As a teenager I had spotless skin. But at age 25, when I was sure that I had escaped the acne time of life, my skin turned on me; I got super-sized acne. It was as though I was getting a double portion of acne for all the years I had been acne-free. My confidence became unsteady.

Over the next four years, under my dermatologist's supervision, I vigorously tried every available treatment, until I found the one that worked best for me. Now I am acne-free, and there are new challenges to address, like ageing of the skin.

Acne is common. It is usually referred to as 'teenage bumps' but it may occur at any age. There is some family tendency to acne. Unfortunately, acne commonly occurs in teenagers who are usually self-conscious and unsure about their appearance. Plus, it occurs on the face; a difficult body part to hide from the public.

Sebaceous glands in the skin produce sebum, the skin's natural oil which keeps skin lubricated and supple (elastic). The sebum normally drains from the hair follicle, the sac from which the hair shaft grows, and flows out on to the skin's surface. But at puberty and beyond, there's an increase in the production of androgens (male hormones) in both males and females, which may stimulate the over-production of sebum and keratin (tough skin protein).

This excess sebum and keratin become trapped and block hair follicles. Bacteria called propionibacterium acnes multiply in the trapped sebum, infecting surrounding tissues and causing bumps. Acne typically affects the face, neck, centre of the chest, upper back and shoulders since the sebaceous glands are present in large numbers in the skin of these areas.

There's no cure

Acne cannot be cured. Treatment of acne should be started early to prevent scarring. Failure to follow-up on treatment after early success is a common cause of disappointing results and maintenance of treatment is the key to keeping acne suppressed for long periods.

Mild acne may be controlled by regular use of scrubs, soaps and lotions containing salicylic acid, and moderate exposure to sunlight. Medical treatment for mild and moderate forms of acne includes applying creams, lotions or gels to the skin containing:

benzoyl peroxide (PanOxyl, Benzac),

tretinoin (Retin-A), Stieva-A),

adapalene (Differin, Deriva), or salicylic acid (Acne-sol, Sali-Res).

Antibacterials clindamycin (Clidets) and erythromycin (Stiemycin).

These are keratolytic ingredients which act by loosening keratin and dead cells which are blocking the hair follicles. Sebum then escapes and air will enter the follicles, reducing bacteria.

At first, benzoyl peroxide may cause skin stiffness or dryness. Stopping the treatment for a few days makes stiffness subside. Benzoyl peroxide may cause bleaching of clothing which it comes in contact with the skin, but it will not bleach skin.

Use a sunscreen

Tretinoin and adapalene should be applied at nights, avoiding the eyes, nostrils and mouth. Exposing the skin to sunlight should be avoided or a sunscreen should be used, while using these products. These products cause the skin to be sensitive to sunlight.

When topical preparations alone are ineffective, treatments taken orally, including antibiotics, are prescribed by a doctor. Women with severe acne which has not responded to oral antibiotics are prescribed a preparation containing an oestrogen (female hormone) and cyproterone (drug which opposes male hormones).

In severe cases, a powerful vitamin A-like drug, isotretinoin, is prescribed to be taken by mouth. Pregnancy must be prevented while taking isotretinoin, since it is harmful to the developing baby. With most acne preparations, an improvement may not be seen until two months of use.