Treatment and Care

The treatment of acne is based on a clear understanding of the underlying causes. The different types of acne require different approaches and kinds of medication to treat them suitably.

In order to treat acne, we have to address the cause of acne.

Acne is caused by

  • The blocking of the follicle pore
  • Presence of bacterium P.acnes inside the follicle and
  • Excess sebum (oil) production.

The above changes occur because of hormonal imbalance, use of comedogenic products, genetic factors and stress to name a few.

Medicines can treat one or more of these causes. Hence, it is not a major reason for worry or concern. Doctors choose the medication depending upon the severity of acne, its formation and underlying cause. Hormonal treatment may be used for women who get acne due to hormonal imbalance. Antibiotics may be used if the acne is infected. Thus we use the medication depending upon the cause and condition of acne.

Doctors can treat acne with-

  • Topical creams, gels, liquids etc.,
  • Oral medicines such as antibiotics, Isotretinoin and Nicotinamide,
  • Physical and surgical procedures
  • Light and laser therapy

The main medications for acne are benzoyl peroxide, antibiotics, retinoids, antiseborrheic medications, salicylic acid, alpha hydroxy acid, azelaic acid, nicotinamide, and kera-tolytic soaps.

These medicines have 4 effects on acne:

  1. To make normal the shedding into the pore to prevent blockage
  2. to kill Propionibacterium acnes
  3. anti-inflammatory effects
  4. hormonal manipulation

Dos and Don’ts for Acne Treatment:

  • Choosing the right kind of ointment is very essential for proper cure.
  • Different solutions are of different compositions namely oil based, alcoholic solutions, aqueous solutions, creams, foams, gels and lotions. Similarly creams, foams and gels cause mild irritation while others cause more.
  • More importantly based on the skin type of the user, the user must be careful in choosing the type of ointments. Alcoholic solutions that evaporate quickly are ideally suited for oily skinned people. Creams, gels and lotions are suitable for normal to oily skinned people. Lotions are suited for any skin type.
  • Regular cleaning- Remember to cleanse your skin regularly and only with mild soap as too much soap usage can also spoil skin texture and cause dryness.
  • Never pick or touch the acne- It is very important to ensure that you do not touch the acne so that it does not spread and cause further eruptions.
  • Home remedies- Certain home remedies can greatly help in curing acne.
  • Consult Dermatologist- When acne is persistent and causes concern, do not delay to visit your dermatologist. It is always better to acquire professional support than to while away time or follow the wrong remedies that may further worsen the existing conditions.
  • When trying medication, always start at a lower dosage level and then migrate to a higher dosage in the absence of harsh side-effects if the acne condition calls for it.
  • In case you encounter any side effects during the usage of any skin product, immediately discontinue its usage and contact the dermatologist for guidance.

Practices for protection from acne:

  • Applying Jojoba oil and tea tree oil can prove beneficial for mild acne concerns. Home remedies are always ideally suited for mild acne concerns.
  • Stringent skin care habits are a must to get rid of acne. Scrubbing the face repeatedly or vigorously must be strictly avoided.
  • Using the right kind of moisturizer with the medication is important to treat acne. At the same time, absence of moisturizing agents or the wrong compound can cause greater complications for acne sufferers.
  • Using a light and water based moisturizer can help make the skin feel open and not heavily coated.
  • Those with oily skin must also use moisturizers just as those with dry skin. It is a misconception that those with oily skin do not require moisturizers. They only require additional cleansing to remove excess oil and accumulated dirt.
  • Alcohol saps skin moisture and hence alcohol based products, such as many after shaves are not suited for those with sensitive and acne prone skin. It causes dryness and constriction.
  • Lemon juice is a natural skin exfoliating agent that could help clean the skin. As it is acidic in nature and hence must be diluted. The advantage of using lemon juice is that it removes the marks and dark spots left behind by previous acne and also acts as a preventive agent against eruption of acne in future. In addition to this, it is also an anti-bacterial agent and helps prevent development of infections.
  • Care must be taken while choosing cosmetics. It is important to ensure that the cosmetics are not oil based on do not clog your skin pores. Cosmetics are also specifically designed to suit skin types and tones.
  • Whenever there are early signs of facial pigmentation or redness, it is best to consult the dermatologist before the worsening of the conditions.
  • Women undergoing menopause and pregnant women must watch out for acne as they are more prone to acne under increased androgen levels.

Such precautionary measures will help prevent acne formation and repeated attacks. Care must always be taken to treat and eliminate acne at initial stages rather than allowing them to prolong and precipitate to reach cyst and nodule formation.

Acne Treatments – Things to do to treat acne

Acne treatments are more effective when they are used to treat the intended kind of acne. That is why it is best suited to apply solutions based on the type of acne.

A. Whiteheads and Blackheads- Treatment

  1. To treat whiteheads and blackheads medication is used. Medication unplugs the pore and prevents future blockage of the pore. Most of the OTC topical acne medications can be used to treat comedones.
  2. Comedones can also be extracted.
    • If you extract them yourself take care to use sterile tools otherwise infection may occur.
    • Also extract them gently, or you may cause a bigger pore.
  3. Wash your face gently with lukewarm water and mild soap to remove excess sebum and dead skin twice a day. Excessive washing will not help but instead may flare up acne.
  4. Avoid touching the affected skin to prevent infection.

B. Treatment of papules and pustules

The second stage of acne is called moderate acne. Moderate acne is also known as pimples or zits. These pimples can be papules or pustules. Papules are solid mass of cells and pustules are infected lesions filled with liquid.

