#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.

#JanuaryJoy – Dry January

The health service is full of health initiatives, I should know – each new one brings a slew of patients worried about the recently highlighted health issue. There was Stop-tober (Stop Smoking) recently and this month Alcohol Concern is promoting Dry January and Cancer Reaserch is simultaneously running Dryathalon and using it as a fundraising opportunity.

Image credit

So time for a tough question. Do you ever feel like you drink too much? I definitely drink less than I used to (in the Uni years for example!) but the festivities seem like a never ending marathon of drinks and overindulgence. When the party season isn’t in full swing it’s all too easy to unwind after a busy or stressful day at work by heading straight for the fridge and pouring a chilled glass of Sauvignon Blanc.

So until 25th of January (when we’re planning a weekend away for Pete’s birthday) and with the exception of next Saturday when I have an annual Black Tie event to attend, I’m staying off the hard stuff, the bubbly stuff, the lot. I know it’s not the whole month, but it’s what will work for me and a good start.

For me this is about health. Cutting out alcohol not only cuts out the calories it contains but hopefully is going to seriously help my will power when it comes to making healthier food choices. You see, put a drink in my hand and I suddenly lose all ability to make sensible choices when it comes to food. For me, a drink goes with nibbles, olives maybe or some bar snacks. Then I’m hungry, and I go for a burger or the cream sauce pasta instead of a healthier choice. That’s before I even get to the dessert menu.

So who’s with me? I’m hoping cutting out alcohol is going to make me feel fitter and brighter. No hangover at the weekend and a healthier start to the New Year. I’d love to hear what your attitude to alcohol is – have you ever given up the booze for a short period like this or wanted to do it? Let’s raise a glass (of tonic, hold the gin,) to Dry January.


#BeYourPersonalBest [Part 3]

Last week, amidst the other swimmers in the pool, it suddenly struck me that triathlon is a real challenge. When I started this Be Your Personal Best challenge, I was pretty fit, after months of BMF classes and I was feeling pretty smug when I had my gym induction and tore up the treadmill with my usual activity of running. The cycling was harder, definitely harder, and then last week came the swimming. As I did my lengths I realised that doing all three back to back was going to be even harder. And it’s going to be even harder on my holiday!

You know what though? I think I’m getting the bug all over again. Being fit is addictive. Before this year, I never missed exercise, even when I did it regularly, now 2 or 3 days go past and I’m desperate to properly exert myself. And I’m not talking about a brief amble on the treadmill, or 10 minutes on the cross trainer, barely breaking a sweat and paying more attention to Coronation Street than what my arms and legs are doing.

Just like I said last week, trying something new has got me excited again. Whilst I can’t see myself taking up cycling (the thought of cycling on the road terrifies me and unfortunately I don’t live close enough to work for cycling there to be a viable option,) I am loving getting into swimming again and the fact that I have something to aim towards. I want to improve my front crawl (currently I swim breast stroke pretty well,) and I’m going to do what Carley did, and try and build up my ratio of crawl to breast stroke over the coming weeks. I think winter will be all about swimming for me 🙂

In the meantime, I have just under a week of training left for me to improve my fitness and Be My Personal Best! So this weeks question is, have you ever trained for an exercise related challenge like this? What was it and how did you train? Did you follow a plan or just keep practising? I’d love to know 🙂


#BeYourPersonalBest challenge [Part 2]

This week, to continue my #BeYourPersonalBest challenge in association with Virgin Active, I wanted to talk about swimming. I’m a really big believer in switching up your exercise routine to get better results, and not only that, but swimming is often a form of exercise you can take on holiday with you. After all, it’s nothing but a pleasure doing a few lengths in the sun, rather than in a local pool. I’ll admit, so far I’ve been a bit slow to take advantage of the pool at my local Virgin Active, but I’m really excited to try it out today and see what my personal best is for the 400m I have to complete as part of the triathalon challenge. Eek – it’s not far off now!

