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!

Someone upthread recommended cutting out sugar and dairy- is there evidence for this helping? It would have a massive (doubtless beneficial but super challenging) impact on my teen's diet.

You should probably try benzoyl peroxide (Acnecide) for a month so you can tell the gp you’ve tried it. That’s the last thing to try before gp.

aramox some people have found cutting out dairy and sugar helps but many others haven’t (incl me). Not enough find it helpful for doctors to recommend it. In general dairy and sugar are inflammatory, so cutting them out may help a bit, but if there is an underlying hormonal cause (which there is with a huge amount of acne) then it won’t make such a huge difference. Obviously it’s healthy in many other ways to reduce sugar and dairy though.

From what I’ve read I think there may be a closer link between diet and rosacea, which is classed with acne but isn’t really the same.

We've tried topical antibiotic lotion, antibiotic tablets, facewashes, topical prescription cream for 3 years and it isn't improving. Would love to see a private dermatologist

@aramox

Someone upthread recommended cutting out sugar and dairy- is there evidence for this helping? It would have a massive (doubtless beneficial but super challenging) impact on my teen's diet.

NICE looked at this in detail and decided there is no evidence to support it. Also, you can't actually cut out sugar, as all carbohydrates are broken down to sugar by the digestion.

@wordsareveryunnecessary

We've tried topical antibiotic lotion, antibiotic tablets, facewashes, topical prescription cream for 3 years and it isn't improving. Would love to see a private dermatologist

You could ask for a referral on the NHS, as this would follow the NICE guidance (linked above). Unfortunately, waiting lists are likely to be long. Worth speaking to your GP though.

Thanks all,

We have an actual in person appointment on Tuesday so will see how it goes. She looked at the photos and said he would benefit from a course of antibiotics.

We are going through the same thing with ds now.

Salicylic acid products helped for a while, got worse again so switched to Acnecide for last few weeks. Some days it looks like it is calming down, then he has a flare up for a few days again.

Logged an econsult and pictures with dr this morning. Got a call back this afternoon and they issued a prescription for DUAC (basically acnecide with topical antibiotic in it). He is to try that for 6 weeks and if no improvement they'll get him in for some blood tests (not sure why they need bloods) and a course of oral antibiotics.

Another vote for roaccutane.
My son had really bad acne, tried everything. Fortunately our dr was very sympathetic, said her brother had acne and it affected his mental health so she referred us for roaccutane. Cleared him up perfectly.
Went through the same with my daughter and she was referred too.
Although she was only 16 and had no boyfriend she had to do a pregnancy test before every prescription.
Neither of them had any problems when taking it. Now both have lovely spot free skin.

Oh and the only thing that duac did was bleach all of my towels!

Can anyone recommend a sunscreen for teens who are on the medication that makes their skin sensitive?

DS has an oral antibiotic and a face gel which is antibacterial from GP. They are working moderately well -in that he's still prone to large lumps which are painful but the spots are much better, the redness is improved and the lumps have reduced in frequency. And he's not being left with scars, which is what he is interested in.

However, his skin is sensitive and gets dry. He's been using aveeno and rose hip oil on it if it's very dry.

He ould do with a moisturising sun screen - but I don't know what will be best with outbreak prone skin.

Anyone got a top tip? Thanks

@Cassimin

Another vote for roaccutane. My son had really bad acne, tried everything. Fortunately our dr was very sympathetic, said her brother had acne and it affected his mental health so she referred us for roaccutane. Cleared him up perfectly. Went through the same with my daughter and she was referred too. Although she was only 16 and had no boyfriend she had to do a pregnancy test before every prescription. Neither of them had any problems when taking it. Now both have lovely spot free skin.

It's not a question of whether or not your doctor is sympathetic . Roaccutane can cause severe depression and lead to suicide. It can cause liver failure. It can cause loss of sight. It can cause pancreatitis. These effects are rare, but very serious and potentially fatal.

It would be totally wrong, medically, to prescribe Roaccutane for someone who doesn't need it. Anyone whose acne responds to other treatments is much safer using those. Roaccutane is fantastic for the minority who don't respond to other treatments, but there is a very good reason why it isn't the first line medication.