  1. If you are doing self-treatment of pimples with OTC medicines, choose them carefully.
  2. What is good for your friend may not work for you. Your skin is different and the cause of your pimples may be different.
  3. Someone may get acne because of excess sebum, while another may get it because of the use of comedogenic products.
  4. It is preferable that instead of using OTC medication you consult a doctor. If you are doing self-medication of pimples, you need to know the following.

1. Topical medication for pimples-

The first choice for the treatment of pimples is the use of topical medication. Benzoyl Peroxide is one of the most popular medications. Other medications that are used to treat pimples topically are: Salicylic Acid, Resorcinol and Sulphur, Alcohol and Acetone, Azelaic Acid, Topical Antibiotics, Topical Retinoids and Nicotinamide that are usually available in pharmacies.

2. Physical and Surgical Procedures for Pimple Treatment-

Physical and surgical procedures such as chemical peeling, lasers, microdermabrasion, surgical extraction, and light therapy are used to treat acne. Some of these procedures cannot be used in infected and inflamed pimples while others such as surgery and light treatment can be used. Light treatment is especially useful for pimples on the back because it is a difficult to apply medication on back.

3. Oral Medication for Pimples-

  • Antibiotics, Isotretinoin and Nicotinamide are used orally to treat pimples.
  • Amongst antibiotics, Tetracycline, Minocycline, Doxycyline and Erythromycin are commonly used. Sulpha drugs are also used to treat pimples.
  • Oral antibiotics kill the bacteria P. acnes in the pimples and reduce infection and inflammation.
  • Isotretinoin is prescribed in case of persistent acne and is one of the best medications of acne.
  • Oral nicotinamide is a good anti-inflammatory agent for pimples and does not have the side effects of antibiotics.
  • Women are also given birth control pills and Spironolactone to treat hormonal disorders and to treat pimples.

C. Treatment of cysts and nodules

  • Isotretinoin is one of the most potent medicines for acne and is a retinoid (a compound of vitamin A). Isotretinoin helps treat all the following four causes of acne:
  • Excess oil, Clogged pores, Inflammation, and the bacteria P.acnes.
  • The normal dose of isotretinoin is one or two pills a day for up to twenty weeks. Your dermatologist will decide the dose. Please don’t take Isotretinoin without medical supervision.

Side Effects Of Isotretinoin:

  • The common side effects of isotretinoin are: joint pain, headache, nausea, and depression.
  • For women, it is very important to be in regular contact with their doctor because isotretinoin can cause damage to the development of a fetus and hence Isotretinoin is not prescribed during pregnancy.

Injecting Corticosteroid in the Lesion:

In this treatment, a mild steroid solution is injected in the cyst. The steroid dries the acne within a few days. This treatment may prevent scarring as it reduces the infection quickly

Surgical procedure:

Sometimes the lesion is cut open and drained. This procedure needs skill and patients should not try it themselves. Popping a cyst can lead to more infection. The appropriate treatment is decided based on the severity of the acne condition.

D. Oral Contraceptives For Women:

Hormones are responsible for overactive sebaceous glands. These glands produce more of the sebum that causes acne. In women the hormonal activity can be corrected with oral contraceptives. These drugs should be taken only under medical supervision.

Spironolactone-

Spironolactone is a steroid. It is prescribed along with oral contraceptives to women. Spironolactone controls the production of Androgens (a group of hormones). By controlling androgens, the sebum production is reduced and acne is treated.

E. Medications

  • Benzoyl peroxide is the first medicine that comes to mind to treat mild and moderate acne vulgaris due to its effectiveness and mild side-effects.
  • The side effects of Benzoyl peroxide are dryness of the skin, slight redness, and occasional peeling as part of some side-effects.
  • When patients use this, they become sensitive to the sun; so sunscreen should be used during the treatment to prevent sunburn.
  • Unlike antibiotics that generate bacterial resistance, benzoyl peroxide does not appear to generate bacterial resistance.

F. Antibiotics

Antibiotics are useful for more severe cases of acne. With increasing resistance of P. acnes worldwide, they are becoming less effective. The most common antibiotics, either applied topically or taken orally, include erythromycin, clindamycin, and tetracyclines such as minocycline.

Oral Antibiotics:

  • Antibiotics can be used topically as well as orally. For severe acne oral antibiotics are preferred as they produce faster results.
  • The main function of antibiotics is that they kill the bacteria P.acnes.
  • With reduction in the population of this bacterium, infection and inflammation reduces.
  • Commonly used antibiotics include tetracycline, erythromycin and doxycycline.
  • Excessive use of antibiotics can cause resistance to the antibiotic and gastro-intestinal problems.

G. Hormones

  • In females, hormonal treatments are very effective for acne. The antiandrogen cyproterone in combination with an oestrogen (Diane 35) is particularly effective at reducing androgenic hormone levels.
  • Both can be used where blood tests show abnormally high androgens and are also effective in non androgen related cases.
  • Along with this, doctors can add low-dose spironolactone as it has anti-androgenetic properties, especially in patients with polycystic ovarian syndrome.

H. Topical and Oral retinoids can also be used by those with acne for better cure.

I. Anti-inflammatories are usually used in conjunction with medication and even as a stand alone since most of the severe cases of acne are associated with inflammation. Care must be taken not to use anti-inflammatories on top of the pore opening and only surrounding the acne.