Teenage Acne - what can the GP do?

[Tarrarra]

Poor ds is really suffering with acne. We’ve tried lots of skincare, most recently the nip+fab teen range but nothing is shifting it on his face or back. Is this something that the gp can help with and if so, what shall I be asking for? Thanks!

There are lots of treatments available. First line treatments are usually topical ones like benzoyl peroxide or antibiotic creams/gels. If that doesn't work there are options of oral antibiotics, or at the extreme for really stubborn acne that isn't responding to anything else, sometimes roaccutane is used (although usually only under dermatology advice and supervision).

Yes - they can try topical solutions, oral antibiotics, they may try the contraceptive pill, refer to a dermatologist.

yes this is something that the GP can help with, depending on severity age and sex of your teen ...GPs also make referrals to dermatology for specialist prescribing and advice.

You shouldn't need to ask specifically for anything. The diagnosis and treatment are in the GPs hands and are laid out in the NICE guidelines (national institute for clinical excellence) ranging from prescriptions for topical treatments to antibiotics to roaccutane. All these treatments are available on the NHS.

Benzoyl perozide cream is a great place to start from the GP, or Epiduo which is a mix of adapalene (a retinoid) and benzoyl peroxide. It definitely helps if used every day. It bleaches fabric though so be careful on pillowcases etc if using at night.

GP may also suggest topical antibiotics.

A lot of anti acne skincare has benzoyl in it but a weaker % than the prescription stuff. Be careful not to double up or he’ll dry his skin out which is counterproductive. Also avoid any other drying skincare for the same reason. Cetaphil does a good facewash for oily skin.

I assume you've tried all the over the counter stuff, & tried cutting out dairy (you need to be absolutely strict with this), & also cutting right down on sugar, which can both be dietary triggers.

If none of these have worked, request a dermatology referral. There are a number of prescription medications that can only be given by a proper dermatologist. Roaccutane, certain other topical medications.

In the meantime, clean towel, face flannel /cloth every day. Unscented non bio laundry detergent. Clean pyjama top or tshirt & pillow case for bed every night, I bought a load of plain hand towels, cotton flannels, tshirts, pillowcases etc. All in white so they can be thrown in the wash together! He should use mild face wash, don't use severe, drying type of washes etc that strip all the grease off, it makes the skin pump loads more out.

It's been a very slow process for teen DS. They start off with suggestions of topical treatments--otc treatments like Acnecide, etc for 3-6 months.Then move on to prescription-based topical antibiotics, which is where we are now. If there's no improvement in another 3-6 months, there might be a consideration for oral antibiotics.

@LegoCaltrops

I assume you've tried all the over the counter stuff, & tried cutting out dairy (you need to be absolutely strict with this), & also cutting right down on sugar, which can both be dietary triggers.

If none of these have worked, request a dermatology referral. There are a number of prescription medications that can only be given by a proper dermatologist. Roaccutane, certain other topical medications.

In the meantime, clean towel, face flannel /cloth every day. Unscented non bio laundry detergent. Clean pyjama top or tshirt & pillow case for bed every night, I bought a load of plain hand towels, cotton flannels, tshirts, pillowcases etc. All in white so they can be thrown in the wash together! He should use mild face wash, don't use severe, drying type of washes etc that strip all the grease off, it makes the skin pump loads more out.

There are several lines of treatment that the GP can try between OTC and dermatology!

OP - yes it’s totally worth an appointment.

GP here. There are prescription treatments that will deal with 90% of teenage acne. For anyone who doesn't respond, they can be referred for Roaccutane, though this does carry some risks, which is why other methods are tried first - very successfully in most cases.

Definitely talk to your GP. I feel sad, seeing teens with bad acne, when I know that it can be treated successfully in most cases.

The NICE guidance is here. There is no evidence for any dietary restrictions by the way - NICE considered this in detail.

@MrsMariaReynolds

It's been a very slow process for teen DS. They start off with suggestions of topical treatments--otc treatments like Acnecide, etc for 3-6 months.Then move on to prescription-based topical antibiotics, which is where we are now. If there's no improvement in another 3-6 months, there might be a consideration for oral antibiotics.

This is an important point. Nothing works quickly, so it's important to manage expectations, and to encourage your DS to keep trying a treatment, even if there is no immediate effect.

