinations in
oral contraceptives help acne, while other
combinations can worsen the condition.
There are many factors that determine
which Pill may be suitable for you and
this should be discussed with your doctor.
Will the oral contraceptive pill treat
severe acne?
Pills containing low doses of oestrogen
are referred to as low dose pills and some
of these are indicated for moderate to
severe acne. Some combination therapies
can be used to treat acne for more severe
cases but the most effective treatment for
severe acne is an oral retinoid.
26
"Although dermatologists are
experts in skin, it is often best
that the GP is the first point of
call. If you need further help, get
a referral to a dermatologist."
Dr Jo-Ann See, Dermatologist, NSW
Once taking the oral contraceptive
Pill, how long until I notice a visible
improvement in my acne?
You will only notice a visible improvement
in your skin after taking the Pill for eight
to twelve weeks. Further improvements
can be seen from three to twelve months.
Is it true that applying toothpaste to
a pimple can cause it to clear up?
Applying toothpaste to your skin will
cause dryness and irritation. Rather than
using toothpaste, you should obtain a
gentle cleanser that is pH balanced and
soap free. If you have oily skin, avoid
cleansers with ‘significant emollient’
or ‘moisturising’ properties. Applying a
topical agent to inflamed nodules and
papules only addresses the inflamed
lesion. It does not stop new lesions from
forming. A general whole skin approach
is required to improve acne and reduce
the number of new formations.
Where should I go for more information
about acne?
This booklet provides general information
for acne sufferers. You can also visit the
All About Acne site, www.acne.org.
au, for additional information, however
for personal medical advice, you should
27
visit your doctor, who may refer you to a
dermatologist.
The role of the
dermatologist in acne
treatment
A dermatologist is a qualified medical
professional who has undergone
extensive training and postgraduate
qualifications enabling him/her to
diagnose, treat and prevent skin
diseases, including acne.
You will require a referral from a GP to
visit a dermatologist. Dermatologists
consult generally in the community as
well as in private and public hospitals.
A dermatologist will decide which
therapy is best for your acne based
on your individual circumstances.
Factors that will be considered include
the extent and severity of your acne,
previous scars or your risk of scarring in
the future, as well as the emotional and
social impact of your acne. As a trained
professional, your dermatologist will
also take you through the appropriate
skin care products to control your acne
and help avoid treatment related issues.
CASE STUDY
Age: 53
Sex: Female
Occupation: Artist
I began to get acne at age 17 and have had bouts of the condition
into my late 40's. As well as being painful, the acne was extremely
embarrassing and could not be easily covered with makeup. The
scarring that resulted is a constant reminder of the awkwardness and
embarrassment I felt as a teenager. In my mid-30’s, my skin needed
further treatment so my dermatologist prescribed spironolactone,
the birth control pill, a retinoid based cream and a skin peel every six
weeks or so.
Useful sites for more
information:
There are many resources available
if you are seeking information on
acne and the available treatment
options. We recommend visiting the
following websites:
All About Acne
www.acne.org.au
American Academy of Dermatology
www.aad.org
Australasian College of
Dermatologists
www.dermcoll.asn.au
British Association of Dermatologists
www.bad.org.uk
"One of the reasons why I
became a dermatologist is
that when I was younger
I suffered from both acne
and eczema."
Dr Jo-Ann See,
Dermatologist, NSW
28
5
Where to get help
General
practitioners (GPs)
A GP is usually the first point of call for
anyone looking for medical information.
GPs can offer ways to manage your acne,
including information about treatment
options for acne, as well as information
on how to avoid treatment related issues.
Your GP may prescribe medication to
treat your acne after assessing your
medical history and specific needs. They
can also provide a referral if you need to
visit a dermatologist.
It’s a good idea to find a GP whom you
can relate to and trust, and establish
an ongoing relationship with them.
By going to the same GP on a regular
basis, he or she is able to get insight into
your medical background and have your
history on file. If you don’t have a regular
GP, ask your friends, family or neighbours
if they can recommend someone.
Different GPs have different payment
schemes. Under Medicare, the
government will pay most of the
scheduled fee for an appointment.
However, some clinics choose to include
a charge on top of the Medicare rebate
and you may need to pay some money
out of your own pocket. Check with your
GP when you make an appointment to
see what the consultation fee is. If your
GP ‘bulk-bills’ that means he or she only
charges at the Medicare rebate rate and
you do not have to pay any additional fee.
CASE STUDY
Age: 18
Sex: Female
Occupation: Student
I first started getting acne when I was twelve. It affected my
self-esteem and I thought I wasn't good enough for anyone. I tested
different creams that were recommended by my GP, but I preferred
taking pills to using creams. I am now taking an oral antibiotic twice
a day, which started working about two weeks after I started taking it.
I am a lot happier now and feel more comfortable in my own skin.
29
30
Specialists
Pharmacists
When it comes to skin diseases, including
acne, dermatologists are the specialists.
You will require a referral from a GP
to visit a dermatologist, in order to be
eligible for a Medicare rebate. A GP
referral generally lasts for 12 months
for the specified skin condition (e.g.
acne). Some dermatologists can also
be consulted through public hospital
outpatient clinics. As with a GP, your
dermatologist will decide if therapy
is recommended for your acne based
on your individual circumstances.
Dermatologists are able to prescribe an
oral retinoid for severe acne, which is not
usually prescribed by GPs, unless they are
an authorised medical practitioner.
Pharmacists are trained healthcare
professionals who are able to provide
patients with their medications and
medicine information. In Australia, some
acne medications can only be purchased
with a prescription from a doctor or
specialist, while others can simply be
purchased over-the-counter.
Talking about it with your
healthcare professional:
Your GP or dermatologist is the best
person to answer all your questions about
acne and the different treatment options.
Whenever you get a prescription
or ‘pharmacist-only medicine’, the
pharmacist is likely to perform a number
of checks to ensure the medication is
right for you. You can also talk to your
pharmacist if you are not sure how to
take your medication properly.
In addition to pharmacists, pharmacies
employ pharmacy assistants. Pharmacy
assistants are not usually trained
healthcare professionals, though they
may be able to provide you with basic
information and advice on over-thecounter products.
To make sure you get the most out of
your consultation with your healthcare
professional, there are a number of things
you can do to prepare:
• Give your doctor as much information
as possible
• Always be sure to provide honest
answers to the questions you are asked.
This will ensure your doctor can provide
the most suitable advice for you
Disclaimer information:
The statistical information provided within the “Did you
know…?” statements within this booklet was collected from
an Australian survey conducted by McCrindle Research and
commissioned by Bayer Australia Limited. The survey consisted
of a sample of 1598 women between the ages of 18-46, who
had suffered acne within the last 5 years.
• Take a list of the points you would
like to discuss or the questions you
would like to ask, and don’t be afraid
to take notes.
31
Views expressed by dermatologists and patient case studies
presented within this booklet reflect the opinions of the
individuals and are not intended to represent Bayer’s position
on the subject matter.
32