Consultant Dermatologist Answers Your Acne Questions



We have spoken to Dr Adam Friedmann from the Harley Street Dermatology Clinic all about Acne to answer your common acne questions. Watch the videos or read his answers below.

What is the best treatment for acne?

I’m often asked what is the best treatment for acne and this is a difficult question because there are lots of treatments out there and really depends on how severe your acne is. Depending on the severity of your acne, it can be treated with topical agents such as washes and lotion or tablets. The tablets can either suppress the acne in the form of antibiotics or hormone suppression in women, or occasionally they can cure acne. Drugs such as retinoids. So depending on how bad your acne is, your dermatologist or doctor will make a decision about what is required, hopefully they will give you a combination of a facewash, a couple of antibiotic ointments or gels and possibly some tablets and this can bring about complete resolution of acne, although not on a permanent basis. It is fair to say the best treatment for acne is a drug called a retinoid and these drugs have the potential to cure people of their acne. They don’t work in everybody, but for the majority of patients to take a sustained course of about five or six months, resolution can be complete and can be long-lasting. A large proportion of patients don’t get acne again and those who do get acne again can get a long period of rest bite, sometimes measured in many years or even decades before it comes back. Often after retinoid treatment, acne can be a lot less severe if it does come back at a later date.

Will my acne ever go away?

People want to know, will their acne ever go away. The answer to that question is usually yes it will depending on your age. If you are young, a teenager or child with acne, normally the acne will go away within two or three years. If you are an adult with adult-onset acne or a recurrence of acne in adulthood, it can often last a lot longer than this. However there are a number of treatments out there that can control it very nicely, and in the event, your acne is disfiguring or has aggressive, active scarring then it’s possible for you to see an acne dermatologist and we will give you some treatment to settle the acne or to remove your acne scars. These can comprise of topical agents, creams, lotions, washes, antibiotic tablets, hormone suppression tablets or occasionally a drug called a retinoid. All of these treatments can help to control and clear very nicely.

How do you clear up acne?

Something I am often asked is how do you clear up acne. Again this depends on the severity of the ance. On the whole, acne will get better naturally over time, but in young people this can take many months or years. The majority of people will have acne for a while, then it disappears spontaneously. In kids or teenages this can take an average of two to three years for acne to disappear, but in adults acne can last a lot longer than this. Treatment usually comprises of topical agents such as washes, creams or lotions, or tablets in the form of antibiotics, birth control tablets or retinoids. These tablets are very good at clearing up acne. The only drug that will clear up acne permanently is a retinoid, which can give a good result in 65% of people, who won’t have acne again after treatment or will have a very long respite measured in years. With a combination of topical agents and antibiotics or hormone suppression in women, acne can clear very nicely, but it can take six to eight weeks to get the full impact of treatment and when you stop taking treatment, the acne may come back again, over time the acne will dissipate but it can take many months or years for this to happen.

How do dermatologists treat acne?

One thing I am asked regularly, is how do Dermatologists treat acne. This to me implies people have already been treated by a primary care physician or by a general practitioner (GP). On the whole, general practitioners will use straightforward acne treatments which are safe and generally available in the form of creams, washes or lotions to settle down the acne and control bacterial growth. Tablets such as antibiotics and birth control can be used very well to control acne, however birth control is only used in women, along with other forms of hormone suppression. Where dermatologists really differentiate from a GP is that we are able to prescribe drugs called retinoids. These do come in cream forms which anyone is able to prescribe, but also they come in tablet form and the tablet form of a retinoid is probably the most powerful treatment for acne. Retinoids are powerful drugs and they do have a lot of side effects. They cause dryness of the skin, they can sometimes cause a flare up of the acne, they can cause an aching and they are very risky to give to young, fertile women as they can cause birth defects. However, in the hands of a consultant, prescribed appropriately and monitored appropriately with blood tests and pregnancy tests, these drugs are extremely effective at treating acne, and about 99% of people will respond positively to these medications. The course is relatively protractive, around four to five months depending on dose, sometimes a little longer. Usually at the end of treatment, around 99% of people will be clear of their acne and results can be sustained, some people are clear forever, and others are clear for a long period, if you are lucky measured in years, if you are unlucky measured in months. Often if the acne does come back it is a lot less severe. So as a general rule, dermatologists will use a very strong treatment, only if the acne is severe enough. Dermatologists use a few makers to assess severity, such as the appearance of the ance, how inflammatory the acne is, how extensive the ance is, how disfiguring the acne is, if the acne is causing any scarring at all, how long the acne has been there, how little the acne has responded to previous treatments and how much psychological impact it is having on the patient. If any of these markers are positive, we would consider prescribing a strong drug such as a retinoid. Retinoids have really revolutionised the way acne is treated because none of the other treatments usually provide a cure, whereas a retinoid does cure acne in a large proportion of patients who take it. They have the treatment, they don’t get acne again, or if they do it is many years later. So if you have acne, if you are worried about the appearance, the disfigurement, the scarring or the psychological effect, then please get in contact with a dermatologist and let us consider you for a retinoid.

What age does acne stop?

