Treatment of Acne

Medications for acne try to stop the formation of new pimples by reducing the sebum secretion, the bacteria, and the dead skin cells that clog the pores. They can also decrease the inflammation or irritation response of the skin to bacteria. It may take from 4 to 8 weeks before you see any improvement and know if the medication is effective.

There are many types of acne treatments. Some are applied to the skin (“topical” medications) and some are taken by mouth (“oral” medications). In most cases of mild acne, the doctor will start with a topical medication. If acne is more severe and it does not respond adequately to a topical medication, or if it covers large body surface areas such as the back and/or chest, oral antibiotics and/or oral hormone therapy may be prescribed. In general, it is usually best to start with acne medications that are least likely to cause side effects but are at the same time capable of addressing the specific causes for the acne. Some patients have a good result with just one medication, but many will need to use a combination of treatments: two or more different topical agents or an oral medication plus a topical medication.

Specialized treatments for acne including therapeutic peels, intense light based therapy, vacuum assisted expression of comedones are well tolerated and safe for various aspects of acne. They not only treat existing acne but also help to avoid scarring.

Therapeutic peel is rather an umbrella term encompassing various medicines applied to skin under expert dermatologists observation. Several peeling agents are now available, they are classified according to the specific change they bring about in your skin, as well as according to the depth of skin these changes occurs.

In cases of acne scar surgical methods are effective, including skin resurfacing with skin abraders, realignment of acne scars, grafts, loosening of deep scar tissues. Fillers are skin friendly materials deposited below the skin to replenish the deficit found in acne scar, and may provide the most rapid means to resurface the acne scars.

Fractional Lasers and autologous platelet rich plasma therapy have shown excellent results in treating acne scars.

TOPICAL ACNE MEDICATIONS

• Benzoyl peroxide (BP) helps to fight inflammation and is anti-microbial (kills bacteria, viruses, and other microorganisms) and is believed to help prevent resistance of bacteria to topical antibiotics. A benzoyl peroxide “wash” may be recommended for use on large areas such as the chest and/or back. Mild irritation and dryness are common when first using benzoyl peroxide-containing products. Be careful because benzoyl peroxide can bleach towels and clothing!
• Retinoids (such as adapalene, tretinoin, or tazarotene).unplug the oil glands by helping peel away the layers of skin and other things plugging the opening of the glands. Mild irritation and dryness are common when first using these products. Facial waxing and other skin procedures can lead to excessive irritation and should be avoided during retinoid therapy.
• Antibiotics fight bacteria and help decrease inflammation. Topical antibiotics commonly used in acne include clindamycin, erythromycin, and combination agents (such as clindamycin/benzoyl peroxide or erythromycin/benzoyl peroxide). Mild irritation and dryness are common when first using these products. Typically, topical antibiotics should not be used alone as treatment for acne.
• Other topical agents include salicylic acid, azelaic acid, dapsone, and sulfacetamide. Mild irritation and dryness can also occur when first using these products.

RECOMMENDATIONS WHEN USING TOPICAL ACNE MEDICATIONS

• Apply your medication to clean, dry skin. Topical medications may lead to significant dryness of the affected areas. To minimize this, wait 15-20 minutes after washing before applying your topical medication.
• The medications work by preventing new breakouts. Spot treatment of individual pimples does not do much. When applying topical medications to the face, use the “5-dot” method. Start by placing a small pea-sized amount of the medication on your finger. Then, place “dots” in each of five locations of your face: Mid-forehead, each cheek, nose, and chin. Next, gently apply the medication into the entire area of skin – not just on individual pimples! Try to avoid the delicate skin around your eyes and corners of your mouth.
• Be patient and give your medicine some time to work, apply them on a daily basis or as directed for six weeks before asking if your skin looks better. Try not to miss more than one or two days each week when using your medications.
• If your medications make your skin too dry, try using them “every other night” or even “every third night.” Gradually work up to daily.
• The same medications often come in various forms or formulations: Creams, ointments, lotions, gels, microspheres, or foams. Use the formulation that has been recommended and don’t switch to other forms unless instructed. Some forms (such as alcohol based gels) may be more drying and less tolerable for certain skin types.
• Many tretinoin formulations should be applied at bedtime as they can be inactivated by sunlight. If a retinoid product and a benzoyl peroxide product are prescribed separately, the benzoyl peroxide should be applied during the day and the retinoid should be applied later in the evening. If a once daily routine is easier for you, ask your doctor about treatment plans.
• Sometimes individual medications are not as effective as a combination of two or more agents. The doctor may need to try several medications or combinations before finding the one that is best for that patient.
  Ask your dermatologist if you wish to apply moisturizer, sunscreen, and make-up in conjunction with acne medications.
• Don’t stop using your acne medications just because your acne got better. Remember, the acne is better because of the medication, and prevention is the key to treatment.

ORAL ACNE MEDICATIONS

• Antibiotics include tetracycline-class medicines (tetracycline, minocycline, and doxycycline) erythromycin; trimethoprim-sulfamethoxazole; and occasionally cephalexin or azithromycin. These drugs may decrease bacteria and inflammation, and are most effective for moderate-to-severe acne. A product containing benzoyl peroxide should be used along with these antibiotics to help decrease the possibility of microbial resistance.
• Hormonal treatment is used only in females. Spironolactone is also sometimes used.
• Isotretinoin, a derivative of vitamin A, is a powerful drug, reserved for acne which is severe or when other medications have not worked well enough.