1. What causes spots?
Spots can occur due to a variety of reasons. Acne is most commonly caused by how the skin reacts to hormonal changes and sometimes spots can occur from birth until well into adulthood. Acne frequently occurs during puberty, when there are raised levels of hormones which cause glands in the skin to produce excess sebum, or oil and may lead to blockage of the hair follicles and then the appearance of a spot.
2. What are spots and how do they form?
A spot is essentially a combination of blocked hair follicles and dead skin cells. Bacteria causes inflammation below the skin’s surface and this may result in pain and discomfort. There are different types of spots:
- Blackheads: These are blocked hair follicles which may be “open” or “closed”. An open blackhead is visible as a small black dot while a closed blackhead has a tiny layer of skin over it resulting in a small skin coloured/white bump under the skin’s surface.
- Pustules: Otherwise known as pus bumps, these are small, raised areas with white/yellow centre containing dead skin cells and bacteria and which may be painful.
- Papules (red bumps) - These are small raised, red areas of the skin which are often painful
- Nodules - large, firm/hard areas under the skin, which are often painful
3. Are some skin types more prone to getting spots than others?
Yes, people who produce more oil may be at greater risk of developing spots, particularly if they do not have a cleansing regimen. As a group, teenagers are particularly prone to getting spots due to the increased hormones which cause excessive sebum production. The hormones cause an increase in the size of the sweat glands and excess sebum production. Some people are also genetically more prone to getting acne due to how active their sweat glands are. If people use products (moisturisers, make-up) which are oil-based on already oily skin, this may lead to excessive oil accumulation and result in blockage of the hair follicle which may lead to spot formation.
4. I am in my thirties and have recently started getting spots – what could be causing this and how common is adult acne?
Adult acne is very common and often under recognised. It can be divided into two main types.
- Acne Vulgaris which is similar in appearance to acne seen in the teenage years, although the causes may differ. This may consist of red bumps, pus bumps, blackheads and nodules and may affect the face, neck, back and chest.
- Another type of acne known as Acne Rosacea or more commonly referred to as Rosacea may also affect adults from their 3rd/4th decade onwards. This is generally confined to the face, particularly affecting the cheeks, chin and forehead. People may also describe dry/gritty eyes and flushing. There are many reasons for developing acne as an adult. Some people never fully cleared their acne from teenage years and it grumbles on into adulthood and others who may have never had spots when they were younger or very minimal spots, develop it as an older adult. Stress and hormone changes such as pregnancy, menopause, and change of the oral contraceptive pill are all possibilities and less commonly, some medications may cause also cause it. The cause of rosacea is not fully understood, but may be due to genetic and environmental factors such as alcohol, spicy food, sunlight, temperature extremes etc.
5. Can a poor diet or stress result in spots?
Yes, absolutely. Stress has numerous effects on the skin and people with acne may report worsening of their acne during times of stress, however is not usually an isolated cause of acne.
A poor diet is also not the only cause of acne but a well-balanced diet rich in fruit and vegetables and protein is needed for skin healing and is recommended for people who suffer with acne. There are reports of groups of people who consume excessive dairy products, chocolate and carbohydrate-rich diets who have more severe acne compared with those who have a more balanced diet, so there is a link with diet and acne, but acne is multifactorial.
6. I have recently started getting spots on my back. What could be causing this and how should I treat it?
The back is a common location to develop acne as there are sebaceous glands present on the back. People may develop small red spots or pus bumps on the back, a condition known as “folliculitis” due to excessive sweating, particularly in keen gym goers.
Friction of the skin, caused by being in constant contact with a chair or bed throughout the day can also lead to the appearance of spots on the back. Acne, or “bacne” may be a little bit more difficult to treat as it is not as readily accessible for the application of topical therapies compared with the face.
I recommend daily washing with a gentle cleanser. Do not scrub too vigorously as it may irritate the area and cause further inflammation. If you attend the gym regularly you should wear cotton clothing in contact with the skin rather than other synthetic materials which tend to hold the excess sweat on the skin and may lead to further blockage of the hair follicles.
7. Is it bad to squeeze spots?
Yes, a spot essentially contains sebum, dead skin cells and sometimes bacteria. By squeezing it, you risk spreading the contents to the surrounding skin which can lead to further blockage and therefore more spots will appear.
8. Why do I get clogged pores?
There are a number of reasons for this. Excessive sebum production is sometimes down to your genetic makeup and how old you are. Using oil-based products such as moisturisers and make-up may increase the amount of sebum the skin produces which can lead to blockage of the pores. What’s more, inadequately removing make-up and not having a regular cleaning regimen can all contribute to clogging of pores.
