Meet the team: think beyond spots
ACNE- NOT JUST SPOTS
Acne affects up to 80% of teenagers to some degree at a time in their lives when they are moving to adulthood and developing social skills. It has been shown to cause psychological harm and may contribute to school refusal, exam failure and anxiety amongst other issues. In this generation where Instagram and snapchat are widely used, appearance becomes even more important.
Studies have shown a high burden of psychological issues for young people with acne including depression, poor self-esteem and low self-worth. A study on a general population of teenagers has shown increased suicidal ideation due to acne. The distress due to acne starts high and slowly reduces with time but is still above that of the general population at 5 years after diagnosis.
On this background, it is proposed to try to improve standard acne management and to integrate assessment of psychological distress at the consultation.
Young people with acne are initially treated by their general practitioners using topical agents then oral antibiotics. If these do not work, they may be referred to secondary care after a variable length of time. The wait for treatment may be several months, during which acne may progress and cause scarring. In secondary care, they could be prescribed isotretinoin, which is an effective treatment for acne, which needs to be prescribed by a physician expert in its use.
Information needs to be available in a form that young people will access. Initially, this could be signposting of existing information when a patient is referred in to secondary care. On-line resources such as the acne decision tool (https://www.healthwise.net/cochranedecisionaid) and other information that can be accessed via a phone or tablet (http://healthtalk.org/young-peoples-experiences/acne/topics) could be used. Ultimately it would be good to get information more widely available to primary care, for patients and general practitioners. This information may allow the young person to come to a secondary care appointment ready for the discussion of which treatment may be best for them. It may also bring forward the time that patients are referred, knowing that psychological distress occurs early in the disease.
Timing of referral is also important as treatment can sometimes affect how the patient is feeling, even causing low mood or lack of concentration. The appointments could be timed around exam times and we could make sure that young people aiming to head off to University are fully treated before they go.
As young people may not have accessed secondary care outpatient before, it is proposed to reduce possible stress in attending a busy unselected dermatology clinic. Sitting is a busy waiting room when you are already self-conscious about your appearance may increase stress. There would be a dedicated clinic (perhaps in an evening to avoid school and college sessions) where there will be other young people, some treated, some waiting to be treated, with facilitation by trained staff to allow them to discuss issues and their expectations of management.
A clinical psychologist would be involved (treating patients over 16) who could use validated tools to assess unmet need for psychological support, which may be one-to-one or group sessions. It is hoped that using a group clinic format will give a degree of peer support which could be taken up by further group sessions if needed.
If a young person is prescribed isotretinoin, they will need to attend for follow up appointments. For young women, this is to perform pregnancy tests as patients cannot take the medication if they are pregnant. If a young person has decided on a different management plan for their acne, again, follow up appointments could be arranged in a group format with private time with the prescriber to offer personal advice. This time could be used for peer support through the process of taking the medication, as discussion of expected and unexpected side effects and how to manage these while still treating the acne, is important. Also, time taken in clinics could be reduced by having a dedicated isotretinoin/acne follow up clinic with nurses, psychologists and pharmacists all involved.
Acne is not “just spots”. The wider issues of young people with acne need to be addressed while managing acne, early and efficiently.
How you can contribute
- Any experience of running young person acne clinics
- Experience of using peer support for young people with acne
- Any experience of running group style clinics for acne