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Acne: who to see and what helps

Acne · Kitchener, Waterloo & Cambridge

Acne is a skin condition in which blocked, inflamed hair follicles show up as blackheads, whiteheads, pimples and deeper lumps. The treatments guidelines recommend are medicines: ones you put on the skin first, with tablets added for more severe acne, from a pharmacist, physician or nurse practitioner. At CARESPACE the first visit for acne is with a Nurse Practitioner, and a counsellor can help when acne is wearing on your mood.

What acne is

Acne happens when hair follicles become blocked with excess oil and dead skin cells. Bacteria can grow in the blocked follicle and cause inflammation and pus. It ranges from a few spots to widespread, painful lumps that leave scars.

It is also very common. The Canadian acne guideline estimates that 85% of people aged 12 to 24 have it, which in a region with two universities and a college is a great many people.

Symptoms of acne

  • Whiteheads: small bumps the same colour as your skin
  • Blackheads: black or brown spots that are usually flat
  • Papules: raised bumps that look pink or red on white skin and may look brown or purple on brown and black skin
  • Pustules: raised bumps filled with pus
  • Nodules and cysts: larger lumps under the skin that may join together and can be painful
  • Scars, such as shallow holes in the skin (ice-pick or boxcar scars)

Blackheads and whiteheads are the feature that separates acne from rosacea, which also causes red bumps and pus-filled pimples on the face but without them, and which usually starts between the ages of 30 and 50.

What causes acne

  • Hormones. Changes in hormone levels during puberty, periods, pregnancy and menopause.
  • Family history. Having a parent with acne raises your chances.
  • Other conditions. Polycystic ovary syndrome is one; see PCOS.
  • Medicines. Certain medicines can bring acne on, and anabolic steroids that people take on their own are one a clinician may ask about.
  • Skin and hair products that make the skin greasy.

The Canadian Dermatology Association lists what does not cause it: acne is not from dirty skin, is not contagious, and has not been connected in studies with greasy foods or chocolate. Tanning does not clear it.

When acne needs urgent care

Call 911 or go to an emergency department if skin that is painful, hot and swollen comes with a high temperature or feeling hot, cold or shivery; a fast heartbeat or fast breathing; purple patches on the skin, which may be less obvious on brown or black skin; dizziness or faintness; confusion; cold, clammy or pale skin; or unresponsiveness. Without those signs, painful, hot, swollen skin may still be infected and needs care the same day: see a physician or nurse practitioner, or go to an urgent care clinic or an emergency department.

Go to an emergency department the same day if severe acne appears suddenly as painful, ulcerated, crusting lumps on the chest and back together with a fever, painful joints or feeling unwell. This rare form, acne fulminans, nearly always affects teenage boys, and can be set off by testosterone, anabolic steroids or the acne medicine isotretinoin. UK guidance is assessment by a hospital dermatology team within 24 hours.

Acne can weigh heavily on mood, and so, for some people, can isotretinoin. If you take isotretinoin and feel your mental health getting worse, get medical advice; if the change is severe, the same guidance is to stop the medicine and seek urgent medical advice. If acne has you thinking about harming yourself, reach out now.

If you are in crisis or thinking about suicide, help is available right now.

  • Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
  • Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
  • Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Without the same urgency, see a physician or nurse practitioner if treating acne yourself is not working, if you have lots of spots or spots that are deep, painful or scarring, or if acne is affecting your mental health.

What the evidence says about treating acne

  • Where these points come from. The Canadian acne guideline, unless a point says it is British, in which case it is from the UK’s national guideline (NICE); plus a Cochrane review of complementary therapies. In the Canadian guideline “strongly recommend” is the firmest wording, “recommend” the middle and “may be considered” the weakest; in the British one “offer” is firmer than “consider”. The wording reflects the panel’s overall confidence, not only the quality of the studies.
  • Treatment on the skin comes first. For blackheads and whiteheads, a topical retinoid or benzoyl peroxide is recommended. For mild-to-moderate inflamed acne in a limited area, either one is strongly recommended, alone or in a fixed-dose combination.
  • Antibiotics are never used on their own. For more extensive moderate acne, adding an antibiotic by mouth to the topical treatment is recommended. The British instruction is not to use an antibiotic alone, on the skin or by mouth, and not to combine the two.
  • Hormonal treatment is an option for women. Adding a combined oral contraceptive to topical treatment is recommended for more extensive moderate acne.
  • Isotretinoin is for severe acne. It is strongly recommended there, with prescribing limited to physicians trained and experienced in its use, because of its potential for adverse events and for harm to a developing baby.
  • Judge it at two to three months. That is when a treatment should be evaluated.
  • Diet and supplements: little to go on. British advice is that there is not enough evidence to support specific diets for treating acne. The Cochrane review, with searches to 2014, found one trial (43 people) favouring a low-glycaemic-load diet for inflamed spots and one trial of tea tree oil (60 people) with fewer spots than placebo; it rated both as low-quality evidence and found the evidence for herbal medicine, acupuncture and wet cupping insufficient. Oral zinc “may be considered” for mild-to-moderate inflamed acne, the weakest wording.
  • Distress counts, at any severity. In Britain, clinicians are told to consider referral to mental health services when acne causes significant psychological distress.

