#JanuaryJoy – Overhaul your Skincare

January is a time for fresh starts, clean slates and good intentions. I don’t know about you but I’m always in need of a kick up the behind when it comes to skin care and I can’t think of a better time than now, when I’m feeling motivated and thinking about all the events I have coming up this year that I want my skin to be glowing for.

In a moment I’m going to share my skin care resolutions and I’d love to hear yours. As with so many of the #JanuaryJoy prompts, just writing something down makes me feel much more committed to the idea and it’s fab sharing tips and thoughts with you all.

Image of and credited to Keiko Lynn

First though, I want to update you all on something I have been doing for my skin for a while now. Back in June I wrote 2 posts on Adult Acne… One busting the myths and encouraging you all to seek treatment if you need it, instead of putting up with less than perfect skin and a second detailing the acne treatments you might be offered. At the time, my skin had been particularly troublesome. Barely a day went by that I didn’t get a new red lump under my skin and whilst they were easily coverable with make-up, who wants to have to do that everyday? The spots were also leaving areas of increased pigmentation behind and after looking back at some honeymoon photos of ours, (when I had been on treatment for spots) I realised how good my skin had been and how I had really just got used to the spots, kidding myself when I had a good few days that it wasn’t that bad. Don’t get me wrong, I was by no means acne-ridden, but I certainly fell into one of the categories of women who I was trying to target in those posts – Living with acne and not feeling like I really warranted medical treatment for it.

Fast forward 6 months and after 5-6 months of treatment, my skin is massively improved. I barely get a spot now and if I do they are much less significant. My skin tone is also so much better. All the pigmentation I was worried about has almost completely faded and apart from my desert island beauty item of blusher to brighten up my monotone skin, I’m happy to go completely barefaced any time, any where. (Here I am, doing just that.)

I’m so glad I went back to my GP (GP’s have their own GP too!) and got it sorted out. As with all my other skin care tips I wanted to remind you, if one of your resolutions this year is to sort your skin out, before forking out on expensive cosmetics and skincare, go back and read those posts and think about whether you actually need professional help. (It was interesting to note, even after writing those posts, that when I tweeted about how much my skin had improved yesterday, everyone was hoping I would reveal a miracle cosmetic product.)

Ok, so skin sorted, what am I focusing on this year when it comes to my skin?

  1. My devotion to Eve Lom is unwavering but my laziness seriously gets in the way of maintaining her regime. I’m going to try my very best not to fall into bed without taking my make up off and at the very least, keep some make-up remover wipes in my bedside to use if tiredness gets the better of me.
  2. Now I’ve turned thirty, I feel like it’s time to start thinking more seriously about anti-aging products. I’m not entirely convinced any anti-aging product actually works but I am going to endeavour to apply my eye cream at night and to moisturise my neck too.
  3. On the same note, I’m going to start the search for a super-serum to improve my skin and at the very least hydrate it better.

So let’s hear your thoughts now. What are your skin care resolutions? Did you visit your GP after reading my Adult Acne posts and have you seen a difference? Or has this post made you realise now is the time?

Here’s to your best skin ever in 2013!


PS. Here are those Acne posts if you want to re-read.

Adult Acne Part 2: Treatment

This afternoon, it’s the second and final part of my series on Adult Acne treatment, you can read part 1 here. I hope the first part gave you a bit more information and most of all motivated you to make an appointment with your GP to discuss your skin if it is a problem for you. Please don’t be put off if things haven’t worked in the past or if you have met an unsympathetic ear. Try a different GP or go back to your preferred one and have an open conversation about your concerns and what you would like to do about them. A good GP will guide your decisions by informing you about the options that are best suited to you.

Today I’m talking you through the treatment options and hope to give you some understanding of who they are best suited to and why.

Lotions and Potions
The first option for treatment is a topical medicine, ie one that you apply directly to the skin in the form of a gel or cream. Don’t be fooled by the formulation, these can be as effective as oral treatments (tablets) when you find the right one.

The catch? ALL acne treatments take 2-4 months to reach their maximum effectiveness and you are a key factor in that. You need to be religious about applying it as prescribed (all over the face, not just on spotty areas,) and patient while you wait to see a difference. A rule of thumb I give my patients is to expect a 10 % reduction in acne per month and no difference for the first month. (So bear in mind if you have only a few spots, it can take a while to see even one less.) Patient and pharmaceutical info varies but most suggest around 12 weeks use to assess results. Pretty disheartening, but if you’re prepared for the long haul you’re often pleasantly surprised by the results.

The topical treatments broadly speaking have three different mechanisms of action: Those aimed at stripping the top layers of skin, those containing antibiotics and those containing Vitamin A derivatives, along with combinations of two types. Some commonly used preparations include Benzoyl Perozide (PanOxyl) Benzoyl Peroxide plus an antimicrobial (Duac, Quinoderm) Antibacterials, (Zineryt, Dalacin T,) and topical retinoids, (Differin, Isotrex, Isotrexin, Retin-A.)