My 13 year old ds has very bad acne and he was prescribed erythromycin which has worked wonders. Spots started clearing up within two weeks and very clear skin within two months. He came off it for a little while recently just to see if the spots came back (as advised by gp) and they did and so he's back on it again now.

Ds has a pharmacy bag of Isotretinoin sat on our dining room table. We have had three years of oral antibiotics, which haven't really worked. His acne is considered moderate though, rather than severe, it's just that nothing has worked. The dermatologist prescribed Isotretinoin last week. He has mental health difficulties, so I'm even more apprehensive.

Your post confirms all my fears MissLucy and I'm still wary of him taking it.

My oldest DD had a course of roacutane. It worked wonders a year later, the acne is back, though not as bad.
The GP put her on antibiotics, but they had no affect.

I don't want to put anyone off using Roaccutane if they need it, @Punxsutawney. As PPs have said, it can be life-changing. Roaccutane has risks, but these have to be balanced against the mental and emotional impact of untreated acne. And you are aware of the side-effects, so will be looking out for them and your DS can stop taking it if there is any sign of trouble.

Maybe have a chat to your pharmacist?

DS had been using Nip + Fab salicylic acid and Acnecide (yes Benzoyl peroxide bleaches everything- including my fabulous Anorak panda towels...) for a year. Phone appointment and photos to GP and he's been given Epiduo ( benzoyl peroxide plus a retinoid) and oral antibiotics- Lymecycline. 5 weeks on, a small improvement but GP did warn it could take a few months to take effect, so we are sticking with it.

Got to be careful to use sunscreen outdoors because of the retinoid, even in this crappy August weather.

@vivariumvivariumsvivaria my son has been using la Roche Posay Anthelios sunscreen (factor 50 if actually sunny, factor 30 grey days).

I've been through this two e and GP prescribed antibiotic.crram whcih did the trick after a few months with ds1 and oral antibiotics on top for ds2 who had it worse, on his back etc (though neither had really bad acne like a few friends who had to have the full on roacuttane treatment) At 17 and 14 they are both pretty much spot free now, as are most of the older mates.

I think he will probably try it. I have to say, the paediatric dermatology team have been good. We've had some negative experiences in other areas of the NHS, but I can't fault their care.

Ds was referred by our GP at the end of December, just as we were going into tier 4 and so far he's had 3 face to face appointments since February.
They did ask him to do a mood questionnaire at the appointment, before they issued the prescription and his score was relatively low.

I've also had contact with his Camhs worker, and discussed this. Ds has some quite complex mental health difficulties that do impact his physical health but the dermatology consultant is aware of this. I think we will need to keep a close eye on things.

From what I can tell. Our GP did everything they could before the referral was made. His first appointment was in 2018 and he was treated in primary care until the end is last year, so it's been quite a long road to get to this point.

My daughter is on tretinoin cream (topical Retin-A which was dermatologist prescribed but could’ve been by the GP.

It’s been really good overall. She had the dreaded Tret purge a few weeks in where everything bad that was going to happen came to the surface but after 6 weeks there was a big improvement and after 12 weeks she just has a few isolated spots and they appear only to disappear shortly afterwards.

She’s on the 0.05% strength and was cautious to start with and things did get mildly irritated/dry to start with but it’s been with it. She’s been left with some mild hyperpigmentation scarring on one cheek but even that’s getting better and there are no actual pitted scars.

Thanks JamesWilby

Also, thanks for your abs.

Retinoids made my acne go away BUT the mental health side effects were awful.
However my mental health was shockingly bad anyway, so it's almost impossible to tell whether it was exacerbated by the tablets but I think probably so.
I had to have at least 2 rounds of it because it came back after the first.
I am loving my clear skin but I asked myself after finishing the retinoids if I would have taken them initially and I said no.
There are probably alot of people that don't suffer mentally with them.

My son's acne disappeared at 15 and never returned after he started using Acnecide cream (Benzol peroxide), which we got on prescription.

It took a few months to work but has been amazing.

It didn't work so well on my DD but she switched to something called Duac cream, also on prescription, which has been better for her.