Adult acne is a crippling condition, and one that, as Brits particularly, we often fail to address directly.
One in five 25 - 40 year old women will suffer from bad skin at some point in their lives, but common misconception suggests that acne - painful pustles and pus-filled mounds that appear on the face, chest, shoulders and upper back - is somehow the fault of the sufferer. We suspect uncleanliness or dirt is the cause, making the condition isolating and upsetting. And so, when medical professionals subscribe pills and not much else, it's accepted as common wisdom that this must be the correct answer.
But a new proposal on a popular web resource for physicians and other health professionals has called for the discontinuation of antibiotics to treat acne and, although controversial, is exactly right.
It's also great news for encouraging an overall general conversation about adult acne.
Muneeza Muhammad, B.A., and Ted Rosen, M.D. have proposed via Medscape.com that dermatologists should severely curtail or outright discontinue the routine and regular use of antibiotics for the skin condition.
The call to arms centers around the argument that the prevalence and worsening of P. acne resistance - the bacteria that causes acne - worldwide means doctors must think more carefully about their prescribing habits.
Bacterial resistance to antibiotics is a global problem, and a cause for serious concern. The emergence of "superbugs" which are resistant to most antibiotics and therefore difficult to treat is a major threat to health. In many areas of the world more than 50% of acne bacteria are resistant to the antibiotics used to treat acne, with rates continuing to rise.
Doctors normally recommend a four- to six-month course of antibiotic treatment, but once spots have cleared, acne commonly flares up again when treatment has stopped. Because of resistance fears, advice is commonly to switch to a topical cream such as benzoyl peroxide- which come with their own side effects, such as dry and tense skin, redness and peeling, or burning, itching and stinging.
It's all confusing and upsetting news for acne sufferers, who typically don't find a sympathetic audience to their blemish plight. Doctors seem unemotional and pill-happy, dermatologists pricey and directorial, and magazine articles that focus on less spot worry, more body confidence are obviously written by journalists who don't know the true pain bad skin can cause.
So what's the answer for treating adult acne?
Laura Jane Williams, author of free ebook ACNE: a comprehensive guide to identifying, treating and generally showing spots who the boss is wrote in an online column, "why is it we can talk about in-growing pubic hairs, fanny farts, thrush and scaly dandruff, but acne is off limits?
"The thing I wanted most during my six-month pizza-face ordeal was, aside from a solution, an honest conversation about it. But I was far too embarrassed."
The internet has done much to encourage (albeit anonymous) conversation about acne. One such example, The Lustre Clinic, acts as a social forum for suffers to discuss their problems and get confidence boosting advice from health and beauty professionals. Lustre promote the use of blue light therapy as a clinically-proven and effective solution to acne, with none of the risks associated with antibiotics or topical creams.
Scientists have found that visible blue light is one of the best at-home solutions for acne management, and much safer to health than the alternatives. Photodynamic light therapy uses visible blue light at a wavelength of 415nm and so blasts the bacteria that cause acne without causing any harm to the skin. Spot-causing bacteria produces porphyrin, which under blue light becomes excited and destroys the p. acnes, ultimately leaving users with reduced symptoms.
There's little general awareness of the use of light to effectively treat inflammatory acne. Traditionally, too, there has been limited accessibility to it. However, companies like Lustre are championing discreet, community-led solutions that could revolutionise acne skincare in an at-home setting.
Blue light has been used by leading dermatologists for years. Trials suggest that with at-home blue light therapy devices users can expect a 60% improvement in inflammatory acne in as little as 20 minutes' daily use.
In my own clinic we offer blue and red light therapy to effectively treat inflammatory acne, and suggest that any blue light therapy can be complimented with skin peels and microdermabrasion- with impressive results.
All accumulating evidence suggests with growing urgency that traditional response to acne management is no longer working. Dermatologists and doctors must be encouraged to experiment with totally safe antibiotic alternatives, and blue light therapy could be just the trick.