Acne and The Oral Contraceptive Pill
Lots of women blame their acne on starting the pill, others want to start the pill as a treatment method. In truth, acne occurs at a time of life when many women need contraception, thereby implicating the pill in the problem, often falsely. In terms of using the pill as a treatment for acne, opinion varies.

My personal opinion is that if you have acne, treat the acne, if you need contraception, take it. Only in circumstances where women come needing contraception as a priority and hoping to improve their skin as a secondary concern, do I offer the pill. The reason for this is simple. There is no guarantee that the pill will clear up your skin. If it does, then great, but it is equally likely to increase your spots by upsetting your hormone balance or increasing skin oiliness.

From a medical point of view, the recommendation is trying a standard pill with a specific combination of hormones, like Microgynon 30, Brevinor or Loestrin 30. Of course, all the normal discussions should take place with your doctor or nurse about your suitability for the medication. Yasmin, (a different combination of oestrogen and progesterones) is often heralded by the media as the ultimate pill for skin sufferers, however it is not recommended as a first choice of treatment due to a lack of evidence for its effectiveness against acne.

Dianette is another second line option for treating acne, which is an anti-androgen and reduces oil production. Although it has a contraceptive effect, it should not be used solely for contraception and carries the usual risks of combined oral contraceptives that your doctor will check before prescribing it to you.

Lastly, the progesterone only pill and progesterone only methods of contraception can cause acne or make it worse. You may have to weigh this up against your need for contraception if the combined pill is not an option for you (if you have migraines for example) and decide which is more important.

Oral Antibiotics.
As I said above, oral antibiotics (in tablet form) aren’t necessarily the next step for acne treatment but are often used as a ‘step up’ option. One indication for choosing oral antibiotics is the need for treating wider areas than just the face, for example acne on the chest or back, where it is hard to apply a topical cream. They can also be useful where compliance is an issue. For example, you might choose not to use a cream because it feels uncomfortable on your face, or maybe you’re that person who doesn’t take their make-up off at night… not conducive to remembering a cream too! You do need to take them for just as long, I usually review patients at 4 months before considering a change of antibiotic or type of treatment. You can combine oral antibiotics with topical treatments too.

Image credit

Some of the popular preparations we use are Lymecycline, Oxytetracycline and Erythromycin. I prefer Lymecycline as it has good effectivity, low resistance against it and is a once a day preparation.

A word on antibiotic resistance. Resistance to antibiotics (and this goes for other situations they are used in too,) is only an issue when using the same antibiotic for long periods of time, so can be a problem in acne. There is an increasing amount of resistance to Erythromycin for example and we don’t recommend the use of topical creams that contain antibiotics after the acne has cleared up or for more than 6 months – switch to something without antibiotics for long term maintenance.

Specialist referral and Roaccutane.
Once all of the above treatments have been tried then your doctor might feel that you need a specialist opinion from a hospital Dermatologist. You should be prepared that your GP is likely to try and treat you without referring you (depending on their level of confidence at treating acne,) for several reasons. Firstly, many acne sufferers can get good relief from ordinary prescription drugs, secondly, it can take some time to find the right one for you and thirdly, there are strict criteria for starting a patient on Roaccutane. Although we as GP’s are not allowed to prescribe Roaccutane (because of the monitoring that needs to be done for patients who are on it,) we are aware of those criteria and there is no point referring someone who doesn’t fit them. However, if you are not being referred and your acne is leaving lasting scars or producing hard inflamed cystic lumps on your skin that take weeks to resolve, you should ask to be referred.

The Everygirl

Roaccutane is a retinoid and Vitamin A derivative which works by reducing the skins oil production. Less serious side effects include extreme dryness of the skin and peeling or flaking, particularly on sensitive areas like the lips. Skin can also be very sensitive to light so should be protected even on cloudy days with sunscreen. Roaccutane is teratogenic, which means it can cause birth defects in babies of women who become pregnant whilst taking the drug. Female patients must have fool proof contraception (i.e. a coil or implant) in place before starting to avoid pregnancy. The bit that has received media attention however is the effect on mood. There are rare cases of Roaccutane causing: depression, anxiety, aggression or hallucinations, sometimes even leading to thoughts of self harm or suicide. Sadly there have been a few high profile cases reported in the media of teenagers who have committed suicide on the drug. What we don’t know is if they would have had depressive tendencies even without taking it. The important thing to remember is that this is a very rare side effect. With every medicine available we weigh up the potential risks of taking it against the benefits the patient might experience. Many many people achieve good clearance of their acne and minimal side effects but only you can decide whether it is the right treatment for you and a risk you are prepared to take.

