Stubborn Acne

Patients with stubborn acne may have experienced skin problems for quite some time. If previous treatments have been ineffective, their condition may be difficult to resolve and could remain symptomatic for months or years.

What is stubborn acne?

Acne Vulgaris is an extremely common skin problem and affects most people at some point in their lives. Typically occurring on the face, chest, back and shoulders, acne can cause a range of spots, pimples and zits to form on the skin.

Acne can vary in its severity and some patients may be more symptomatic than others. Similarly, patients can respond differently to treatments. Whilst some individuals are able to reduce symptoms with relatively minor treatments, others undergo numerous treatments with little success.

Generally, patients with stubborn acne have had the condition for a significant period of time. In addition to this, their skin condition may have persisted, despite numerous treatments being used.

What are the symptoms of stubborn acne?

Patients with stubborn acne may experience any or all of the following symptoms:

  • Whiteheads
  • Blackheads
  • Pimples
  • Pustules
  • Nodules
  • Cysts
  • Skin inflammation
  • Redness of the skin
  • Oily skin
  • Pain and discomfort
  • Dry skin
  • Itching of the skin
  • Increased risk of secondary infections

Acne causes spots to form on or in the skin. Whiteheads are closed spots, containing pus, oil and skin debris, whilst blackheads are spots which are open and do not contain pus. Pustules can be any size but the term is typically used to refer to larger, closed spots which appear on the skin's surface. Nodules and cysts, however, tend to form under the skin and are rooted deep in the skin’s pores. These usually occur in the most severe cases of acne and can be extremely painful.

As well as the development of spots and pimples, patients with stubborn acne may experience ongoing skin inflammation. Often, the patient will experience pain at the site of each pimple but also report generalized sensitivity in the affected area.

Although acne is primarily a physical condition, it does have an emotional impact on patients. Many people feel embarrassed about the appearance of their skin and can develop anxiety and depression as a result of stubborn acne.

Whilst patients with acne experience the above symptoms as well, individuals with stubborn acne may suffer these symptoms for longer periods of time. As treatment often fails to resolve stubborn acne, patients may find it difficult to obtain relief from their symptoms.

Furthermore, individuals with stubborn acne may experience a higher rate of secondary infections than other people. When open pimples develop or when closed pimples begin to leak pus, the skin is broken and additional bacteria can enter the patient’s body. When this happens, a secondary infection can be contracted and additional treatment will be required.

What causes stubborn acne?

The exact causes of acne vary, although there are many factors which contribute to the condition. Similarly, physicians are unsure why some patients respond well to treatment, whilst others develop stubborn acne, which persists despite various treatments. In cases of stubborn acne, the following factors may contribute to the condition:

  • Excessive oiliness of the skin
  • Hormonal imbalances
  • Dry skin
  • Diet
  • Excess bacteria on the skin

Sebum, or oil, is produced by the sebaceous glands which are present in every hair follicle. When too much oil is produced, the hair follicle can become clogged and a spot can form. Often, this oil mixes with bacteria and skin debris, which is why a pustule or whitehead may develop.

Hormonal imbalances may be responsible for the increase in oil production and could be at the root of many cases of stubborn acne. As adolescents experience numerous hormonal changes during their teenage years, this may be why this age group are most affected by stubborn acne.

Although excess oil production can be responsible for stubborn acne, dry skin can be a factor too. If the skin is too dry, it can become flaky. When flakes of skin clog the pores, spots can form.

Diet may also play a role in the development of acne, although not all cases of stubborn acne are linked to food intake. Some physicians maintain that certain foods, such as carbohydrates, can exacerbate the symptoms of acne. Similarly, some patients maintain that eating dairy products triggers the symptoms of acne.

Most patients with stubborn acne take great care to cleanse their skin regularly and poor hygiene is not usually a contributing factor to their condition. However, excess amounts of bacteria on the skin could contribute to the symptoms of acne. If bacteria is not washed off the skin, it can enter the skin’s pores more easily and spots may form at a higher rate.

What is the treatment for stubborn acne?

Patients with stubborn acne may have already tried a range of treatments with limited success. However, every patient responds differently to treatments so it is worth trying a variety of remedies until the patient find one which is effective for them. Stubborn acne may be treated with the following measures:

  • Over-the-counter cleaners and lotions
  • Topical antibiotics
  • Oral antibiotics
  • Hormone treatment
  • Steroid medication
  • Light therapy
  • Dietary changes
  • Lifestyle changes

As a first-line treatment, many people with stubborn acne use over-the-counter products, such as cleansers, scrubs and lotions. These often contain chemicals, such as Benzoyl Peroxide or Salicylic Acid, which can help to kill bacteria. Products aimed at people with oily skin can also help to remove excess oil from the skin and, therefore, reduce the number of spots which form.

In most cases, people with stubborn acne will not obtain significant symptom relief with over-the-counter treatments alone. If necessary, they will be prescribed topical and/or oral antibiotics. In some cases, prescription-strength face washes can also be prescribed. These are stronger than over-the-counter remedies and will be more effective in killing bacteria and, therefore, reducing spots.

If patients are experiencing stubborn acne, hormone tests can determine whether an imbalance is present. If so, hormone treatments may be the only way to balance the patient’s hormone levels and reduce the symptoms of acne. Whilst removing excess oil from the skin may help to reduce the patient’s symptoms, if unbalanced hormones are causing the excess oil production, the condition will only be remedied once the underlying cause has been addressed.

In addition to this, steroid medications can be used to help minimize the symptoms of stubborn acne. Steroids are often effective in reducing inflammation and can, therefore, reduce the pain and discomfort associated with the condition. Similarly, steroid medicines can reduce the redness caused by stubborn acne and may improve the appearance of the skin.

Although light therapy does not usually cure acne, it can reduce the symptoms and may, therefore, be appropriate for patients with stubborn acne. Most effective on smaller pimples, light therapy can penetrate various layers of skin and kill bacteria, thus reducing the chance of pimples forming.

Dietary and lifestyle changes can also be crucial forms of treatment for patients with stubborn acne, particularly if they have not responded to topical remedies and oral medications.

If patients are currently eating numerous inflammatory foods, for example, this could be contributing to their symptoms. Cutting out foods which are known to cause inflammation, such as dairy and processed foods, may help to reduce the individual’s symptoms. However, patients should always seek medical advice before embarking on a new dietary regime.

Similarly, lifestyle changes can have a significant impact on the symptoms of acne. If individuals wear make-up, they may want to try non-comedogenic products as these are less likely to clog pores and cause spots, for example. In addition to this, individuals who smoke or consume large amounts of caffeine may find that stopping smoking and reducing their caffeine intake helps to minimize their symptoms.

Can stubborn acne be prevented?

It can be extremely difficult to prevent acne, particularly as it’s such a common condition. However, individuals with stubborn acne should have access to effective treatments. Whilst dietary and lifestyle changes may not always be enough to prevent stubborn acne completely, they can help to reduce the risk of the skin condition occurring and may prevent severe acne from forming. In addition to this, individuals who are able to identify and use products which are appropriate for their skin may be able to prevent the symptoms of stubborn acne emerging.