How acne is treated

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.

However, acne can be classified into two broad types:

• Non inflammatory or purely comedonal
• Inflammatory (papules, pustules and nodules)

Treatment

Before treating acne doctors perform a through history and examination. The medical history of an individual is very important to determine therapy, especially previous responses to therapy and the family history. Emphasis should be put on treating the severest of lesions present as this will automatically cure the less severe ones as well.

It is important for patients to understand that acne occurs from the over secretion of sebum and is not related to diet or cleanliness. A realistic approach to therapy is also needed, for example, patients need to understand that therapy could take several months and that a flare up of acne during the initial phases of treatment is common. Picking at the pimples will only worsen the infection and the medical application is to be put on the entire affected area.

Treatment based on severity

a) 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. 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.

b) Mild papopustular acne

Mild papopustular acne are responsive to topical retinoids and antibacterials like benzoyl peroxide, which helps to eliminate P. acnes bacteria. Since this type of acne has very few pustules, topical antibiotics such as clindamycin and erythromycin are also effective.

c) Moderate acne

This type is characterized by many comedones, moderate amounts of pustules and few small nodules. 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.

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.

d) Severe acne

Severe acne is characterized by excessive sebum secretion, gram negative folliculitis (seen as painful inflammatory nodules) and severe scarring, should be treated with oral isotretinoin. 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.

Physical therapy

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.

Conclusion:

For best results, it is imperative that be maintained by the use of topical retinoids even after lesions disappear. Noncomedogenic cosmetics should be used, which help camouflage redness of skin caused by acne. Patients on isotretinoin require moisturizers to prevent drying skin due to effect of this drug.

Combining more than one treatment aimed at different mechanisms of action, generally leads to optimal results. Thus several mechanisms of acne development can be targeted simultaneously. Patients may need adjustment of therapies based on their level of improvement and tolerance to the treatment. Clearance of skin, it is hoped will help the individual cope with the psychological stress of acne.