I hope this helps some of you consider your options – please do pass it on to any friends you have who suffer with their skin. If it can help just a few of you, I’ll be very happy.

In the meantime, again, although I can’t give individual medical advice here and I would encourage you to visit your GP (I know, I know, broken record!) I’ll do my best to answer any questions. I think some of the questions which went unanswered last week are addressed in todays post too. I’d also be interested to hear if there are any other medical issues that you would like to see covered – I’ve already had an email suggesting one topic and whilst it won’t be a regular series and I can’t guarantee it will be suitable for coverage here, I’ll do my best 🙂

Here’s to clear skin!


More resources:

  • This article was complied using my knowledge and day to day practice. I also referenced the NHS website Clinical Knowledge Summaries, GP Notebook and the BNF.
  • British Association of Dematologists patient information leaflet: Acne
  • Patient.co.uk Patient information leaflet: Acne

Disclaimer: Although written by a qualified GP, this article does not substitute you attending your own GP and should not be used for individual medical advice. No liability can be accepted for decisions made on the strength of information contained here or elsewhere on Florence Finds.

Adult Acne Part 1: Causes and Culprits

A few months back I was reading a top women’s glossy in which the topic of adult acne was covered. The front page heralded ‘new cures‘ and suffering from breakouts myself, I flipped to the article and read with interest. Interest soon turned to anger and frustration. The latest potions, lotions and even non-surgical cosmetic procedures were listed with unproven claims and they all required significant financial outlay. I know how desperate your average woman is when faced with bad skin and the lengths we are prepared to go to to try and rectify it, so felt really short changed that there was no acknowledgement of the need for medical treatment required, save for a short line suggesting you ‘see your dermatologist‘ if you have more severe symptoms. Got one of those on speed dial?

The Everygirl

I’ve always shied away from writing about medicine on Florence Finds, (it was a big enough deal going public,) because what I write can be misconstrued. For this reason you will see my tone switch a little and may find my language more black and white. I really dislike medical chatter on the internet as NOTHING substitutes an open conversation with your GP one to one about YOUR problem. Forget what happend to your friend, what Aunty Annie recommends and the google search you did before attending. Share them by all means, in fact you probably should so your GP understands where you are coming from, but be prepeared to start afresh. And don’t underestimate your GP. Approximately 15% of all problems a GP sees are skin related (probaly 4-5 a day) and as a female GP I tend to see more women and children, so probably even more skin. If you’re not getting on with your GP try asking at reception when you make an appointment if there is a GP with an interest in skin, as we often have extra qualifications which might help you. Only the very top level of treatment for acne (Roaccutane) requires a dermatologist, so save your money.

Image: Keiko Lynn

The pep talk and the personal view.
In this and Part 2, I’m going to cover the medical options for treating acne and hopefully dispell a few myths along the way. Above all I want to encourage you to see a GP about your skin if it is bothering you. On a personal level I have only been to the GP once in my life about spots, when in reality, they have been an on and off problem for about 12 years. I have cycles of good skin and bad, often hormone related, so when it’s good I forget about it, then it comes back and I’m miserable. But the predominant thing that stops me going is myself. I tell myself my skin isnt that bad, it could be a lot worse, and there are more important things to worry about in life. For the most part that’s true and I don’t dwell on it, but sometimes it drives me mad. It’s nothing that can’t be solved with great make-up but the person I want to look my best for is Pete and I hate him seeing me with bad skin.

Don’t sell yourself short, being an intelligent well rounded woman does not mean you can’t go in search of great skin.

There might be more to life, but good skin is a great place to start.

Image: Refinery29

Getting to the bottom of things
Another thing that frustrates me about acne is that there are so many myths surrounding the cause. Dietary changes or choices, including chocolate, dairy and alcohol all get blamed, we’re told to drink more water, avoid stress and analyse our hormones.

The main culprits? Bacteria, skin and sebum (oil produced by the skin to moisturise it naturally.) Acne is still not fully understood, however it is thought that a combination of factors cause the lesions. Certain skin types are slower to shed their outer layers which can then clog up the pores with dead skin cells. Propionibacterium acnes is a normal bacteria found on the skin – a kind of bacteria which grows without oxygen (anaerobic,) so when a pore becomes blocked, the perfect environment exists for it to grow out of control. P.acnes also feeds on sebum, so oilier skins also contribute to the problem. So you can see that treatments are centred around increasing the skin cell turn over, killing the bacteria and reducing oil production.

That’s all for Part 1. Next week I’m going to tackle specific treatments, how they work and who they’re best for. I’d love to hear what you think about this and if you’ve learned anything. Although I can’t offer individual medical advice here, I’ll do my best to answer any questions you may have too, just leave a comment!


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