One question that comes up quite often is what age will acne stop. This is a difficult question to answer because it’s different for everyone. On average, most people who are teenagers will get a bit of acne and it is generally teenagers who suffer from the condition, however it can affect anyone from any age, right from being a baby all the way through to retirement age. The general rule when you are a young person with acne is it will reflect your hormonal changes going through puberty and growth spurts, so teenagers will have this going on for a couple of years, three years on average, however it can be longer or quicker than this. With adults, it is more difficult to be certain as adult onset acne is often a different condition and can be chronic, it can go on and on and certain variants of acne such as acne rosacea may be permanent. The good news is acne can easily be treated and controlled well by GPs, and more often Dermatologists, and for severe disease we can use powerful treatments such as retinoids to bring a permanent solution.

What foods cause acne?

This question comes up often in my clinic and this is what foods cause acne. The answer to this question is there is no specific food which will cause acne. When scientific studies are done of large groups of people, we don’t often find a food that stands out. However in individuals, is it commonly reported that certain foods will worsen acne, for example sugary or fatty foods but this is not true for all people. There is a certain type of acne called acne rosacea which gives a redness to the face and it is well documented that there are many foods which will worsen the redness. Any foods that increase the warmth of the skin such as spicy foods or curried foods, foods that dilute the blood vessels such as caffeine and alcohol, as well and acidic foods such as lemons, limes, apples and strawberries. So there are foods which will worsen acne, but as a general rule they don’t cause acne. The rules are different for different people, everyone responds differently so in short there is no easy answer about which specific foods cause acne.

Does drinking water help with acne?

I was asked the question, does drinking water help with acne and I’m afraid the answer is no, drinking water does not help with acne. Acne is a disease affecting the grease glands so it tends to be the oils in the skin that are worse with acne, the grease glands are overactive and the skin is oily and greasy. Drinking excess water will not change the appearance of acne overall.

How do I prevent pimples on my face permanently?

Here’s another question, how can I prevent pimples on my face permanently. There are only really two ways for acne to disappear permanently. The commonest way is for nature to take its course and for acne to burn out and disappear itself over time, in teenagers and young people this will take two to three years and eventually the acne will disappear in most cases. In adults it is more difficult to be certain, especially if the acne has relapsed at a later age as it tends to be more chronic, and certain types of acne such as acne rosacea can often go on for many years or decades. If one is lucky, nature will take care of the acne problem and it will disappear over a period of time, if not, you need to see a dermatologist and we can start you on some treatment. Classically, there are two ways of treating acne, on one hand the acne can be controlled with medication, and on the other hand we can try to cure the acne with medication. To date, there is only one medication out there which has the potential to cure acne and this is a drug called a retinoid. A retinoid is a derivative of vitamin A, vitamin A is retinol and a retinoid is a chemical variant of this, such as retinoic acid. These drugs can be given in cream format where they do not cause permanent effect, but they do improve acne, or they can be given in an oral tablet. Retinoid tables have an incredibly powerful effect with acne and they will often clear it in most people over a period of four to six months. The majority of people will stay clear when they come off the drug, many people will stay clear for life so there is an argument that this is a curative process. Some people will stay clear for a protracted period measured in years or decades, and some people will have a less sustained result where they are only clear for months. If the acne does come back following retinoid treatment, it is often much less severe. That is how a dermatologist would attempt to get rid of the acne on your face permanently. It is important to state however when talking about retinoids that these are drugs which although are members of the vitamin A family, do have a lot of side effects. The side effects comprise of a flare up occurring in the face or body, sometimes referred to as purging where the acne can come out worse at the beginning of treatment, this is usually short lived and will get better over time and will eventually clear completely along with the rest of the acne. Everyone complains of very dry skin when they take retinoids, they will often get dry lips and eyes and regular moisturising is required and even putting vaseline or cream inside the nose to prevent cracking and bleeding. Other side effects include muscle and joint aches in about 20% of people, sunshine sensitivity in about 20% of people and everyone requires blood testing on this drug to monitor liver and cholesterol, although it doesn’t tend to cause much by the way of harm. In fertile women, the biggest side effect of this drug is it causes birth defects so it is essential that if you are a woman going on to this drug you practice effective birth control. Very rarely this drug can cause mood changes and psychological side effects. There are documented cases of low mood and even depression, but pleasingly this is a very rare consequence and should be reversible upon stopping the drug. Depression is a very common condition in life and there is no evidence that being on a retinoid will increase your later risk of developing depression.

How do I get rid of pimples overnight?

One question that often comes up is how can I get rid of pimples overnight. I often get contacted by people who have a big event coming up in the next two or three days, such as a wedding, a conference or a presentation, and they have pimples that have appeared on their face. In short, very very small pimples will often clear quickly with topical agents such as antibiotics or retinoids, but only if they are superficial. Normally a dermatologist will also add in an antibiotic but this can take a few days rather than having an overnight effect. For any pimple or cyst containing pus or inflammation, the quickest way to reduce this is a shot of steroid into the acne cyst, this normally gives very quick results within 12 hours. You go to sleep with an acne cyst and when you wake up they have often gone down dramatically following a steroid or a corticosteroid injection. So if you have a big event coming up and you have developed a cyst on your face, try to see a dermatologist no later than 24 hours before your event and intralesional steroid shots should be able to bring about good control of your acne cysts in good time for the event.

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