Alison Dudley was 22 when a comment from a little boy at her local swimming pool sent her rushing off to the changing room in tears. It was the first time she had been swimming for as long as she could remember, and it had taken a great deal of courage to get her there.
Alison is one of millions of Britons who suffer from acne and, until that day, she had been too embarrassed to display the rash of angry spots that covered the whole of her back and chest.
"I couldn't do much to hide the spots on my face, which first erupted when I was 12 and became the bane of my life, though I never displayed the rest of my upper body in daylight," says Alison. "But when a couple of friends invited me along to the local pool I decided to take the plunge. I was sick of acne getting in the way of my enjoyment of life. Then, before I'd even got in, a little boy stared up at me and said to his mother: 'Mummy, look at that lady's back. What's wrong with it?'
"She tried to tell him as politely as possible that it was nothing and not to worry about it. But the damage had been done. I already felt self-conscious. After that, I wanted to die. I could have hit him for drawing attention to it.
"I should have been more grown- up about it. But at any age that sort of incident is very upsetting."
Twelve years later, after having finally found an effective treatment for the pimples that blighted her earlier life (the drug roaccutane), Alison is chief executive of the Middlesex-based national Acne Support Group. She has two daughters, Jessie, seven, and Lucy, two, and, as acne is often hereditary, it was for their sakes that she initially became involved in the organisation .
Around 90% of teenagers and adults have to contend with unsightly spots at some stage, and 15% require help from a doctor for clinical acne at some point. Even into their 40s, 5% of women and 1% of men still have big problems with spots.
Acne is a skin disorder affecting the tiny pores and grease glands (sebaceous glands) most common on the face, neck, back and chest. During adolescence, rising hormones - specifically, male hormones found in both men and women - cause the sebaceous glands to get bigger.
These glands make an oily substance called sebum, which reaches the skin by emptying through the openings of hair follicles. As a result the cells from the lining of the hair follicle shed more rapidly and stick together, forming a plug at the skin's surface.
The mixture of oil and cells also helps bacteria in the follicles to grow, and these create chemicals that can cause the wall of the follicles to break. At this stage, sebum, bacteria and shed skin cells spill into the skin causing redness, swelling and pus. In other words, spots.
Dr Tony Chu, a consultant dermatologist at Hammersmith hospital in London and one of the country's leading experts in acne, says that not enough people take the condition seriously. "Acne leaves scars on the skin and the psyche," he says. "And the psychological scars are as damaging as the physical.
"It usually strikes in puberty when children are just coming to terms with their sexuality and their physical appearance is very important. Along with the designer clothes they want a girlfriend or boyfriend but sadly acne very often results in poor body image and gets in the way of this natural development.
"I get lots of letters from people saying: 'Acne destroyed my life. I didn't achieve at school, I've never had a relationship and I can't get a job.' However sympathetic people might be, if it's a choice between dating or employing someone with acne and someone without most will opt for people with clear skin. Employers justify it because few people feel happy about being served in a restaurant or even being greeted by a receptionist with a face full of spots.
"And it's a disease we laugh at, many stand-up comedians have jokes in their routines about pizza faces or spotty dicks and this is very damaging for people who have acne. Although there are no hard figures, we know through experience that the suicide rate among acne sufferers is considerably higher than the population as a whole."
In Dr Chu's view the biggest tragedy is that so many people are troubled for years with a condition which is "totally treatable".
No treatment works for everybody, but there are hundreds available and it is simply a case of finding one that suits. Most take weeks or months to work.
Anti-bacterial lightbox
The latest treatment on the market is a lightbox, Dermalux, which kills the bacteria that cause acne. It sends out red and blue waves of light, which zap the spots and heal the skin by, in effect, exposing spots to extra oxygen.
The bacteria responsible for acne colonise in ducts in the skin. Because they are averse to oxygen, they breathe through a chemical, poryphyrin.
