Acne is a very common skin condition which it is tempting to characterise as purely a teenage affliction.
However, it can last into the late twenties or even thirties and become a serious and embarrassing problem affecting relationships, confidence and the mental health of sufferers.Yet a recent review of research into treatments for acne found lots of gaps in information, particularly when comparing how well different products work.
Online acne support groups are full of people feeling depressed, lonely and enduring sleepless nights before they find the right treatment and get rid of the terrible spots that characterise this chronic skin condition.
Professor Hywel Williams, from the centre of evidence-based dermatology at Nottingham University, says there is no wonder when there are now 40 or 50 different acne products available.
"As a patient you see all these products on the shelves of the chemist, but which one is the best? There is very little comparative information."
He believes more independent research is needed, not just research led by the pharmaceutical industry.
"There are lots of unanswered questions... like when should you start treating acne? And what should you start the treatment with?" Prof Williams says. This is complicated by the fact that experts still do not know exactly what triggers acne and how treatment affects the course of the disease.
Nick Geddie had acne from the age of 12. Now a primary school teacher in West Sussex, his acne has still not disappeared, but it is something he has found ways of dealing with.
"I can keep it under control with the drug I am using now and I don't tend to get as many spots as I did, but I still don't like going to the beach and stripping off.
"When I was a teenager I got it severely on my back, chest and neck and it had a massive impact on my self-esteem.
"It felt like the end of the world not looking like everyone else in the changing rooms at an all boys' school.
"After I went to see the GP and started taking tablets I felt my confidence start to return."Dr Susannah Baron, consultant dermatologist with East Kent NHS Trust and a spokesman for the British Skin Foundation, says the psychological impact of acne on teenagers is huge.
"Being a teenager is really hard anyway and then you get acne. Girls often try to do something about it earlier than boys, who may get worse acne because of the surge in testosterone.
"Many people spend a lot of money on products which may not work. Some of the over-the-counter washes and gels may help but the best thing is to go and see your GP who can give you prescription treatment to put on your skin which may be a roll-on anti-bacterial liquid, cream or gel."
A typical acne journey can start with a cream or gel treatment, progressing to others if the first one doesn't work, then perhaps a course of oral antibiotics and then a referral to a skin specialist if there is no improvement.
Treatment with isotretinoin (also known as accutane or roaccutane), is usually for people with moderate to severe acne or for anyone with acne scarring, because of the side effects associated with the medication. However it does work extremely well and after one course of treatment 80% of people never get acne again.
In fact there are huge variations in the reactions to different treatments.
While Dr Baron is sceptical that alternative therapies make any difference to acne because of the lack of evidence, some people beg to differ.
Elaine Mummery is a nutritionist who runs an acne clinic in Glasgow. She has also written a book called Spotless - The Essential Guide to Getting Rid of Spots and Acne.
She says acne is the body giving us a sign.
"When I look at someone's face I know by the type of spots what the problem is and how to fix it.
"For some people it means cutting out cow's milk from their diet, for others they need to cut down on sugar - but there's always a reason and you can fix it. The clue is in the spot."
She works with her patients for four weeks, assesses them individually and then encourages them to change one or more elements of their diet.
"In the past, I've got them to drink vegetable juices, increase their fruit intake maybe or cut out carbohydrates to try to turn the body more alkaline and improve their acne."
It doesn't work for everyone but as long as something does then acne sufferers will undoubtedly be happy.
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