First up, I’m all about the kit, and I think lots of women avoid swimming because they dont have appropriate swimwear for exercise, as opposed to poolside in the sun. I must confess, I’m a bikini lover and yet it feels more than a little bit silly heading into a lap pool wearing a two piece. I invested in a new sports swimsuit last year for exercising in and now I wish I had investigated some of the options from the more design led brands aimed at women. Here’s just a few that I would snap up if I was in the market for a new one-piece and some other finds that make swimming that bit more exciting. 🙂

Dynamo swimsuit and Power swimsuit (black) both from Sweaty Betty // Merlin Swim MP3 – 4GB Waterproof MP3 Player // Microfibre Sports/Travel Towel // Boots Sun Swim & Gym Shampoo for dry or damaged hair.

It’s funny, when I was a child, swimming was one of my ‘things’. You couldn’t get me out of a pool on holiday and I had swimming lessons and took part in competitions for several years until I was into my mid teens. Why do we get so lazy about it when we get older? One of my friends has recently got back into swimming competitively, has lost a ton of weight, met a whole new group of friends and is getting amazing fitness results after a lapse in her competitive swimming since being a teen. It seems to me that for women it has so many benefits, the type of exercise protects your joints, supports your body through pregnancy and post-natally, and it the kind of exercise that promotes lean muscle rather than bulking up, which some women are afraid of in the gym. For me it’s pure laziness and a constant battle with my hair that keeps me away from the pool- how lame is that? I tend to wash my hair every other day and think it is the most boring activity known to man, so if going swimming and inevitably messing up my hair doesn’t co-incide well with my hair-schedule (i.e. if I have already washed it that morning,) then it’s just another excuse.

This week, I’d like to hear if any of you reading enjoy swimming – do you go regularly, did you use it through pregnancy, or would you like to restart after doing it as a child like me? What’s your favourite stroke?! And do you have any beauty tips for keeping your hair protected from the chlorine?


Disclaimer: Rebecca has been provided with Virgin Active membership whilst completing the challenge but all subsequent posts are an honest appraisal of the service provided and the benefits she gained.

#BeYourPersonalBest Challenge [Part 1]

Just last week, I was contacted by Virgin Active to see if I would take part in their #beyourpersonalbest campaign. The idea is to highlight the facilities they have and the personalised support and training they have available at their fitness clubs and put it to the test. My challenge was an indoor triathalon – 2.5km run, 10k Bike ride and a 400m swim.

The idea couldn’t have come at a better time for me as I had already felt my enthusiasm for the British Military Fitness classes that I usually attend waning, as the nights drew in and more significantly the rain continued to fall. Although I started the classes in January and went through bitter frosts in the dark, somehow it only got easier as the weather improved. In reverse it’s not as appealing. Cold I can manage, wet I don’t love. So with my holiday at the end of the month (and bikini) in mind I decided to take them up on their offer, and to see if I could improve my fitness. I know many of you will be facing the same challenges I am right now so thought by sharing some of my activities it might help you guys stay motivated as the long dark nights approach, when the urge to get off the sofa and away from the ice cream tub hits an all time low.

I headed down to my local Virgin Active club last week for my induction with Terry and stated my intentions, so we started off on the machines with a half duathalon to measure my success against at the end of the training period. With Terry spurring me on, I managed 1.25k in 7.08minutes and did 5km on the bike in 9.08. The time I did for the run wasn’t spectacular for me but an improvement on the first fitness test I did at BMF earlier in the year so I’m hoping to shave a bit off that. The bike though? That was hard! I hate cycling and I haven’t dipped my toe into a pool (aside from the holiday variety,) in over a year, so that’s going to be a shock.

It can only be a good thing though right? One of my reasons for taking them up on the challenge was having a specific measurable way of recording my progress but I also wanted to mix up my exercise routine a bit and improve my overall tone. BMF is great but I certainly haven’t lost any weight doing it and whilst I feel a lot more ‘solid’ all over and strong, I’d like to be a leaner more feminine version of that fitness level. I’m a firm believer that shocking your body by trying new things is a great way of doing that. As a result of my request, after tackling some training techniques to improve my fitness, like gradient training on the treadmill, we headed over to the mats for some resistance work.

