Sunday, January 27, 2008

How to Treat Acne

Acne is a chronic condition, but almost all cases of acne can be treated. Appropriate management should heal current lesions, prevent new lesions and minimize scarring. It is important to remember that proper treatment of acne takes time, at least 4 to 6 weeks. Fast acting potions are false promises. It is also crucial to be consistent with therapy. Non-compliance is the most common cause of treatment failures.

The type of medication used to treat acne depends on the severity of the condition. Mild to moderate acne is treated with topical medications such as retinoids, benzoyl peroxide, salicylic acid and topical antibiotics. Topical retinoids are the foundation of treatment. They are a derivative of vitamin A and work to unclog pores and prevent whiteheads and blackheads from forming. They may cause an initial irritation of the skin in the first 2-4 weeks. This is a common reaction and can be managed by moisturizing the skin, using sunscreen and increasing the dose of the retinoid gradually. My personal choice is Adapalene (Differin) because it is non-photosensitizing (doesn't cause irritation with sun exposure) and it can be used in the mornings. Other retionids include Treinoin (Retin-A) and Tazarotene (Tazorac) which is reserved for oily skins.

In general, if the topical retinoid alone is not sufficient, then a combination of the retinoid with a topical antibiotic (newly approved Ziana Gel) or a combination of benzoyl peroxide with a topical antibiotic (Duac or Benzaclin) may be given for a broader coverage. I prefer Duac because it does not need to be refrigerated and it can be applied once a day which improves compliance.

Oral agents are used to target moderate to severe acne. These include antibiotics, isotretinoin (Accutane), birth control pills, testosterone blockers and corticosteroids. Antibiotics are the most commonly used of these options. They include tetracycline, doxycycline, minocycline, and erythromycin. Each of these has its own set of side effects. The choice of the antibiotic depends on the tolerance of side effects as well as the cost with doxycycline and tetracycline being the least expensive and minocycline being the most expensive. Antibiotics are generally given for 3-6 months and are then tapered off.

Almost all birth control pills can help reduce acne for the majority of women. They are especially useful for premenstrual flares of acne. My preferred oral contraceptive for acne is Yasmin because it helps to block the affect of androgen on the sebaceous (oil producing) hair follicles. Other pills are Demulen 1/50, Orhto-Tri Cyclen, Orhto-Cyclen, Ortho-Evra, Mircette, Brevicon, and Modicon. All of these are higher estrogen, lower androgen potency pill.

Please note that Depo-Provera, a long acting progesterone contraceptive, is often associated with acne. It needs to be avoided in patients with acne.

Severe acne with scarring may be treated with Accutane. Patients should not get pregnant during treatment with this medication because it can cause birth defects. The treatment is 20 weeks long and the major side effects are dryness of the lips. The patient should also be monitored for depression and for abnormalities in liver or cholesterol by routine blood tests.

Once the acne is controlled, there are several methods available to improve the scarred areas. These include fillers, chemical peels, dermabrasion, or laser resurfacing. These procedures may be done by a dermatologist or a plastic surgeon.

References: please see above links.

Resources: Acne tutorial. NIH Questions and Answers about Acne. AcneNet.


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Peter said...

Many people feel that their acne is overly embarrassing and unmanageable. I have read story after story of heartache, especially from teens that endure heartless bullying from schoolmates. There are so many different remedies and medications. What most people fail to realise is that each individual has a different biological makeup and what works for one person may not work for everyone. In some cases certain acne treatment can adversely affect already irritated skin. This further causes unnecessary embarrassment and frustration to an already uncomfortable situation. Propaganda fuels misconceptions about different so-called remedies and even causes. The idea that chocolate and oily food causes acne is unfounded. When in truth, makeup, unhealthy skin and even perspiration can cause acne. All of these factors affect the skin. But even your skin makeup can affect your skin and create back acne, scalp acne, large assesses or ingrown hair. There is an acne treatment questionnaire (just navigate to it on the right hand side) done by a company called SkinMed that will help to diagnose acne problems through a series of questions, and then it recommends the best acne treatment for each individual. Teen acne is typically the most difficult to diagnose because of hormonal considerations, but there is a special area meant just for teen acne that has a completely different set of rules when running the formula that determines the best medications or treatments. In some cases simple changes in hygiene and daily washing is all that it takes. The site also has a free offer on an acne facial cleanser that is made up of a three step process. The primary reason most teens, especially boys tend to have more problems with chronic acne is because of a lack of simply washing their face regularly. So this treatment is free and is a way to create a healthy daily routine, while gently healing the skin to prevent acne scarring brought on as a result of squeezing the sores. Once daily cleaning is practiced, and hormonal issues are taken into consideration, a proper treatment regiment can be highly effective. At the end of the day most acne, even teen acne , can be eliminated quickly and permanently with the right motivation. After all, we all want to be beautiful don’t we?

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