The lightbox works in two ways. The blue light activates the poryphyrin in the bacteria which, once stimulated by the light, produces oxygen that overwhelms the bacteria. At the same time, the red light stimulates the white blood cells, which then produce fibroblasts, the building blocks from which new tissue is created, which in turn heal any abrasions. The lights do not damage the skin because they are outside the UV spectrum.
In trials, the treatment worked for 75% of patients who, after 12 weeks, experienced a 76% decrease in the number of visible spots. There are also none of the side effects associated with some drugs traditionally used to treat spots.
The downside is that the box has to be used for 15 minutes every day and, as the treatment is not available on the national health service, it costs £200.
Roaccutane
One of a group of medicines known as retinoids which are derived from vitamin A, roaccutane is taken in tablet form daily, usually for four months. It works by dramatically reducing the formation of sebum in the skin.
At the same time, it attacks blackheads and whiteheads, bacteria and inflammation. It can only be prescribed by a dermatologist, usually after several courses of antibiotics have failed to work.
While the treatment has a very high success rate, in the initial stages it can exacerbate acne. It can also cause an increase in liver enzymes - so pre-treatment and follow-up liver function tests to keep levels in check must be carried out on all patients.
As it can damage unborn children, roaccutane must not be taken in pregnancy.
Over the counter
Many non-prescription acne lotions and creams help milder cases of acne. However, many will also make the skin dry if used too often.
Oral antibiotics
These drugs include erythromycin, minocycline and tetracycline. It may be up to six months before you see the full effects, although there will probably be some difference after about six weeks.
Oral antibiotics are effective in about two-thirds of cases of moderate to severe acne, and can safely be taken for a year or more.
Topical antibiotics
Mild-to-moderate acne can often be controlled using antibiotics such as erythromycin applied directly to the skin. These treatments come in bottles with a special sponge applicator, and should be applied over all affected areas, not just individual spots. The treatment is not useful for treating blackheads or whiteheads.
Peeling agents
Treatments such as benzoyl peroxide and tretinoin are effective against blackheads, unlike antibiotics, but can cause dryness and irritation.
Hormones
Women with acne can be helped by taking Dianette. This contains the hormones oestrogen and cyproterone, which counteract the male hormone androgen. Over-production of this hormone is the main cause of excessively greasy skin in women, which can then lead to acne.
Dianette is very effective for many women, and can be taken for many years. It is also an effective contraceptive.
Some common myths about acne
Junk food causes spots
Acne is not caused by eating chocolate, chips, pizza or any other food. Opinions from dermatologists on the importance of diet in the management of acne vary, but all agree that a strict diet alone will not clear up spots.
Too much sex causes acne
While the sex hormone testosterone is the primary cause of acne, spots do not develop because you have too much of the hormone or are over-sexed. Neither sex not masturbation causes spots. In fact, as both are believed to reduce stress levels, they may also help alleviate the aggravating effect stress has on acne.
Spots are caused by dirt
Acne is not caused by dirt. The black of blackheads is due to the pigment or colouring of the plug of "sticky" cells blocking the hair duct. Most people with acne wash more often than those without to clear away excess oil produced by their skins.
You should wash more with acne
Over-washing can actually make acne worse by drying the skin and making it sore. Washing with mild soap twice a day is all that is needed.
Pregnancy cures acne
While some women's acne virtually disappears during pregnancy, in oth ers the change in hormones reactivates an old condition or worsens an existing one.
Sun is great for spots
Although sun may temporarily mask acne, tighten pores or dry up oil glands it also damages follicular walls, thereby clogging pores. This results in more acne which may not not surface for three to four weeks after exposure to the sun.
Acne is curable
There is no cure for acne. However, through consistent use of appropriate treatments and remedies, it can be controlled or prevented.
More Information
The Acne Support Group can be contacted by phone on 020-8841 4747, by post at First Floor, Howard House, The Runway, South Ruislip, Middlesex HA4 6SE or via its web site, The Acne Support Group
American Academy of Dermatology
absoluteacneinfo.com