I tried the Vipr technique, kettle bells and resistance bands and really rated the Vipr technique – it’s unbelievable how many muscles you can feel working and I think it would produce quite a difference if done regularly.

On that note, I’ll keep you posted. Each week I’ll be trying to get you guys involved a little bit so today I’d like to hear what your current exercise regime is, have you winter proofed it and if you want to take the challenge with me, how about doing a preliminary time like the one I recorded above and testing yourself again at the end of the month with me?


Disclaimer: Rebecca has been provided with Virgin Active membership whilst completing the challenge but all subsequent posts are an honest appraisal of the service provided and the benefits she gained.

Friday Feel…

Hmmm, this isn’t Friday Frock I hear you say… No, it’s not, it’s far more important in fact. This Friday I’m taking the opportunity to remind you to Be Breast Aware. What can I do as a Doctor to help some of you? I thought it might be useful to talk about self breast examination.

Let me start by saying I see probably 1 or 2 women a week who think they might have a found a lump, or sometimes just want to know how to properly examine their own breasts. Regardless of outcome, I always teach them how to self-examine because there’s nothing better you can do to help protect yourself against Breast Cancer than to be Breast Aware. As a Doctor, I can examine you and pick up what’s normal and what’s not, but you cannot underestimate how different breast tissue is from person to person so the best thing is to get to know your own boobs and then you know if there’s anything different.

As a rough guide, I tell women to self-examine once a month (often enough,) after their period, when the breast tissue is the least hormonally inflamed.

So here’s my DIY guide to Self Breast examination. Please do it. It might save your life.

Illustrations by Laura Manfre for Florence Finds

1. First of all you’re looking for changes in how your boobs look, so stand in front of the mirror stripped off and have a good look. You’re checking for any changes in the skin like puckering or dimples. Check for any new inversion of the nipples (this can be normal for some people so don’t panic if yours are always like that, but get it checked if you’re worried.)

Illustrations by Laura Manfre for Florence Finds

2. Next, still looking in the mirror, place your hands on your waist and squeeze whilst leaning slightly forwards. This tenses the underlying chest muscles and would accentuate any changes you could see within the skin that I described above, so just look over them again in this position.

3. Next, whilst standing, place your left hand over your head and rest it on the back of your neck or just below that. Put your right hand out in front of you with the palm and fingers flat and the fingers closed. Now use the flat part of your fingers to press your breast tissue in small circular movements. Work around the breast systematically, covering all the way from the edges to the nipple itself. It doesn’t matter if you work round in circles or up and down, as long as you do it all.

Illustrations by Laura Manfre for Florence Finds

4. Breast tissue actually has a ‘tail’, by which I mean it extends all the way up across the chest into a point that ends in your arm pit to make sure you continue feeling all the way up your chest towards the arm pit and feel under your arms too.

5. Lastly gently squeeze the nipple to check for any discharge and repeat all steps of the examination on the other side.

You can repeat steps 3 and 4 whilst lying down for extra reassurance, if you want to.

Top Tip: I generally self examine in the shower, having a look in the bathroom mirror before I get in and then using the soapy-ness to allow the hand to slide around easily whilst checking for lumps.

Any GP will always be happy to go through these steps with you – you don’t have to have a lump to go to the doctors and make sure you’re doing it properly. And if you do have a lump, even if you’re not sure if you can feel something or not, we’ll always check it out for you and refer you for further tests if necessary. If you’re under 50 that often includes a (painless) ultrasound scan and sometimes a sample taken from the lump with a needle to check the cells under a microscope.

So ladies, it’s time to Cop a Feel (have you heard of the charity CoppaFeel?) and make sure you know your own boobs. If you have any questions, please just leave a comment and I can try to help where I can, but please remember, even this advice does not substitute a chat with your own GP and/or being examined if you are concerned about anything to do with your boobs.

