Acne & spots

Why some people get acne

Normal hormone changes at puberty. No one knows why some people’s skin secretes more sebum (grease) than others. The sebum-producing glands become particularly active soon after puberty, around the age of 11–14 years, and this is when acne usually starts.

Heredity. Acne tends to run in families. If your parent, brother or sister was (or is) an acne sufferer, you are 3–4 times more likely than average to have it yourself. Studies of twins have shown that acne is 80% genetic; everything else is relatively unimportant (British Medical Journal 2006;333:949–53).

Smoking. Smokers have more and worse spots than non-smokers. For example, a study found that 40% of smokers, but only 10% of non-smokers, had acne (British Journal of Dermatology 2007;157:1070–1).

Medications. Some drugs can cause acne. The best-known example is anabolic steroids taken by body-builders, but phenytoin (for epilepsy), rifampicin (for tuberculosis/TB), vitamin B12 (for anaemia) and lithium (for mood-swings) can also produce acne. Occasionally, chemicals in the workplace, such as industrial oils, are responsible.

Skin-lightening creams. These often contain strong steroids, and can cause acne as well as skin infections (GP 2006;Nov 26:48). Never use them!

Contraceptive pill. Most oral contraceptives contain both oestrogen and progesterone. Oestrogen usually improves acne, whereas progesterone can make it worse, so it is not surprising that the pill worsens acne in some people and improves it in others. There are various different types of progesterone, so check the label on your pill packet: ‘gestodene’, ‘desogestrel’, ‘norgestimate’ and the pill containing ‘drospirenone’ (Yasmin) are good choices.

Polycystic ovary syndrome. If you are a woman, and your periods have become irregular and you have noticed an increase in hairiness of your skin as well as acne, you might have polycystic ovary syndrome. This can be treated, so see your doctor if you suspect it.

Make–up. Some make-ups can make acne worse. The acne is likely to be all over the face, with lots of blackheads (GP 2006;Nov 26:48).

Environment. Chefs and sauna masseurs find that their hot, humid environment worsens acne – perhaps by causing further blockage of the pores. Similarly, acne may worsen if you move to a hot country. For this reason, the armed forces are reluctant to enlist individuals who have moderate/severe acne, in case they have to be posted to the tropics.

• Acne & spots – main page
• Common beliefs – true or false
• How you can improve your skin
• What your doctor can do
• Acne and pregnancy
• Scarring
• Useful contacts