Oral antibiotics are increasingly understood to have many negative side-effects, e.g. on the gut flora ('friendly bacteria'), and this can cause long-term problems, so topical treatments are the first line treatment for most teens.

Dd was put straight on oral antibiotics….something beginning with L…..¿

She often feels nauseous and is sick….I wonder if it’s the medication now?

@CovidCorvid

Dd was put straight on oral antibiotics….something beginning with L…..¿

She often feels nauseous and is sick….I wonder if it’s the medication now?

Oral antibiotics are sometimes the recommended first -line treatment. See the NICE link that I posted above. But, if your DD is feeling nauseous, you could ask your GP about trying topical treatments instead.

Acne is a hormonal condition that GPs are used to treating. There are clear it guidelines and it is well worth seeing your GP.Diet doesn't have any significant effect and nor does cleansing etc. Normal washing is fine. Some otc solutions contain mild percentages of benzoyl peroxide which is active against acne so can start there but otherwise there is no need for special measures.

Topical creams
Oral steroids
Standard Combined pill
Dianette
Roaccuatane from a dermatologist

Standard combined pill not ideal for the OP's DS 😉

Our GP refuse to offer an appointment or any treatment even for severe cases. My sons is horrific but they say it is not something they treat as we can access over the counter medications.

Hi OP,

I had awful awful cystic acne as a teenager and the many doctors I saw were pretty adamant i'd grow out of it and refused to really do much more than some short courses of lymecycline and offer me patronising platitudes. Nothing over the counter worked, it's just not strong enough. The antibiotics weren't strong enough - a lot of the advice being offered above is suitable for spots but not acne, which is written into your DNA and no amount of clean flannels and Benzoyl perozide cream will really go any way to helping.

Acne is not a hormonal condition as someone said above - it is a bacterial skin infection. It can last into adulthood depending on the type of acne it is.

I gave up in the end and just endured, but when it was still active in my twenties, I paid to go to a private doctor to ask them about laser treatment for the severe scarring. They wouldn't do it without me undergoing proper treatment to ensure the acne was no longer active, so wrote me a letter suggesting a course of roaccutane/isotretinoin which I was to take to my NHS GP. It worked and I was on the waiting list for roaccutane within a week. It was a six month wait, and a very tough treatment to go through, but very successful. I now have the kind of skin I dreamt of for years.
It is easier for boys to be referred for it than girls (speaking from personal exp.) as the risks of the medication include serious birth defects if you were to become pregnant whilst taking it (obvs not a risk for your DS - but something that will be in his favour).

The dermatologists I saw at the hospital couldn't believe that GPs during my adolescence hadn't taken me seriously (my scarring is very severe across my neck, back and chest) and told me always to just kick up a fuss, ask to see different doctors, complain if it wasn't being taken seriously.

Acne leaves physical and psychological scars that last forever, it's a serious medical condition. My heart goes out to your DS - there is treatment out there. The private doctor's appointment cost me £50 and was the best money I have ever, ever spent. If you are able to afford that, then it might be a good route to go - the actual roaccutane treatment is on the NHS, it's just getting that initial referral that you need.

Best of luck OP - fight for the right treatment for your son, I promise it is out there. It's just not on the shelf at Boots!

DD has just finished her course of roaccutane, prescribed by her GP and monitored by her GP; so you don’t need a dermatologist referral necessarily. She has been through everything else-antibiotics/the pill/countless creams etc. The result has been nothing short of miraculous-her skin is beautiful, soft and spot free for the first time in years. She’s delighted and the effect on her mental health and confidence was worth the risks of the treatment.

There are several lines of treatment that the GP can try between OTC and dermatology!

OP - yes it’s totally worth an appointment.

That's fair. I've had acne for nearly 30 years & the only things that have made any impact were from the dermatologist. I vaguely remember the GP prescribing some long courses of antibiotics when I was a teenager but they didn't work & coincided with a massive deterioration in my IBS, which has never really got completely better. I don't know what GPs tend to prescribe now, I requested help with it again last year & they referred me straight back to the dermatologist again.

@hermionegranger

Hi OP,

I had awful awful cystic acne as a teenager and the many doctors I saw were pretty adamant i'd grow out of it and refused to really do much more than some short courses of lymecycline and offer me patronising platitudes. Nothing over the counter worked, it's just not strong enough. The antibiotics weren't strong enough - a lot of the advice being offered above is suitable for spots but not acne, which is written into your DNA and no amount of clean flannels and Benzoyl perozide cream will really go any way to helping.