Be Breast Aware!


PS. A huge thank you to Laura Manfre for providing the beautiful illustrations for this post at very short notice – head on over to her site to see her work and do get in touch if you have any custom projects you would like to talk to her about – I was blown away by these. 🙂

*This post was published as part of Breast Cancer Awareness month and #pinkfridays. It was Kirsty from A Safe Mooring who alerted me to the #pinkfridays and I was more than happy to oblige by taking part – I’ll let her tell you all about it…

On Friday 5th October, bloggers are turning their blogs pink in support of Breast Cancer Care. Join them by turning a Friday pink this October!

Dress pink, eat pink, party pink or work pink. How you turn your Friday pink is up to you. It doesn’t matter how pink you go, we just need you to join the thousands who’ll be raising money during October, Breast Cancer Awareness Month. And if a Friday doesn’t work, just pick a day that does! It doesn’t matter if you raise £20 or £200 at your Pink Friday as every penny will be help us support more people affected by breast cancer today.

SIGN UP NOW to receive your free Pink Fridays fundraising kit and help make 2012 the best year yet!

To see which blogs are turning pink for Pink Fridays, visit A Safe Mooring or follow #pinkfridays.

If you would like to support Breast Cancer Care but can’t throw a Pink Friday of your own, you can donate here.

Olympic Fever…

A show of hands then… who has been watching the Olympics and feeling inspired? Inspired to get off the couch? I have been. One of the things about exercise that I love is the feeling of strength. I can’t say I’ve ever been athlete standard of fitness of course, but at my best and certainly since taking up BMF (British Military Fitness), my fitness and strength has rocketed. I started BMF in January, just like many others, full of new years resolutions. I went ski-ing in February and noticed a vast difference in fitness, my legs held out so much longer, I could ski harder and faster for longer without feeling the burn. By the time I went on holiday in May I was positively antsy because I missed the exercise. Trust me when I say that has never happened before. Then came the rain. I kept going in April, then the weather changed, the rain came and every single opportunity I had (my usual sessions for BMF are Tuesday, Thursday and Saturday,) it was literally tipping down. At first it was easy to put off, I was about to go on holiday and gave myself time to prepare the blog and pack. I came back to more foul weather and through much of June the rain continued, day after day, night after night. Come July, I attended the odd session, whenever I could between work, Florence Finds and the weather. My fitness went through the floor. I never thought that returning to exercise would be so hard but when I started, I had nothing to miss. Going back after the best part of six weeks away and I was astounded at how much slower I was, how much harder every sprint was. The worst thing was that I started to hate it. The fitter I am, the harder I try. I spurs me on, I feel like I can take on anything. Instead, I left every session exhausted, I let the rain deter me. Last week was a turning point. For the first time in months I’ve been to a full three sessions. For the first time I’ve felt my feet wanting to fly, I’ve enjoyed pushing myself. On tuesday it was warm but drizzling and I loved every second despite the rain because I started to feel the benefits again. So what is the point of this waffle? Well, I thought I’d open the discussion up to hear about how you have been exercising through the poor weather this summer? Pre-BMF, normally come summer I’d be out running a couple of times a week if not more. The pull of BMF is always stronger and I know I would have exercised even less if I hadn’t had that and Pete dragging me there to motivate me. Have you been like me and totally skipped out on exercise or have you managed to stay motived? Have you tried BMF since hearing me talk about it? I’d love to hear your thoughts… Love, Rebecca xo

How to get the best from your GP… Part 1

Today I want to give you some insider insight and tips from my perspective, not only as a young woman (can I still say that now I’m thirty?!,) but as one that also happens to be a GP. One of the things that has surprised me the most since I have come out of the closet and revealed my job, is the relationship that other people have with their family doctor. Because most of all, that’s what I think of myself as. I see people as kids, then as young women who need contraception, through their pregnancy and if I’m lucky I get to do the six week check on their new baby. Even though I haven’t been practicing that long, I’ve already enjoyed giving that continuity of care. It’s made me sad on occasion to hear that other people don’t feel satisfied with the experience they have at their GP’s. I guess because a lot of my training focuses heavily on communication skills and I’ve been lucky enough to work at some great practices, I forget there are perhaps practices out there that don’t suit some of their patient population as well. Whilst I’m definitely not opening the door here to hear your opinion of your GP, I do think that I might have some tips for you to help you get more out of your experience of going to see the GP.

