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Acne
Who gets acne ?
Over 80 % of everybody gets acne sometime in their lives. It occurs most commonly in puberty, due to hormonal imbalance ( androgens ).
Found mostly in the face and upper body that has the highest concentration of sebum glands.
What causes acne ?
Pores in the skin becomes blocked by cells that stick together and causes a plug. The plug along with the sebum secreted by the sebaceous glands become a source of nutrition for bacteria. The result is inflammation and acne.
Why does it happen ?
- Androgens
- Endogenous (our own hormones)
- Exogenous people on steroids (oral or topical)
- Testosterone
- Cosmetics (not removing it before sleep)
- Self induced (picking at skin with finger nails)
Treatment:
Usually start with topical treatment. If not satisfactory, additional treatment required for optimal control.
Topical:
(1) Cleansing.
Wash face 2 times / day with a good cleanser.
Dry skin : Use a creamy cleanser
Oily skin : Use a gel cleanser
Cleansers containing Salicylic or Glycolic acids are ideal.
(2) Benzoil peroxide.
Use daily. Commonly used and mixed with antibiotics.
(3) Retinoids. (Vit. A derivatives)
Controls the cell stickiness. Examples ;
Tretinoin : Retin A, Retin A micro, Renova
Adelapine: Differin gel
Tazarotene: Tazorac ( less irritating than tretinoin )
Retinol : Over the counter ( more irritating than tretinoin )
Retinoids side effects :
Initial ; Redness and flakiness that clears up soon
Increase photosensitivity ( sun sensitivity )
Important to apply sunscreen when outside
Better applied at night before bedtime
After use for 3 months can expect a decrease in fine lines and wrinkles. An added bonus for the patients with “adult acne”.
(4) Antibiotics.
Clindamycin and Erythromycin are 2 examples of antibiotics commonly used topically.
General treatment of acne.
- Antibiotics by mouth. ( Tetracyclines, Erythromycin )
- Hormonal Anti androgenic Rx. ( BCP , Diane 35 )
- Accutane ( Isotretinoin )
Should stay on the Rx for 5 months for maximum benefit
Absolutely not to be used in pregnancy or women planning to fall pregnant
soon.
Blood tests needed every 6 weeks through out course.
Advantages : Works very effectively and regarded as “curative” for acne.
Disadvantages : Potential for some serious side effects.
Above is a brief summary of commonly used treatment options , either on their own or in combination. If these are not effective , consider the following :
(1) Salicylic acid and Glycolic acid peel.
Superficial peel and an excellent choice in the treatment of acne.
Salicylic acid is fat soluble and can penetrate into the pores.
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(2) Photodynamic therapy with Levulan and BLU-U light.
This procedure utilizes a photosensitizing chemical, 5-ALA (Levulan).
5-ALA is preferentially absorbed by sebaceous glands ( which harbours the
Propionibacterium acne, responsible for acne flare up and inflammation).
The photosensitizing chemical is then activated with the BLU-U light.
Photodynamic therapy has been studied extensively and was approved by
the FDA in the US in 1999.
This is also an effective way to eliminate actinic keratoses and reduce the
risk of developing certain skin cancers (squamous cell carcinoma).
Some redness and peeling are noted for a few days following the procedure
but the clearance rate for acne is outstanding.
Quite often one treatment is adequate. If not satisfactory treatments can be
repeated at monthly intervals.
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(3) Intense Pulsed Light Treatment.
Concentrated light pulses attack acne on two fronts.
- Destroy acne bacteria for a quick clearance of current acne breakouts.
- Penetrates into the hyperactive sebaceous glands to slow down the production
of sebum, which can clog pores and cause future acne breakouts.
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