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Treatment options

Acne is a very common disease that significantly affects the lives of people who have it. Fortunately, there are treatments that can help reduce symptoms. This can improve the appearance of the skin, and lead to a better quality of life for people with acne.

Acne treatment aims to: NIAMS 2006

  • Make existing pimples go away
  • Stop new pimples from forming
  • Limit side effects to a tolerable level
  • Help prevent scarring when possible

Main Types of Prescriptions Treatment

There are several different types of acne treatment. Your doctor may suggest over-the-counter medications, or prescription drugs. Some of these will be applied directly to the skin, while others are pills or capsules that are meant to be swallowed. The acne treatment will depend on the severity of your acne, and may include one or more of the following types: NIAMS 2006

  • Topical retinoids
  • Benzoyl peroxide
  • Topical antibiotics
  • Oral antibiotics
  • Hormones/ antiandrogens
  • Oral retinoids (isotretinoin)

Topical Retinoids (retinoids for topical use in acne)

Topical retinoids are derivatives of vitamin A. These different treatments have similar abilities to improve acne, but all can irritatethe skin, particularly during the first few weeks of use. Topical retinoids can be used as initial treatment and as long-term maintenance therapy.” Gollnick 2003
Some topical retinoids can be found in fixed-dose combination products with other topical agents (eg. adapalene or benzoyl peroxide)

Benzoyl Peroxide (peroxides, anti-acne for topical use)

Benzoyl peroxide is an antimicrobial, meaning it can kill bacteria. It is able to quickly and effectively kill P. acnes  bacteria in the skin of people with acne. Unlike antibiotics, bacteria have not been able to become resistant to benzoyl peroxide. It is available in several different concentrations. The more concentrated forms may be more irritating to the skin. Gollnick 2003  

Topical Antibiotics

Topical antibiotics are also able to kill bacteria, including P. acnes . Antibiotics are also able to reduce inflammation in the skin. Unlike benzoyl peroxide, antibiotics are limited by resistance of bacteria. These bacteria may not be affected at all by antibiotics, or may become progressively resistant over the course of therapy. To reduce the proliferation of antibiotic-resistant bacteria, antibiotics are used in combination with other treatments. Gollnick 2003

Oral Antibiotics

Oral antibiotics are antibacterial and anti-inflammatory, but are taken as pills or capsules rather than creams or lotions and are used in more severe forms of acne Gollnick2003 .

Hormonal / Antiandrogen Therapy

These treatments are option for women with endocrine abnormalities or difficult-to-treat acne. Gollnick 2003

Oral Retinoids (retinoids for treatment of acne = isotretinoin)

Oral isotretinoin act on the 4 factors involved in the pathogenesis of acne. It is used for the most severe cases of acne, or in cases where other treatments cause continued relapse or cannot prevent scarring. Women taking oral isotretinoin cannot be pregnant at the time of initiating treatment, and cannot become pregnant during treatment or one month after stopping the therapy, due to birth defects caused by the drug. A strict contraception regimen must be followed. Physicians and patients must register using the iPledge program to ensure that these risks are communicated properly. Gollnick 2003

Beginning Acne Treatment

Treatments for acne can be very effective at reducing pimples and improving the appearance of skin, but this requires time. It’s natural to want to see the effects of treatment right away, but most treatments will not have a significant effect until several weeks have passed. People with acne who experience this can sometimes become frustrated with this delay, and stop taking their medication before it has had time to make an effect on their symptoms. Keep in mind that this is typical of acne treatment, and don’t be discouraged if acne does not improve in the first few days. Also, several treatments for acne may initially make symptoms worse at the start of therapy. This is a temporary effect, and sticking with the treatment will typically result in symptoms improving after the first few weeks. It’s important to always take acne treatments as prescribed by your doctor, and give them the necessary time before making decisions on their effectiveness. Gollnick 2003, Zaenglein 2008

Long-Term Treatment

It is important to understand that acne is a long-term disease. Most people’s acne resolves when they are in their twenties. However, some people with acne will have symptoms that stay with them their entire lives. There are several effective treatment options, but no one “cure” for acne. In some cases acne medications should be taken over the long term, as stopping  treatment when the acne improves can result in symptoms coming back. In some cases, your doctor may prescribe an initial treatment to get your acne under control, followed by a long-term treatment that can help keep it from coming back.

The Right Treatment for You

Your doctor will help you to decide which treatment is best for you. In addition, you may want to consider the following factors when selecting an acne treatment that is agreeable to you:

  • First, the treatment should never be worse than the acne itself!
  • The treatment may need to be used for prolonged periods of time or continuously in order to keep acne symptoms under control
  • Some acne treatments (particularly oral treatments) are associated with birth defects; if you are pregnant or plan on becoming pregnant during acne treatment it is important to talk to your doctor about what treatment options are appropriate
  • Acne treatments may be irritating to the skin and appear to be causing even more acne, but don’t worry - if its the case, use every other day, use a non comedogenic moisturizer and call the doctors. These irritation is temporary and generally resolve fairly quickly with continued use of the treatment
  • Keep in mind: treatment adherence strongly influences treatment effectiveness (If you don’t use it, it won’t work!)

Practical Treatment Tips

Cleansing

Cleansing habits are an important aspect of treating acne, but are also an area of misinformation for people with this disease. Keep in mind that acne is not caused by poor hygiene: there is no evidence that a lack of washing causes acne or that frequent washing improves it. In addition, cleansing that is too frequent or too vigorous can actually make matters worse by aggravating the skin. This is especially true if rough cloths or other scrubbing materials are used. These abrasives disrupt the follicle and cause further aggravation to the inflamed skin. Best practice is to clean affected areas using only warm water and a gentle cleanser and no more than twice daily. Gollnick 2003 Also, some prescription acne treatments should not be used with harsh cleansers or scrubs because they may increase irritation. Make sure you discuss with your doctor all skin products and cleansers you are using before you start treatment with a prescription product.

The choice of cleanser is also an important consideration. Although P. acnes bacteria play an important role of acne, soaps labeled “antibacterial” have not been found to help. These soaps typically don’t affect P. acnes , in pore (where it causes problems), but can only wash off bacteria from the surface of the skin. Gollnick 2003

Skin Care Tips Gollnick 2003, NIAMS 2006

  • Clean skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse.
  • Sometimes even acne-prone skin can feel dry (particularly when first using topical medication like retinoids). Using a mild, “noncomedogenic” moisturizer may help, but avoid oily or heavy products that can clog pores.
  • Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to.
  • Choose makeup carefully. All makeup should be oil free. Look for the word “noncomedogenic” on the label. This means that the makeup will not clog up your pores.
  • Stay out of the sun. Many acne medicines can make people more likely to sunburn.

HELPFUL HINT

All topical treatments should be spread over the entire area where acne appears, not “spotted” only on visible pimples. Talk to your doctor about the best way to apply a topical medication.

CAUTION

Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin.

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