Snapped on my last visit to the GP, this poem tickled me! Supplied by Poems in the Waiting Room, a registered charity supplying leaflets with poetry to hospital waiting rooms across the country.

So here goes…

Tell them why you’re there.
This might sound obvious but it’s a well documented phenomenon that people often save the important problem they want to discuss until the end of the consultation. It’s known as the ‘door handle problem’, when they turn back as they’re about to leave and say ‘and I also found a breast lump…‘ It goes without saying we would much rather have dealt with that first rather than checked your ears for wax. Psychologists think people often do this because they ‘test’ the GP with something that isn’t important to them and when they feel the GP is trustworthy and won’t laugh/tell them off, they open up about the more important problem.

If you’ve got a list, ‘fess up.
I understand. You’re busy, it’s a nightmare to get an appointment, let alone one that fits in with your working hours and once you have got it, you value the opportunity to quickly discuss a couple of minor niggles you have. If you come in and confess, we can often decide on the spot if it’s feasible for us to get through all of that in the 10 minute appointment we have available. Honestly, this is not about us running to time. It’s about doing your problems justice and having the available time to address them all adequately. Sometimes, a mole that needs the once over, an itchy toe and a quick look in your throat can take a few minutes max and we’ll get through them all, but if you’re really worried that mole is skin cancer and you want to know why I think it’s normal and find out how to keep an eye on it yourself at home, I can’t do that without rushing you AND do the other things properly in 10 minutes. Most surgeries will let you book a double appointment if you have several things to discuss, or come back – we really don’t mind seeing you again!

Don’t read about your problems on the internet.
This should come with the sub-heading ‘or if you’re going to, read a reputable source.
Again, I get it, you’re educated and why shouldn’t you read up on a problem that is affecting you? I bet you’re thinking you might not need to go to the doctors after all right? In an ideal world that would be the case but in reality one of 2 things will happen. The internet is a scary place and when it comes to medical information there are 2 broad categories it fits into. The professionally written sites, and opposite. Even professionally written sites, like NHS direct for example have to cover their backs. Any bit of information will be prefaced by a disclaimer and no doubt a list of reasons why you should disregard the forthcoming information and see your GP to get checked out anyway. If that’s not enough to make you think the worst, then I don’t know what is.

The second option is that you read a non-professional site where people share their personal experinces. There’s nothing worng with poeple doing that, the problem is the unintended influence it has on people who read it – that’s you by the way. Every patient is very different, from the subtlties of their medical history to the social and personal factors that may have influenced the doctors choice of treatment for them. There are guidelines and protocols for so many conditions but as doctors, we then use our knowledge of the guidelines and evidence and balance it with our knowledge of the patient as an individual. For example, someone with a hectic shift pattern for a job might not be suited to a medication like the pill that needs to be taken regularly and jump at the chance to try a method that they can forget about for a longer period of time. That’s just an example but I hope it illustrates why nothing substitutes actually talking to your doctor.

My favourite site for patients to use to read up on their problems (once diagnosed,) is Patient.co.uk. I use it as a professional, but there are tons of patient leaflets there with clear and thorough explanations about many conditions.

I’m going to leave it there for now, but as and when the thoughts occur to me I’ll add more. In the meantime, if there’s something about doctor-patient etiquette that you’ve always wondered about then fire away, or just let me know if this post has been helpful. I’ll put my best GP hat on and see if I can explain some things for you. 😉


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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