Q.  My teenage daughter has bad acne, which makes her unhappy and self-conscious.  It hasn’t responded to treatment so far and the doctor mentioned roaccutane but I have seen frightening stories about it. A.  Acne, which affects 90 per cent of adolescents, can cause immense emotional distress, agrees consultant dermatologist Professor Nick Lowe.  It’s basically due to blockages in the follicles, caused by an over-production of sebum combining with dead skin cells.  Natural bacteria feed on the oily sebum and multiply, leading to inflammation and the formation of pimples, blackheads and whiteheads, papules of different sizes and often scarring.

The male hormone testosterone increases at puberty in both sexes, triggering excessive sebum production.  Contributory causes include stress, a high glycaemic diet with lots of sugar and carbohydrates, and dairy products.

Roaccutane, a vitamin A derivative, works by reducing sebum,and also inflammation. Professor Lowe, who did the first clinical research on roaccutane in America in the 1980s, says, ‘these drugs are valuable for people with severe acne but should only be considered when all other prescription treatments have failed because of the potential side effects’.

Other treatments for females include oral and topical antibiotics with appropriate skincare, also spironolactin, a drug that at low doses blocks testosterone and can be combined with antibiotics.  Specific laser treatment can help, as can dermabrasion and peels.  Two forms of the contraceptive pill, Dianette and Yasmin, may help but are not suitable for smokers, anyone who is overweight or has a family history of deep vein thrombosis.

Roaccutane must be prescribed by a consultant dermatologist according to stringent guidelines.  Professor Lowe’s patients complete an extensive questionnaire, including sections on depression, bowel problems, and pregnancy status.  They are given full information and sign a consent form.  They must return every four weeks for monitoring and another prescription.  Blood, lipid (cholesterol and triglyceride) and liver function tests are necessary before treatment then every eight weeks.

Side effects include headaches, muscle pain, dry skin, mouth and eyes, poor night vision, inflammatory bowel disease, also flu-like symptoms preceding serious skin reactions, conjunctivitis and ulcers of the mouth, throat or nose, which must each be reported to your dermatologist immediately.

Women planning pregnancy or pregnant must not take roaccutane, because of the risk of birth defects.  Professor Lowe’s women patients take a pre-treatment pregnancy test and repeat every four weeks.

In rare cases roaccutane may cause depression, anxiety, aggression and mood changes.  Very rarely, it may lead to delusions or hallucinations and suicidal thoughts or attempts.  However, the issue is clouded because some people with acne are obsessed and depressed with their condition before they start the drug.  It is vital to report any mood changes to your doctor immediately.

Lower slower dosage may avoid side effects, including initial worsening of acne.  Prof Lowe starts patients with 10-20 mg for one month rather than the usual 40-60mg.  If there are no problems at a month, he increases it slowly to 30 or 40 mg for six months.

Following a low GI diet, avoiding dairy produce and adopting calming relaxation techniques such as yoga or meditation are all vital.  ‘I’m a great believer in working with patients to help them reduce stress, which is often a big factor with students,’ says Prof Lowe.

KEEP IN TOUCH:  MAKE IT SNAPPY

Keeping in touch with loved ones who are away from you and lonely or unwell is hard when you are busy. Sending frequent postcards (address and stamp several at a time), or taking snaps with an iPhone of things you are seeing or doing and emailing them with a one-liner are simple quick ways of staying connected.  If they are close enough to visit, massaging hands and/or feet with skin cream is wonderfully soothing.

SIZE IS A STATE OF MIND

Our size 20 tester loves State of Mind active wear for sizes 16 to 26.  She says: ‘Wishful Shrinking joggers (£49) and Cosy Hooded Fleece (£55) have taken me to Pilates classes, power walking in the Highlands and a few zumba-thons.  They hold you in while looking good.  Their fantastic flattering Va-Va Voom one piece swimsuit (£73) got me to a swim party after several tearful hopeless searches.  The quality and colour range means I actually want to move more.  State of Mind has totally bolstered my confidence.’

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NO GRAINS FOR BRAINS...?

Gluten, the protein in wheat and other grains, can cause mood problems including anxiety, depression and social phobia, also fatigue, aches and pains, poor focus and digestive problems, according to US nutritionist Trudy Scott, quoted by Food and Behaviour Research (www.fabresearch.org).  Most clients with mood problems have dramatic improvements on a gluten-free diet.  Find more in The Anti-Anxiety Food Solution by Trudy Scott, £14.99 at www.amazon.co.uk - buy here