Puberty is a time of hormonal change. This can lead to an imbalance between female and male sex hormones. Some people also have a genetic disposition to acne.

It is chiefly the androgens (male sex hormones) which are responsible for the development of acne as they stimulate excessive activity of the sebaceous glands. The sebum (the oily substance produced by the sebaceous glands) blocks the ducts of the sebaceous glands and the hair follicles. This is accompanied by abnormal shedding of dead skin cells. The resulting plug of sebum and dead skin cells provides an ideal breeding ground for bacteria. Blackheads (comedones) and pimples develop. If these become inflamed small pus-containing abscesses may develop. The deeper the inflammation the more likely there is to be scarring. Acne affects particularly the face and the parts of the chest and back where there are many sebaceous glands.

Acne is particularly common and particularly severe in girls between the ages of 16 and 19.

Treatment

You should see a doctor if you find the effect of the acne on your appearance distressing or if you develop inflamed blackheads and pimples. There are a number of very efficient treatments available.
You should also support the treatment with appropriate skin care, so-called ' acne hygiene'.

How acne is treated depends on its severity. But acne treatment always takes time. You do not usually see any effect until after six to eight weeks. During the first one or two weeks the skin may actually get worse, even with the right treatment.

Topical treatment (external treatment) In milder forms of acne it is often sufficient to use a cream containing vitamin A acid. Benzyl peroxide and azelaic acid inhibit cell reproduction in the sebaceous glands and have anti-bacterial action. These agents can be used alone or in combination with an antifungal drug. In severe acne the doctor may use an antibiotic instead of or in addition to the other agents. Special skin cleansing by a professional cosmetician can make the acne heal faster.

Internal (systemic) treatment The doctor may prescribe antibiotics to be taken internally. Another drug for internal use is isoretinoin, a derivative of vitamin A acid. Isoretinoin has a number of potential side-effects. Women of child-bearing age must use effective contraception during the treatment as the drug can cause birth defects. The causal treatment of acne is to suppress the action of the male hormones (androgens). Progestins with anti-androgenic action are an established treatment. The particular advantage of this approach is that progestins also have contraceptive action. Additional use of a contraceptive is therefore superfluous.