Acne is quite a distressing problem for teenagers which, in severe cases, can be very embarrassing and badly affects their social lives.

But acne is not restricted to teenagers. Some women get acne before and during their periods and people under stress can also break out in acne.

Cases vary from being mild - a few spots on the chin or face which come and go - to being moderately extensive and persistent.

Severe acne vulgaris causes cysts or comedones with pustules or blackheads and subsequent facial scarring.

The spots are caused by blocked sebaceous glands which are aggravated by high levels of testosterone. Once blocked, these get infected.

Acne can be controlled effectively with antibiotics such as tetracycline and erythromycin, which kill the germs, have anti-inflammatory properties and reduce the keratin plug in the ducts but these must be taken for months or even years and can cause side effects.

Retinoids, which are derivatives of Vitamin A, are extremely effective in treating severe acne but can cause serious side effects and have to be monitored by dermatologists. Local retinoid creams adapalene and isotretinoin are well tolerated and reduce the formation of cysts.

Cleansing the skin regularly to unblock the ducts is very important. You can do this with a peroxide or iodine solution.

Try applying lemon peel soaked in hot water to the skin and then washing with warm lavender water.

Research shows some of the modern medications work by reducing the superoxides and free radicals formed in the skin. This means any herbal and mineral formulations which have antioxidant action should be effective, too.

In severe cases, I have had good results with patients by combining the initial conventional treatment with the Ayurvedic herbal preparation chyavanprash.

It contains Indian gooseberry and myrobalan fruits which are rich in vitamin C, vitamin A and bioflavanoids so it is a powerful antioxidant and tissue-healing agent Ayurvedic medicine also believes acne can be precipitated by toxins in the body and reduced immunity caused by poor liver function.

Take a combination of herbs such as trifala and psyllium seeds to maintain clear bowels, live yogurt as a probiotic and chyavanprash to heal the skin.

Treatment can leave the skin dry and flaky. I have found my formula of aloe vera gel and glycerine with extract of neem and frankincense and anti-inflammatory essential oils is an effective complementary treatment. It moisturises and revives the skin, leaving it soft and smooth.

Acne sufferers should try to avoid fried food, coffee, sugar, hot curries and very sour foods. Eating lots of fresh organic vegetables and fruits and drinking fruit juices helps to provide excellent nourishment for the skin.