Acne is a skin condition in which there are red pimples, spots or zits on the skin, especially on the face, due to inflamed or infected sebaceous glands. It is more prevalent among adolescents. It occurs when the pores of the skin become clogged with oil, dead skin cells, and bacteria.
How is acne treated?
Treatment of acne depends on its severity – mild, moderate or severe.
General principles of treatment
Acne can be effectively treated, although response may sometimes be slow. Eat fresh fruit and vegetables. Avoid chocolates, cold drinks, excess tea etc. Say no to smoking. Avoid or at least minimize the use of creams and other cosmetics to the affected skin. Abrasive skin treatments can aggravate both comedones and inflammatory lesions. Avoid to scratch or pick the spots. Avoid excessive sun exposure. To avoid sunburn, protect your skin outdoors using a sunscreen and protective clothing.
Management of mild acne
Mild acne can be managed with topical treatment (gels, solutions and lotions). People usually use topical agents for facial skin only. The affected areas should be washed twice daily with a mild cleanser and water or an antiseptic wash. The topical Acne products should be applied to all affected areas, rather than applied just on individual spots. A thin smear should only be applied to dry clean skin at nighttime. Acne products may work better if applied in the morning as well. They often cause dryness particularly in the first 2–4 weeks of use. This is partly how they work. The skin usually adjusts to this. Apply an oil-free moisturiser only if the affected skin is obviously peeling. Avoid applying oily cosmetics such as foundation or sunscreen. It may take several weeks or even months to see convincing improvement. Discontinue using product if severe irritation results and see your doctor for advice.
Suitable topical agents for mild acne include:
- Antiseptic washes with triclosan or benoyl peroxide (Acnegon Bar, Acne Bar, Benzacne, Presyz and many others).
- Mild salicylic acid preparations to exfoliate and unplug the follicles (Acne Wash, Clobetrex-S, Dithrosil and many others)
- Benzoyl peroxide, Azelaic acid or Hydrogen peroxide cream/lotion/gel (Acne-Pearl, Benoxyl, Primox cream and many others).
- Antibiotics, such as clindamycin solution (Clinda Derm, Clinda V, Clindacin Gel, Dalacin-V and many others) or erythromycin solution (D Mycin, Erithrin, Eryderm, Erymac, and many others) and gel (Arynoin Plus, Esotek, Isotrexin, Tretocin, Visorex and many others), which are best used with benzoyl peroxide or azelaic acid to reduce the chance of resistance
- Retinoids i.e. tretinoin (Flutren, Lazma, Siton Plus, Tritenex, and many others), isotretinoin (Arynoin plus, Cosmin, Isotrex™ and many othes), adapalene (Adapco, Clear cream, and many others). Combination prescription topicals include clindamycin / benzoyl peroxide (Clinda Plus, Duac, Dupearl and many others) and adapalene/benzoyl peroxide gel (Adaplus and many others).
Note: Before prescribing retionoids pregnancy test and LFTs should be advised.
See your doctor or dermatologist for advice if your pimples fail to clear up within six weeks or you have severe acne.
Management of moderate acne
Treatment for moderate acne usually includes the topical agents described above. In addition, oral medication may be prescribed, usually for at least 3–6 months.
Suitable oral medications include:
- Antibiotics such as minocycline (Tetraderm, Cycloxin, Minoderm, Minolox, Myno and many others), doxycycline (Dotur, Doxicap, Parkedox, Vibramycin, Welcodox and many others) or erythromycin (Eryrocin, Erythrin, Erywil, Trycin, and many others).
- For resistant or persistent acne, oral isotretinoin (Arynoin, Isoderm, Verion and many others) may be more suitable.
When oral antibiotics are discontinued, control should be maintained longterm by continuing topical therapy.
Management of severe acne
Treatment for severe acne requires oral treatment. Patients should be under the care of a dermatologist. Many patients will be treated with oral isotretinoin (Arynoin, Isoderm, Verion and many others). In addition the following may also be prescribed:
High dose oral antibiotics for six months or longer. In females, especially those with polycystic ovary syndrome, oral anti-androgens such as oestrogen/cyproterone may be suitable for long-term use.