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Breakouts and acne

What are breakouts and acne?

Acne is a very common skin problem in young people and it often lasts for several years, sometimes until mid-life.  It appears as blocked pores, pimples and cysts and usually affects the oily skin areas of the face chest and upper back – and is also termed ‘breakouts’.

What causes breakouts and acne?

The main cause is an increase in sensitivity to androgen hormones.  Stress, medication, smoking and a high sugar or milk diet may also aggravate.

How can breakouts and acne be treated?

Acne-friendly skin care is very important. The next step is prescribed treatment with creams and oral medication such as antibiotics.  In women, hormonal treatment such as spironolactone can be helpful and for severe or persistent acne, a course of oral isotretinoin (‘Roaccutane’) is usually very effective.  Ongoing treatment may be needed as acne is often a long-term condition.  Early effective treatment is important to prevent scarring.


What is rosacea?

Rosacea is an acne-like inflammatory facial complaint that mainly affects the cheeks and nose with background redness, spots and pimples.  It often goes with a sensitive skin and a tendency to flush and blush.  The eyes can also be involved with redness, a gritty sensation and eyelid swelling (blepharitis).

What causes rosacea?

We don’t fully understand the cause but the latest theory is that harmless microbes may be involved in triggering an over-reaction of immune cells causing inflammation and increased blood flow.  Sunlight may also be an aggravating factor.  Flares can be triggered by alcohol, heat, spicey food and steroid tablets or creams.

How can rosacea be treated?

Good skin care and sun protection are important.  Prescribed treatments include creams and courses of antibiotic tablets.  Repeat courses of treatment are often needed as rosacea is usually a long-term skin complaint.

Eczema and dermatitis

What are eczema and dermatitis?

‘Eczema’ or ‘dermatitis’ are names given to a group of skin conditions that cause red, itchy, sore skin.  Affected areas may be blistered and swollen before turning rough, dry and wrinkled.  Atopic eczema is one kind of eczema that runs in families with hay fever and asthma and usually starts in childhood.  Other types of eczema may develop for the first time in adult life.  All parts of the skin can be affected, particularly the hands and face.  Eczema ranges from a mild problem affecting one part of the body such as the eyelid to a widespread severe skin disease.   The soreness and itch can have a big impact on daily life and cause loss of sleep.

What causes eczema and dermatitis?

Eczema /dermatitis are sometimes caused by something that has come into contact with the skin – an irritant (such as soap or shower gel) or an allergen (such as perfume or nickel metal in jewellery).  In other cases, there is no identifiable external cause.  Research has identified genes that make people prone to atopic eczema and dry skin.  The natural microbe levels are also altered in eczema with a loss of healthy bacteria.  Scratching and rubbing the skin leads to further damage and this happens more at times of stress.

How can eczema and dermatitis be treated?

Gentle skin care is essential in all types of eczema.  This usually includes avoiding irritants and using soap substitutes and moisturisers.  Most people’s eczema can be settled and managed with topical therapy (steroid / non-steroid creams) but if it is widespread, a course of ultraviolet treatment or oral medication may be needed.  For severe eczema there are new drugs called biologics and JAK inhibitors.  If contact allergy is suspected or needs to be excluded, patch tests are recommended.

Acne scarring

What causes acne scarring?

Acne causes inflammation in the deeper layer of the skin called the dermis and this can damage the elastic fibers which give skin its smoothness and elasticity.  The end result is an irregular skin contour with dips and dents.  Severe acne is more likely to lead to scarring but it can also happen after mild acne.  In people with darker skins, acne often leaves long-lasting pigmented blemishes (post inflammatory hyperpigmentation).

How can acne scarring be treated?

It is really important to make sure that all active acne has been ‘switched off’ first with effective treatment (as above) as further spots may cause scars.  Treatment options then include resurfacing the skin with chemical peels or lasers and cosmetic surgical procedures to remove scars and tethered skin.  Dermal fillers can also be used to even out irregular skin contours.

Facial flushing and redness

What is facial flushing and redness?

Flushing and blushing are common skin responses to heat and emotion.  Some people who flush or blush easily suffer with feelings of anxiety and embarrassment.  A permanent flushed appearance can also be an early sign of rosacea.

What causes facial flushing and redness?

They are caused by increased blood flow to the skin and are more noticeable in people with a fair complexion.  In most people this is a harmless complaint, but it can occasionally be due to medication or an abnormality in the blood.

How can facial flushing and redness be treated?

The first step is to diagnose whether this is just a natural process or whether there is an underlying skin complaint or health problem.  Treatments for facial redness include topical medication such as brimonidine gel and tablets such as alpha blocking drugs which are usually given to treat high blood pressure.  Gentle skin care is important, avoiding products that irritate the skin and with regular use high factor sun blocks to protect against ultraviolet.  Laser treatment may also give long-lasting benefit.