Puberty is a time of many changes, physical and emotional. Unpleasantly for many, it is accompanied by the onset of acne which may seriously impact an adolescent’s life and not only leaves facial scars but also psychological ones.
There are studies which clearly show that acne significantly impairs quality of life and is also responsible for impaired social interaction, consultant dermatologist Lawrence Scerri says.
“One of the negative consequences of acne is the psychological impact such as low self-esteem, poor morale, anxiety and depression which one should strive to address through proper and timely treatment.”
Types of acne
Acne tends to present most commonly in the early to mid-teens and, on average, it tends to appear slightly earlier in females than in males. It affects the face in the majority of cases and also the trunk in around two-thirds of cases, especially males.
Acne lesions may be subdivided into two categories: inflamed lesions (red spots, boils and inflamed lumps) and non-inflamed lesions (blackheads or whiteheads, also known as comedones).
There is another form of acne which tends to occur in the ages between 25 and 45 years and which is known as post-adolescent acne.
“The latter form of acne is becoming more common and affects especially females,” Scerri points out.
What causes acne?
Acne is mainly a hormonal issue, although lifestyle factors may aggravate the situation.
“It is caused by the effect of the male hormone testosterone, which is found in both males and females, on the pilo-sebaceous unit which in actual fact is the structure containing the hair follicle plus sebaceous or oil-producing gland,” Scerri explains.
“The level of testosterone in the skin tends to shoot up especially around puberty as part of the transition from childhood to adulthood, and such a state of affairs tends to persist for a number of years. Hence teenage acne tends to occur mainly between the ages of 11 to 25 years.”
He adds that occasionally a high level of testosterone may be caused by certain hormonal diseases such as the Polycystic Ovary Syndrome and virilising tumours of the ovaries or adrenal gland.
“One of the negative consequences of acne is the psychological impact such as low self-esteem, poor morale, anxiety and depression”
A number of factors may play a part to make the condition worse, including stress and oily cosmetics. Among older individuals, certain drugs such as muscle-enhancing hormones and hormonal intra-uterine contraceptive devices may play a part.
As for the popular belief that food plays an important role in the development of acne, Scerri says that “the evidence is not so strong as most people like to believe”.
Another good thing to know about acne is that although it includes inflamed spots such as boils, it is not contagious.
“Hence there is no fear of spread to different parts of the body or to others. There is no need for one to worry about sharing towels or change pillow cases every day or avoid skin to skin contact with others,” Scerri stresses.
Various treatments are nowadays available to keep acne under control.
“We now have very effective medical remedies to treat the various forms and severity of acne, ranging from topical products to oral medications including antibiotics, oral contraceptive pill for females and a vitamin A derivative,” Scerri says.
“There is no one-size-fits all and the treatment regime needs to be adapted according to each case after proper medical assessment.”
In mild cases of a few spots here and there, there are various over-the-counter topical remedies available at the chemist. However, anything more than this warrants proper medical assessment and treatment.
Scerri suggests to avoid greasy cosmetics and greasy skincare or hair care products, as these clog the pores and aggravate acne. Nowadays, one can find oil-free, mat, non-comedogenic foundations which are designed for acne-prone skin and water-based hair gels. Moisturisers used on acne-prone skin should be also non-oily or non-comedogenic and should aim for a matifying effect. Sunscreens, which are an important part of everyone’s skin regime, should be oil-free too.
“Acne is a medical condition, hence medical treatment is the most appropriate line of action”
As regards natural remedies, Scerri says that scrubs and masks might be suitable for mild acne, predominantly consisting of blackheads. However, these are suitable for people with significant inflamed spots or for the more severe forms of acne “as they tend to aggravate the inflammatory picture”.
What about facials? Do they help?
“Acne is a medical condition, hence medical treatment is the most appropriate line of action, especially if serious undesirable consequences such as scarring are to be avoided,” Scerri recommends.
As acne usually drags on for years, the treatment plan should be of a continuous nature with periodic assessments and treatment reviews, rather than short courses of treatment “with nothing in between”, as the latter approach does not ensure consistent control.
“Delayed treatment, under-treatment and inappropriate treatment may lead to disfiguring permanent scarring. Indeed, this should not be the case nowadays given that we have an effective armamentarium of medical treatments at our disposal,” Scerri says.
He urges parents not to triavialise acne or ignore the negative psychological effects.
“Do not underestimate acne. Parents should be instrumental in facilitating proper and timely treatment. Today there is no excuse for allowing it to bring anyone down and for not preventing permanent physical disfigurement.”
This article was first published in Child magazine in 2017 and updated in 2023.