Acne Treatments

  

Acne is the term used to describe blackheads, whiteheads, pimples or any clogged pores that occur on the face or body. Most acne problems occur during the adolescent years, but it can sometimes occur before or even after the teenage years.

Acne can often play a detrimental effect in one’s self-esteem because it ruins the natural beauty of a person’s facial features. Normally, minor acne will come and go on its own, recurring more frequently between the ages of adolescence and becoming less thereafter. Occasionally, acne can continually cause problems for a person later in life. More severe cases of acne can lead to more serious, permanent scarring.

Oral and Topical Medications

There are a number of oral and topical medications available to treat mild to moderate acne. While the ingredients and directions vary from product to product, most of these medications involve either decreasing your skin’s natural oil production, or treating bacteria and blocked pores in the targeted area. This will lessen the severity and frequency of acne outbreaks.

Topical Antibiotics work by killing the Propionibacterium acnes bacteria. This not only helps reduce the small infections in the pores, but also indirectly keeps the pores open. Topical antibiotics have been around for years without many changes to the formulations. Some topical antibiotics include:

  • Clindamycin – The most frequently used topical antibiotic for acne. It is available as a solution, lotion or gel at 1% strength. It is applied twice a day to all acne prone areas. It is generally tolerated but may cause some irritation. It should not be used by people with regional enteritis, ulcerative colitis, or a history of antibiotic-induced colitis.
  • Erthromycin - The second most commonly used topical antibiotic used for acne.  It is available as a solution, gel and ointment at 2% strength.  It is applied twice a day to all acne prone areas.  It is generally tolerated but may cause some irritation.  This product is safe for pregnant women.  
  • Metronidazole - Is used frequently for acne caused by rosacea.  It is available as a gel at 0.75% or 1.0% strength.  It is applied once or twice a day.  It is generally tolerated but can cause irritation.

Topical Retinoids.  Retinoid medications are derivatives of Vitamin A and the treatment of choice for comedonal acne, or whiteheads and blackheads.  They work by increasing skin cell turnover promoting the extrusion of the plugged material in the follicle.  They also prevent the formation of new comedones.  Some topical retinoids include:

  • Tretinoin - The best known topical retinoid, marketed as Retin-A, Avita and Renova.  This is also avaialble as a generic.  It is available as a cream (0.025%, 0.05% and 0.1%), gel (0.01% and 0.025%), and a liquid (0.05%).  Creams are less potent than gels, which are less potent than the liquid.  It breaks down chemically in the presence of benzoyl peroxide, therefore cannot be applied at the same time of the day.  There is a high incidence of skin irritation and precautions must be taken when started.  There is an increased risk of sunburn.
  • Adapalene - Is a newer topical retinoid.  It is marketed as Differin and available as a gel or cream at 0.1% and 0.3% strength.  A major benefit is that is causes less skin irritation than tretinoin.  It is stable in the presence of benzoyl peroxide; therefore they can be applied at the same time.  It treats acne as well as tretinoin.
  • Tazarotene - Is also a newer topical retinoid.  It is marketed as Tazorac and available as a gel at 0.05% and 0.1% strengths.  It is more expensive than the other retinoids and may be more irritating to the skin than the other retinoids.  It treats acne as well as tretinoin.

Combination Products.  Combination therapy can offer a strategy for preventing resistance to the antibiotic.  Its synergistic effort can prevent more resistant bacteria, as well as other susceptible acne causing bacteria, from growing during treatment.  Often when a combination topical product is used, less antibiotic is needed to prevent the growth of resistant bacteria compared to the amount needed when the antibiotic is used alone.  Combination products are all effective for treating inflammatory acne and include:

  • Topical retinoid plus erythromycin - It should be applied to the affected areas once daily before bedtime after the skin has been thoroughly washed, rinsed and patted dry.
  • Topical benzoyl peroxide plus erythromycin - A thin layer should be applied to the affected areas 1 to 2 times daily after the skin has been thoroughly washed, rinsed and patted dry.  This product must be refridgerated and may bleach clothing.
  • Topical benzoyl peroxide plus clindamycin - It should be applied to skin that has been washed, rinsed and patted dry.  This product does not need to be refridgerated. 

Oral Antibiotics.  It is these antibacterial and anti-inflammatory effects that are important for acne treatment.  If you inflamed pimples do not respond well to topical acne antibiotics, or if you have ance on many areas of your body, antibiotics in pill form can be more effective, easier to take, and more convenient.  These agents act in two ways (1) to reduce the number of acne bacteria and (2) to reduce inflammation.  The most commonly used antibiotics are:

  • Tetracycline
  • Minocycline
  • Doxycycline
  • Erthromycin
  • Trimethoprim

Accutane is a medicine that revolutionized the treatment of acne.  Accutane belongs to the family of medicines called retinoids, which are similar to vitamin A.  Accutane, like other retinoids, works by altering DNA transcription.  This affect decreases the size and output of sebaceous glands.  It also makes the cells that are sloughed off into the sebaceous glands less sticky, and therefore less able to form blackheads and whiteheads.  It also reduces the number of bacteria in the sebaceous gland and on the skin surface.  Accutane is generally used for nodular, pustular acne that has not responded to full courses of several oral antibiotics.  The trend in Accutane prescribing for acne has been towards using it earlier in the course of the disease, especially if there is significant scarring.  Accutane has a wide range of potential side effects and requires close monitoring by a dermatologist. 

  

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