9. What causes oily skin and how can I treat it?
Oily skin is due to excessive sebum produced by the skin and this can vary from person to person. It can also depend on what stage a person is in their life. For example, the amount of sebum produced by the skin increases during puberty, hence why most teenagers develop spots at some point during their teenage years. There can also be a seasonal change in the amount of sebum the skin produces. Treatments to help this can include: washing with a gentle cleanser twice a day and not washing too frequently or scrub the area too vigorously as this can lead to irritation and further inflammation. Some hormonal treatments for women may help in reducing sebum production. An oil-free moisturiser should be used daily and if one wishes to wear make-up I would recommend using an oil-free/ forming brand. Otherwise heavy make-up with oil could lead to blockage of the hair follicles and result in the appearance of spots.
10. How can I help protect against marks/scarring?
Do not squeeze spots or pick at them as this can lead to scarring and additional inflammation which takes longer to heal than if the spot was just left to resolve by itself. If your acne is severe and consists of large, painful lesions with blackheads you may wish to seek professional advice as you may need a treatment such as isotretinoin from a dermatologist.
11. How can I reduce the appearance of blemishes?
Blemishes can be divided into “spots” which are raised and “marks” which are flat. I advise not to pick at any raised areas on the skin as this can cause further inflammation and potential scarring. Wash daily with a gentle cleanser, moisturise with an oil-free moisturiser, and you can apply camouflage with oil-free concealers/make-up. When spots are clearing they may leave a “mark” on the skin which consists of a darker flat patch which may look pink/purple in appearance. This is not necessarily a scar and what is known as “post-inflammatory hyperpigmentation”. It‘s a sign that there has been inflammation. area This will fade, however it may take months to fade completely. Therefore not all “blemishes” or marks on the skin will lead to scar formation.
12. My acne tends to flare up around my period. Why and what can I do to avoid this from happening? What is the best way to prevent/treat hormonal acne?
Acne tends to flare pre-menstrually and while some women notice that it calms down during menstruation, this is due to the monthly hormonal fluctuations.
There is a mid-cycle progesterone rise which leads to increase sebum being produced by the skin and the hair follicles can become blocked resulting in emergence of spots. The bacteria on the skin feeds on the excess oil and this contributes to the formation of raised red bumps and pus bumps.
Unfortunately, there is no special treatment for this, but women need to maintain their cleansing regimen throughout the month. Some women benefit from the addition of the oral contraceptive pill if they notice a definite correlation between their cycle and a flare of their acne. Other treatments may be recommended by a dermatologist and it may also be worthwhile having further investigations if you report an irregular menstrual cycle as this could be associated with PCOS (polycystic ovarian syndrome) and treatment may differ.
13. What is the best make-up to use on blemish-prone skin
Oil-free, non-comedogenic make-up (non-blackhead forming) is the best. It should be applied over a layer of oil-free moisturiser and should be removed each day with a gentle cleanser.
14. Should I exfoliate every day if I have spots?
You should wash twice daily with a gentle cleanser. Some products contain Salicylic acid which may help clean the skin and dry out some of the spots. But you should not scrub the affected areas with a harsh exfoliant as it could lead to further irritation and inflammation.
15. Have you tried Effaclar with your patients, what results did you see on the skin and general well-being?
Yes I have used the Effaclar range on my patients. For patients with mild to moderate acne who were also on prescribed topical and oral medication, they were very happy with the ease of use of the product and the outcome. I have also used Effaclar H in patients who have completed a course of Isotretinoin and they use this as their maintenance treatment with good response. It is a well -tolerated product.
16. How important is following a skincare routine in managing oily/blemish prone skin?
It’s important to understand that excess oil on the skin can result in the formation of spots so a daily routine of twice daily washing with a gentle cleanser, and the use of oil-free moisturisers and make-up will reduce the risk of further spot formation. It’s also important to have an evening routine, whereby any make-up is removed and the face is gently cleansed. Thereafter the patient may choose to use a prescribed topical medication if the acne is moderate or a product from the Effaclar range if the acne is mild-moderate.
Acne : Acne is a form of chronic inflammatory dermatitis of the pilosebaceous canal. Two types of lesion are linked to acne: retentional lesions (blackheads or microcysts) and inflammatory lesions (papules, pustules, nodules or nodular cysts). The most common scenario is that both types of lesion coexist: it is known as mixed acne.