Home /Acne Treatment
What is the pathophysiology?
The key factor is genetics. If both parents had acne, 3 of 4 children will have acne.
Androgen hormones have been implicated as the initial trigger, clinical lesions begin to appear around puberty in persons with acne.
Androgen hormones promote sebum production and release.
Pacnes is an anaerobic organism present in acne lesions. The presence of P acnes promotes inflammation through a variety of mechanisms.
What is the role of diet?
Comprehensive review of the literature in 2004 concluded that there was no conclusive evidence on the effects of diet on acne.
These studies failed to support a link between the consumption of chocolate or sugar and acne. Thus, no evidence exists on the role of diet in acne.
Numerous dairy sources and foods with high glycemic indices, appears to have solidly-documented potentiating effects on serum insulin and IGF-1 levels, thereby promoting androgens that could potentiate a change in sebum production and therefore inflammation and acne.
More research is needed to determine whether a low-glycemic diet could effectively mediate acne or possibly even prevent it.
At what age dose acne appear?
Adolescent acne usually begins with the onset of puberty, when the gonads begin to produce and release more androgen hormone.
Acne is not limited to adolescence. Twelve percent of women and 5% of men at age 25 years have acne. By age 45 years, 5% of both men and women still have acne.
What are the causes of acne?
Presence of hormonal imbalances (polycystic ovary syndrome, oral contraceptives, exogenous androgens). Systemic medications (anabolic or corticosteroids, OCPs, psychiatric medications). Corticosteroid-containing skin-bleaching agents that are used by some individuals with darker skin (especially in some African populations) to improve hyperpigmentation or lighten complexion may induce steroid acne, which may further worsen PIH. Occlusive topical agents Mechanical irritation Self-manipulation of lesions (picking). The role of diet, sun exposure, and smoking are controversial.
What are the presentations?
Comedonal-non inflammatory: open (black heads) or closed (white heads) 1 -2 mm papules Inflammatory: papules and pustules and cysts Nodular: require systemic retinoids Scarring acne: require systemic retinoids How can I prevent acne? If you have oily skin: benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%) acne wash. It may not be necessary to use it every day, especially if you experience excessive dryness. If you have dry skin: you may not need to wash your face at all unless you have combination skin (dry/oily) or wear make-up or creams during the day. Use a non-comedogenic (non-pore clogging) cold cream, gentle moisturizing face wash or non- fragrance containing soap to remove make-up. Hair products that contain oils – including shampoo, conditioner, hair spray, hair gel, pomade – may cause acne on the forehead, sides of the face, or neck (with long hair). It is recommended that you shampoo & condition your hair in the shower, followed by cleansing of the face in the sink with cool or lukewarm water. Do not use a washcloth, loofah, or other abrasive scrub. Choose a non-comedogenic (non-pore clogging) sunscreen with zinc oxide and/or titanium dioxide if you have acne-prone skin or if you experience skin irritation with other chemical-containing sunscreens.
What are the available medical treatments?
Remove the influencing factors. Topical treatments: Wash the skin with cool or lukewarm water. Cleanse with a prescribed cleanser. Wait 20 minutes before applying the medication. Apply a pea-sized amount of product to the entire face and gently connect the dots with your fingertips. Retinoid A:
Note that acne often flares up during the first month of using topical retinoids. They also make the skin more sensitive to the sun. Therefore, a noncomedogenic sunscreen should be used during the day.
Benzyl peroxide: wash, gel, lotion, or pads (2.5-10%)
Antibiotics: erythromycin 2% or clindamycin
Azelaic acid (15 or 20% cream) twice daily. Topical or systemic erythromycin base are safe alternatives for patients who wish to become pregnant, for postpartum hypertension, and have an anti-blackhead effect.
An additional anti-blackhead effect can be achieved by adding products containing
Salicylic acid 2% topical gel, lotion or peel 10-30% in the clinic
Glycolic acid 2.5-20% topical gel, lotion, lotion or peel in the clinic
Topical sodium sulfacetamide (10% lotion, gel or lotion such as Plexion, Rosac, Rosanil, Rosula or Sulfacet-R) is a good alternative, especially in acne in adult patients with increased perioral lesions.
Oral antibiotics:
The tetracycline group of antibiotics is commonly prescribed for the treatment of acne. Antibiotics that are more sebum-sensitive, such as doxycycline and minocycline, are generally more effective than tetracycline Doxycycline hyclate 100 mg once or twice daily
Oral contraceptive pills in females
Corticosteroids
Short courses (7-10 days) of systemic steroids (prednisone 20-40 mg/day) will stop flare-ups at critical times (weddings, proms, interviews, etc.).
Inflammatory lesions can be treated with intralesional corticosteroids (such as triamcinolone acetonide 2.5-5.0 mg/cc), which usually improve within 2-5 days by reducing inflammation.
Isotretinoin (Roaccutane®)
Isotretinoin is used to treat severe, disfiguring nodular acne. It should only be used after other acne medications have been tried and failed to help the acne. The duration of treatment should be at least 5 months and the full required dose of 120 mg/kg should be achieved. Most patients tolerate a dose of 0.75 mg/kg. About 85% of patients see clear skin after a single course of isotretinoin.
Isotretinoin is a teratogenic substance and pregnancy should be avoided.
Contraceptive counseling is mandatory and two negative pregnancy test results should be obtained before starting treatment in women of childbearing age. Baseline laboratory testing should also include assessment of cholesterol, triglycerides, liver enzyme levels and red blood cell count. Pregnancy tests and laboratory tests should be repeated monthly during treatment. What are the consequences? Post-inflammatory hyperpigmentation. Acne scars.