Acne is not a hormonal condition as someone said above - it is a bacterial skin infection. It can last into adulthood depending on the type of acne it is.

I gave up in the end and just endured, but when it was still active in my twenties, I paid to go to a private doctor to ask them about laser treatment for the severe scarring. They wouldn't do it without me undergoing proper treatment to ensure the acne was no longer active, so wrote me a letter suggesting a course of roaccutane/isotretinoin which I was to take to my NHS GP. It worked and I was on the waiting list for roaccutane within a week. It was a six month wait, and a very tough treatment to go through, but very successful. I now have the kind of skin I dreamt of for years.
It is easier for boys to be referred for it than girls (speaking from personal exp.) as the risks of the medication include serious birth defects if you were to become pregnant whilst taking it (obvs not a risk for your DS - but something that will be in his favour).

The dermatologists I saw at the hospital couldn't believe that GPs during my adolescence hadn't taken me seriously (my scarring is very severe across my neck, back and chest) and told me always to just kick up a fuss, ask to see different doctors, complain if it wasn't being taken seriously.

Acne leaves physical and psychological scars that last forever, it's a serious medical condition. My heart goes out to your DS - there is treatment out there. The private doctor's appointment cost me £50 and was the best money I have ever, ever spent. If you are able to afford that, then it might be a good route to go - the actual roaccutane treatment is on the NHS, it's just getting that initial referral that you need.

Best of luck OP - fight for the right treatment for your son, I promise it is out there. It's just not on the shelf at Boots!

@hermionegranger thanks for this. I absolutely dread my DD going through what I have. My teenage years & mental health were blighted by my terrible skin, I'm covered in scars & my mother refused to take it seriously. I'm 40 & it's still a problem.

@LegoCaltrops Solidarity. People underestimate the impact of acne on mental health. I have had counselling to deal with the impact of it - it affects everything. Being a teenager is hard enough without the constant pain & shame acne causes.

People who are lucky enough to have good skin have no idea of the physical pain of acne, it can be extraordinarily painful.

Treatment is available for you too! I went to that private doctor at 28, and if my acne ever comes back i'll be banging on his door again in a flash.

Acne is not a hormonal condition as someone said above - it is a bacterial skin infection

Acne is a complicated condition, with more than one contributing cause. Bacteria as certainly part of it, which is why antibiotics work (they also have an anti-inflammatory effect), but teenage hormones cause over-production of sebum, so the hormonal side is important too.

Severe cystic acne needs specialist treatment. Most people with acne have milder forms of the condition, fortunately. Most acne will respond very well to topical and/or oral treatments, prescribed by a GP, as recommended by NICE.

We tried everything including antibiotics with our ds. Eventually say a dermatologist who was horrified by the state of his back and immediately put him on Roaccutane. I think his skin had been bad for so long we didn’t réalise how severe it had become. It took a year but he has beautiful skin now. Although he does have some scarring on his back, his face is unblemished. I would seek a dermatologist ‘s advice.

Yes please please do it. Acne is a condition that should be treated just as any other skin condition would be - please don't ignore it and pass it off as just something teenagers go through, or say he will grow out of it. It causes immense pain and shame!
GP and dermatologist referral.
Roaccutane changed my life.

As a GP, it would make my life very easy if I referred everyone with acne to a dermatologist. Why don't I do that? Because it would be shit for patients with severe acne.

If GPs send everyone with acne to a dermatologist, waiting lists will be even longer, and patients who really need specialist help will be stuck in a queue behind people who could have been sorted out in a few weeks by their GP. I have had patients suicidal due to terrible, disfiguring acne. I want them to get specialist help quickly and not have to wait behind people who could have been treated by a GP.

Not everyone needs Roaccutane or to see a dermatologist. Patients should be treated according to the NICE guidance.

MissLucy , I agree with both your posts. I also have the experience of DC with bad acne , one of whom got a very nasty depression from roaccutane . One of my other DC cannot have oral antibiotics but has had a lot of success with the various prescribed lotions, benzoyl peroxide, nicam, otc salicylate and intermittent use of topical antibiotics. They are very good at regular use and it makes a big difference. It is all worth doing.