Cystic acne and its scarring seem to be disappearing from New Zealand faces. Here\u2019s why.<\/p>\n
A bright green star adorned the freckled face of the teenager manning the supermarket check-out. Groups of schoolgirls sauntered past, clutching Stanley cups, cheeks dotted with neon stickers. At first, I wondered if they were a fashion accessory, but no, they had a purpose. They\u2019re pimple patches, a way to shrink a zit while making it look cute.<\/p>\n
My first thought was \u201cI wish we\u2019d had those when I was a teenager\u201d.<\/p>\n
Back then, I\u2019d relied on a thick layer of Dream Matte Mousse to disguise my bumpy skin. If cute star-shaped pimple patches had existed, I\u2019d have needed an entire constellation to cover my face.<\/p>\n
Then another thought occurred to me. It had been a long time since I\u2019d seen someone with the type of severe acne I had as a teenager years ago.<\/p>\n
Where did all the acne go?<\/p>\n
<\/p>\n
Twenty years ago, having cystic acne as a teen was, to put it lightly, soul destroying. I had huge, puss-filled cysts sprouting belligerently along my chin like the Southern Alps, as well as \u201cbacne\u201d and \u201cchestne\u201d.<\/p>\n
Back then in the early 2000s acne was everywhere, as ubiquitous as low rise jeans, yet for all the camaraderie of this shared affliction, it was still something we desperately tried to cover. My school had a strict no makeup rule, though tactful teachers would turn a blind eye to the layers of concealer and foundation smeared on with a trowel.<\/p>\n
I dreaded swimming pools, sleepovers, down lighting, any situation that brought more attention to my inflamed dermis. I spoke to my GP, who sympathised, but before I could be referred to a dermatologist, I needed to jump through many hoops.<\/p>\n
I tried Proactiv \u2013 whatever was in it was powerful enough to leave face shaped bleach marks on every towel in our bathroom, but my acne remained stubbornly intact.\u00a0<\/p>\n
I tried tea tree oil and multiple brands of birth control to no avail. I tried low-dose antibiotic Doxycycline \u2013 the same type used to treat chlamydia and prevent malaria, and that didn\u2019t banish my acne either. The upside? I also remained remarkably free of both chlamydia and malaria.<\/p>\n
Finally, I was referred to a dermatologist waiting list where my acne and I languished for many months waiting for the appointment.\u00a0When I finally got one, I was prescribed isotretinoin under the brand name Accutane.<\/p>\n
Accutane cleared my skin up within weeks.\u00a0<\/p>\n
<\/p>\n
Acne remains one of the most common skin conditions in Aotearoa, affecting 85% of people at some point in their lives. Of people affected, 15% develop severe acne. But we may not see that full 15% any more, thanks to an obscure healthcare policy change that occurred in 2009, allowing GPs to prescribe isotretinoin.<\/p>\n
Prior to that, the drug was a lot harder to obtain, requiring a referral and regular visits to a dermatologist, which was either costly, a drawn-out process, or both.<\/p>\n
There was a clear reason for the long wait times. New Zealand has only around 80 dermatologists, leaving us with roughly one third the specialist dermatologist density of Australia.\u00a0<\/p>\n
Specialist dermatologist and New Zealand Dermatological Society spokesperson Dr AJ Seine says allowing GPs to prescribe isotretinoin has transformed acne care, enabling them to manage the vast majority of routine cases.<\/p>\n
Since the 2009 policy change, annual prescriptions of isotretinoin have increased by 87%, from 26,897 in 2008 to 50,613 in 2023.\u00a0<\/p>\n
One such patient was Sophie Dunn, who developed acne in her mid-20s. \u201cIt was never severe, but it was really persistent for a number of years.\u201d With her wedding approaching, she decided enough was enough. \u201cI thought, \u2018God, I\u2019m sick of this persistent acne. I\u2019m just over it\u2019,\u201d she remembers. \u201cI went to my GP and they were like, \u2018Yep, absolutely, let\u2019s get you on isotretinoin\u2019. I thought my skin would have to be much worse to warrant it.\u201d<\/p>\n
The accessibility of the treatment was a major factor for Dunn. \u201cSeeing a dermatologist is expensive, it\u2019s not something most people would even consider. But getting an isotretinoin prescription from a GP was straightforward and cheap. After a month, my skin had cleared up.\u201d<\/p>\n
Rachel Read has been suffering from acne and was recently prescribed
isotretinoin by her GP. \u201cIt massively affected my confidence,\u201d she recalls. \u201cThere were many, many moments when I thought: Are people looking at it? Are they staring at it? Have I covered it up properly? Why is this happening to me?\u201d<\/p>\n
In the end, it was social media, where \u201cpeople\u2019s skin looks completely different\u201d, that Read learned about treatment options for her acne. \u201cI would\u2019ve spent hundreds, if not thousands, of dollars over the years going to different skin clinics and having laser treatments,\u201d she says. \u201cI felt like I had exhausted all options. It was actually TikTok that educated me about isotretinoin.\u201d<\/p>\n
<\/p>\n
Treatments for acne have become far more accessible, but is acne itself disappearing? Seine doesn\u2019t think so. \u201cThe prevalence remains quite high. In actual fact, adult acne seems to be on the rise,\u201d he says.\u00a0\u201cIt might look like you\u2019re seeing fewer people walking around with bad acne or horrific scarring\u2026 I think it is because we\u2019re intervening at an earlier stage.\u201d<\/p>\n
Historically, he says, isotretinoin was treated very differently. It was considered a \u201cbreak only in severe cystic emergency\u201d drug of last resort. Instead, teenagers were often simply told to wait acne out. Part of the hesitancy was concern about the drug\u2019s potential side effects, particularly regarding mood disturbance and mental health.<\/p>\n