What is acne?
Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. However, the disease is not restricted to any age group; adults in their 20s - even into their 40s - can get acne. While not a life threatening condition, acne can be upsetting and disfiguring. When severe, acne can lead to serious and permanent scarring. Even less severe cases can lead to scarring.
Types of Acne
Acne can be classified into mild, moderate and severe acne and is usually treated according to this classification.
The mainstay of over-the-counter acne treatment, benzoyl peroxide works to clear up acne by reducing P. acnes and removing dead cells from the skin to prevent comedones. It was one of the first agents found to be effective in treating mild acne and has been used in acne treatment for decades. The principal side effect is excessive dryness of the skin, so be sure to follow directions and not use more than stated unless otherwise instructed by a physician. Care should also be taken when applying it to avoid the bleaching effect.
Effective in treating non-inflammatory acne lesions, salicylic acid helps correct the abnormal shedding of skin cells and unclog pores to resolve and prevent lesions. Salicylic acid does not have any effect on sebum production or P. acnes. Like benzoyl peroxide, salicylic acid must be used continuously. Once stopped, pores clog and acne returns. Salicylic acid is found in many over-the-counter acne products, including lotions, creams and pads. It may be irritating to the skin.
Physical Procedures for Treating Acne
Light chemical peels of glycolic acid and other chemical agents are used by doctors to loosen blackheads and decrease acne papules.
Sometimes removing comedones proves beneficial. To extract whiteheads and blackheads, dermatologists use a sterile pen-sized device. This procedure should only be performed by a dermatologist or other medical professional. Patients’ attempts to extract comedones and drain cysts by squeezing or picking, can lead to worsening of the acne, scarring and infection. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other bacteria.
Phototherapy (Laser and Light Treatments)
Several laser and light treatments are available to treat acne. Some of these laser and light treatments target only one factor that causes acne—P. acnes. For many patients, this is not a comprehensive treatment for resolving their acne. A dermatologist can determine if laser or light treatment is appropriate for a patient.
Advantages to laser and light treatments include not having to remember to apply or take any medication and the ability to treat hard-to-reach areas, such as the back. However, laser and light treatments can be quite expensive, and long-term effectiveness has not been proven.
Over the last several years, laser technology has also assumed an increasingly important role in the treatment of acne scars.
Anyone considering laser or light therapy should consult a doctor experienced in providing the therapy. Don’t be afraid to ask questions about the physician’s experience and qualifications.
Prescription Medications for Treating Acne
Isotretinoin is a potent drug reserved for treating severe cystic acne and acne that has proven itself resistant to other medications. Isotretinoin is a synthetic (man-made) retinoid (form of vitamin A) that comes in pill form. It is usually taken once or twice a day for 16 to 20 weeks.
Today, it is the most effective acne treatment available because it is the only acne treatment that works on all four factors that predispose a person to acne - excess oil production, clogged skin pores, P. acnes and inflammation. The remissions achieved with isotretinoin usually last for many months to many years. For many patients, only one course of isotretinoin therapy is needed
For patients with moderate to severe and persistent acne, oral antibiotics have been a mainstay of therapy for years. Like topical antimicrobials, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation. Treatment with oral antibiotics usually begins with a higher dosage, which is reduced as acne resolves. Generally, antibiotics are prescribed for six months or less.
Oral contraceptives have been shown to effectively clear acne in women by suppressing the overactive sebaceous glands and can be used as long-term acne therapy. However, oral contraceptives should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynaecologist.