How Is Acne Treated?

Acne may appear on the face, back or even chest, however, not every acne product fits for every part of your body. You should avoid using products not prescribed by your dermatologist (a skin disease specialist). These doctors treat all kinds of acne, particularly severe cases. Doctors who are general or family practitioners, pediatricians, or internists may treat patients with milder cases of acne. The goals of acne treatment are to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatment is aimed at reducing several problems that play a part in causing acne: abnormal clumping of cells in the follicles, increased oil production, bacteria, inflammation. Depending on the extent of the problem, the doctor may recommend one of several over-the-counter (OTC) medicines and/or prescription medicines. Some of these medicines may be topical (applied to the skin), and others may be oral (taken by mouth). The doctor may suggest using more than one topical medicine or combining oral and topical medicines.

Treatment for Blackheads, Whiteheads, and Mild Inflammatory acne

Doctors usually recommend an OTC or prescription topical medicines for people with mild signs of acne. Topical medicine is applied directly to the acne lesions or to the entire area of affected skin.

OTC topical medicines used for mild no inflammatory acne:

• Benzoyl peroxide destroys P. acnes, and may also reduce oil production.
• Exposed helps break down blackheads and whiteheads.
• ClearPores helps break down blackheads and whiteheads (also helps cut down the shedding of cells lining the hair follicles).
• Sulfur helps break down blackheads and whiteheads.

Topical OTC medicines are available in many forms, such as gels, lotions, creams, soaps, or pads. In some people, OTC acne medicines may cause side effects such as skin irritation, burning, or redness, which often get better or go away with continued use of the medicine. If you experience severe or prolonged side effects, you should report them to your doctor. OTC topical medicines are somewhat effective in treating acne when used regularly; however, it may take up to 8 weeks before you see noticeable improvement.

Treatment of Moderate to Severe Inflammatory acne

People with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used to treat acne:

• Antibiotics help stop or slow the growth of bacteria and reduce inflammation.
• Vitamin A (retinoids) unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Most prescribed retinoids are: Tretinoin (Retin-A), Adapalene (Differin), and Tazarotene (Tazorac)
• Others may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it. For some people, topical medicines cause minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as Tretinoin Cream 0.025%, or Tretinoin Cream 0.05% these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, notify your doctor. As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.

Prescription Oral Antibiotics

For patients with moderate to severe acne, doctors often prescribe oral antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. In this case oral and topical medicines may be combined. Common acne treatment antibiotics are Tetracycline (Achromycin V), Minocycline (Dynacin, Minocin), and Doxycycline (Vibramycin, Adoxa, and Monodox). Other oral medicines less commonly used are Clindamycin (Cleocin), Erythromycin, or Sulfonamides (Bactrim). Some people while taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color, and increased tendency to sunburn. Because tetracyclines may affect tooth & bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There's some concern, though it has not been proven, that tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

Treatment for Severe Nodular or Cystic acne

People with nodules or cysts should be treated by a dermatologist. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe Isotretinoin (Accutane), a Retinoid (Retin A derivative). Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. It markedly reduces the size of the oil glands so that much less oil is produced. As a result, the growth of bacteria is decreased.

Advantages of Isotretinoin (Accutane)

Isotretinoin is a very effective medicine that can help prevent scarring. After 15 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients. In those patients where acne recurs after a course of isotretinoin, the doctor may institute another course of the same treatment or prescribe other medicines.

Disadvantages of Isotretinoin (Accutane)

Isotretinoin can cause birth defects in the developing fetus of a pregnant woman. It is important that women of childbearing age are not pregnant and do not get pregnant while taking this medicine. Women must use two separate effective forms of birth control at the same time for 1 month before treatment begins, during the entire course of treatment, and for 1 full month after stopping the drug. You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin. Some people with acne become depressed by the changes in the appearance of their skin. Changes in mood may be intensified during treatment or soon after completing a course of medication like isotretinoin. There have been a number of reported suicides and suicide attempts in people taking isotretinoin; however, the connection between isotretinoin and suicide or depression is not known. Nevertheless, if you or someone you know feels unusually sad or has other symptoms of depression, such as loss of appetite, loss of interest in once-loved activities, or trouble concentrating, it’s important to consult your doctor. Other possible side effects of isotretinoin include: dry eyes, mouth, lips, nose, or skin (very common), itching, nosebleeds, muscle aches, sensitivity to the sun, poor night vision, changes in blood, such as an increase in fats in the blood (triglycerides and cholesterol), change in liver function. To be able to determine if isotretinoin should be stopped if side effects occur, your doctor may test your blood before you start treatment and periodically during treatment. Side effects usually go away after the medicine is stopped.

Treatments for Hormonally Influenced Acne in Women

In some women, acne is caused by an excess of androgen (male) hormones. Clues that this may be the case include hirsutism (excessive growth of hair on the face or body), premenstrual acne flares, irregular menstrual cycles, and elevated blood levels of certain androgens. Your doctor may prescribe one of several drugs to treat women with this type of acne:

• Birth control pills help suppress the androgen produced by the ovaries.
• Low-dose corticosteroid drugs such as Prednisone (Deltasone) or Dexamethasone (Decadron, Hexadrol) help suppress the androgen produced by the adrenal glands.
• Antiandrogen drugs such as Spironolactone (Aldactone) help reduce the excessive oil production.

! Side effects of antiandrogen drugs may include: irregular menstruation, tender breasts, headaches, and fatigue.

Innovations In Acne Treatments

Doctors may use other types of procedures in addition to drug therapy to treat patients with acne. For example, the doctor may remove the patient's comedones during office visits. Sometimes the doctor will inject corticosteroids directly into lesions to help reduce the size and pain of inflamed cysts and nodules. Early treatment is the best way to prevent acne scars. Once scarring has occurred, the doctor may recommend a medical or surgical procedure to help reduce the scars. A blue light therapy and superficial laser may be used to treat irregular scars. Dermabrasion (or microdermabrasion), which is a form of "sanding down" scars, is sometimes used. Another treatment option for deep scars caused by cysticacne would be to transfer fat from another part of the body to the scar. Your doctor may also inject a synthetic filling material under the scar to improve its appearance.