Treating acne

Acne is not life threatening, but can destroy the quality of life of an individual. The physical scarring can disturb the body image and self esteem of a person and threaten their psychological and mental framework. Nowadays a variety of systematic treatment techniques are available to treat acne sucessfully.

However, in order to treat the disorder effectively it is imperative that it is graded in order of severity. The number, type and distribution of lesions determine the severity of acne. Currently there are about 25 methods used to grade severity and 19 for counting lesions.

Treatment of Acne

The treatments are made according to the skin type and the kind of acne. There are three main types: mild acne, moderate acne and severe acne.

Mild acne treatment

Mild comedonal acne:
Since non inflammatory comedones are the lesions usually present in mild acne, topical retinoid therapy is usually enough. This eliminates mature comedones and prevents the formation of new ones. Treninoin, isotreninoin, adapalene, tazarotine, and retinaldehyde are some topical retinoids. Retinoids can be used alone or in combination with other treatments such as azelaic acid, benzoyl peroxide and topical antibiotics. Combination therapy helps reduce the drug doses required and reduces the irritation caused by the treatment. Topical retinoids can help increase the penetration of the other topical agents.

Azelaic acid and salicylic acid are not retinoid drugs but they can also be used in a similar way. Physical treatments are required to remove large comedones by the process of extraction and sometimes electrocauterization in a clinic.

Moderate acne treatment

This type is characterized by many comedones, moderate amounts of pustules and few small nodules. Systemic drug therapy is an integral aspect for treating moderate acne especially since there is a tendency towards physical scarring. Moderate acne can be treated using oral antibiotics, hormonal therapy and oral retinoids. Since moderate acne is more extensive than mild acne and since they can result in scarring of the skin, the drug treatment should be systematic. Oral antibiotics like erythromycin, tetracycline and trimethoprin can be used to eradicate P. acnes infection. When inflammatory lesions begin to subside, the intake of antibiotics may be discontinued, but other treatments are maintained. The dermatologist should be aware of the possible interactions of the antibiotic with oral contraceptives and other prescribed drugs.

Adult women who suffer from acne associated with hirsuitism or excessive hairiness should be investigated for ovarian or adrenal dysfunction. Since this is caused by over secretion of androgens, antiandrogens like cyproterone actate, spironolactone or flutamide, which prevent androgen production from the ovaries or adrenal glands can be tried.

Severe acne treatment

Severe acne is characterized by excessive sebum secretion, gram negative folliculitis (seen as painful inflammatory nodules) and severe scarring. It should be treated with oral isotretinoin especially with patients with visible scarring and excessive seborrhea. Lower doses are suggested for the patients with severe back and chest involvement. However, isotretinoin can cause liver dysfunction, dizziness, vision disturbances, and diarrhea and vomiting. Hence before administering isotretinoin, a blood lipids test, liver function tests and complete blood count should be obtained.

Even after successful isotretinoin treatment for severe acne, it is found that one-third of the patients relapse. If relapse occurs the only practical response is to restart treatment.

Maintenance therapy

After every successful acne treatment, once the acne is brought under control, maintenance therapy is required. This therapy usually involves a regime including topical retinoids and benzoyl peroxide.

Treatment for Pregnant Women

Oral and topical erythromycin and benzoyl peroxide are the safest treatments for pregnant women affected by acne. Other treatments are generally not used because of their potential side effect risk to the embryo. In cases of severe acne during this period, short courses of oral steroids might be taken under close monitoring by the doctor.

Cosmetics

If you have acne, choose your cosmetics with great care. Ensure that the cosmetics are noncomedogenic and are able to impart enough camouflage. The cosmetics may have moisturizing agents for the skin and lips since isotretinoin therapy often dries the skin.

Other treatments

Physical therapies include aspiration of deep inflamed lesions in cysts and sinus tracts, phototherapy and photodynamic therapy. Scars can be treated by using collagen injections, fat transfer, chemical peeling, laser resurfacing, skin surgery, dermabrasion and steroid injections depending on their size, shape, number and location. In the future, treatment for acne will probably include new agents like leukotriene inhibitors.

Conclusion: Combination therapies work better for the acne-affected people than single modality therapies. Acne, though a common skin disease, must not be ignored since untreated acne can leave residual permanent scars.