Where the medical treatment comes from

Benzoyl peroxide and salicylic acid products are sold without a prescription, and in Ontario pharmacists can prescribe for acne at no extra cost with your health card; not every pharmacy offers this, so call first.

A physician or nurse practitioner prescribes the stronger options: retinoids and combination products for the skin, an antibiotic alongside them, or a combined oral contraceptive. Isotretinoin comes from a physician trained and experienced in its use, often a dermatologist. Referral is also worth considering when acne is scarring, leaving lasting colour changes, or has not responded to two courses of treatment.

How each CARESPACE service treats acne

Nurse Practitioner

The acne treatments with the firmest recommendations need a prescription, and in Ontario a Nurse Practitioner is authorized to diagnose, prescribe medicines and refer to specialists. For acne, that means they can grade how severe it is, ask about periods, medicines and supplements that may be contributing, prescribe a treatment for the skin with or without tablets, and review it at around 12 weeks. They can also refer you on when scarring or severe acne calls for it.

See our nurse practitioner team →

Counselling

Counselling does not treat the skin, and what psychotherapy adds in acne is listed in the Canadian guideline as something not yet known. What is established is that acne of any severity can cause psychological distress, and that mental health support should be considered when the distress is significant. A Registered Psychotherapist or Registered Social Worker can work with you on the low mood, anxiety and low self-esteem that acne can bring. CARESPACE counsellors offer cognitive behavioural therapy (CBT). At a first visit the counsellor works to understand your concern and comes up with a plan.

See our counselling team →

Other services people ask about

Naturopathic Medicine and Nutrition. None of the sources listed below gives either service a role in treating acne. What they say about diet and supplements is in the evidence list: not enough evidence for any specific diet, single small trials for a low-glycaemic-load diet and tea tree oil, and insufficient evidence for herbal medicine. The Canadian Dermatology Association adds that a low glycaemic index diet or avoiding dairy may help some people. In the trials, tea tree oil caused itching, dryness and flaking, and herbal medicines caused nausea, diarrhoea and stomach upset. Talk to a pharmacist, physician or nurse practitioner before taking zinc or any other supplement for acne.

Where most people start

With mild acne, at the pharmacy. If six to eight weeks of a non-prescription product has made no difference, or your acne is deep, painful, scarring or getting you down, book with a Nurse Practitioner.

How your team works together

Acne care is mainly one service: the medical treatment, which at CARESPACE sits with a Nurse Practitioner. Counselling runs alongside when your mood needs attention, and you can start with either.

Browse by service: Nurse Practitioners, and Registered Psychotherapists and Registered Social Workers.

What to expect at your first visit

  1. Your skin so far. When the acne started, what you have tried and for how long, and any medicines or supplements you take, including anything for building muscle.
  2. An examination of the face, chest and back: the kinds of spots, roughly how many, and any scars or dark marks.
  3. The effect on you. You may be asked about your mood and how much acne is on your mind.
  4. Your plan. Which treatment, how to use it, what side effects to expect, and when to come back.

If the visit is for a teenager or a child, ask when you book which practitioners see young people.

What you can do at home

  • Wash twice a day with a gentle, non-soap cleanser that is pH neutral or slightly acidic.
  • Do not scrub. It irritates the skin and can make acne worse.
  • Choose skincare, sunscreen and make-up labelled non-comedogenic (unlikely to block pores), avoid oil-based products, and take make-up off at the end of the day.
  • Do not pick or squeeze. Persistent picking raises the risk of scarring.
  • Try benzoyl peroxide or salicylic acid, and ask a pharmacist which suits you.
  • For acne on the body, wear loose, breathable clothing, especially when you exercise or sweat.

How long it takes, and whether it comes back

A treatment is judged at two to three months, not two to three weeks. If acne clears and then returns, another 12-week course of the same treatment or a different one is considered; maintenance treatment is not always needed. Acne can persist beyond young adulthood, and the risk of scarring rises with how severe it is and how long it lasts.

Acne treatment in Kitchener, Waterloo and Cambridge

Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo and Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Counselling in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

Does what I eat cause acne?

The evidence does not show that it does. Studies have not connected greasy foods or chocolate with acne, and there is not enough evidence to support any specific diet as a treatment.

Should I see a pharmacist, a nurse practitioner or a dermatologist?

A pharmacist for mild acne. A physician or nurse practitioner when non-prescription products have not worked after six to eight weeks, or when spots are deep, painful or scarring. Referral to a dermatologist is considered for scarring and for acne that has not responded to two courses of treatment.

Can I treat acne while pregnant?

Some acne medicines cannot be used in pregnancy or when planning one: topical retinoids and tetracycline antibiotics are two, and isotretinoin can seriously harm a developing baby. Tell your pharmacist, physician or nurse practitioner before starting or continuing anything.

Will my acne leave scars?

It can, and mild acne can scar too. The risk rises with severity and with how long acne lasts, and picking adds to it.

Where can I get help with acne in Kitchener, Waterloo or Cambridge?

A pharmacy is the first stop for mild acne anywhere in Ontario. CARESPACE has locations in each of the three cities: book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Skin Conditions
Rosacea
PCOS
Self-Esteem

The CARESPACE Central Reception Team

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Book online with a Nurse Practitioner or a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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