Acne Treatments Page
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Sub-headings. Click on the links
below Assessment.
Lesions.
Severity.
Soap
Substitutes.
Benzoyl
Peroxide.
Azelaic acid.
Topical
antibiotics.
Systemic
antibiotics.
Contraceptive
pill.
Pregnancy.
Dianette.
Differin.
Tretinoin. (Topical retinoic
acid)
Systemic
retinoids.
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Assessment by you
Doctor. Your
Doctor ideally should follow these guidelines: Treat acne enthusiastically as
a serious physical and psychological disease. Treat immediately to avoid
physical and emotional scarring. He/She should ensure full
compliance by the patient and
refer to a dermatologist if the alleviation of your symptoms is less than
ideal. He/She should consider oral
isotretinoin sooner rather than later.
Your
Doctor will wish to ascertain whether you have: a.
Predominantly
inflamed lesions b.
Predominantly
non-inflamed lesions c.
Mixed
varieties a.b.c. Determine the choice of
topical therapy. Topical therapies for non
inflamed lesions; Trans-retinoic acid (0.01%,
0.025%, 0.05%) isotretinoin, azelaic acid. Topical therapies for inflamed
lesions: Erythromycin, tetracycline,
clindamycin, benzoyl peroxide. Topical therapies for mixed
lesions: Combinations of therapies
indicated. Assessment of acne severity
will divide the acne into four groups: a.
Mild acne;
requires topical therapy b.
Moderate acne
requires topical and oral therapy c.
Severe acne;
requires oral and topical therapy and very regular review (perhaps every
six weeks). d.
Very severe acne;
requires urgent referral to a hospital specialist for mega dose
antibiotics and possibly oral isotretinoin. These may be mildly antiseptic
and are useful for removing dirt and grease while maintaining the correct
ph value of the skin. Benzoyl peroxide comes in
cream, lotion or gel form and may be mixed with other useful ingredients
such as antiseptics. It is
not a new treatment and has been in use for over twenty years. It can reduce the number or
troublesome skin bacteria by a factor of 100. It also has an anti-inflammatory
action and helps in the fight against comedones. Be sure you don’t have Rosacea, as
it will aggravate the condition.
After the first few days of use patients notice redness and scaling
of the skin this can be reduced by using a less concentrated solution or
not applying as often. This
is normal and should settle after a couple of weeks. It will bleach clothes and hair so
if applying to chest and back wear old clothes. But persevere – Benzoyl
peroxide is an underrated treatment it releases oxygen into the hair
follicle killing bacteria. Start with 2.5% solution if you find this is
irritating the skin apply for an hour or so and wash off, Slowly increase
the length of time you leave
it on for. You can progress
to 5% if you do not have sensitive skin. Do not start treatment with 10%
solution as this will result in excessive drying, redness and
peeling. Part of the
therapeutic action of benzoyl peroxide is drying the skin and also to shed
the top layer of skin. It may
take two weeks to show results, then reassess the strength. It can be worth using an oil free
moisturiser. If you have
tried benzoyl peroxide before it is worth trying again using these
guidelines. Benzamycin is one
of the most popular treatments for Acne in the States – it consists of
Benzoyl Peroxide and the antibiotic Erythromycin. Azelaic acid is a relatively
new acne treatment applied as a cream once or twice a day for a maximum of
six months. It is used to
treat mild to moderate acne and is as effective as benzoyl peroxide,
erythromycin cream or oral tetracycline against troublesome skin bacteria
and comedones. A small
percentage of users may notice redness that shouldn’t
last. These are used for mild to
moderate acne that mainly affects the face. They contain erythromycin (with or
without zinc acetate), clindamycin or tetracycline. Some propionibacterium infections
may become resistant to them.
Topical antibiotics are less irritating than benzoyl peroxide. One or two solutions may fluoresce
under ultraviolet light, and should not be worn to the
disco! Four oral antibiotic treatments
are available, tetracycline, doxycycline, minocycline and
erythromycin. Very
occasionally, trimethoprim may be used. Orally taken antibiotics are
useful for mild to moderate acne that affects a large area such as the
face, back and chest. They
must be taken regularly for prolonged lengths of time, at least three to
six months. Minocycline has
several advantages over the other antibiotics used to treat acne. It can be given once a day, can be
taken with food (but not milk).
It is less likely to induce bacterial resistance and has an
anti-inflammatory action. The
side effects of long term administration of antibiotics affects bacterial
balances in the intestinal tract and can lead to oral thrush, nausea,
abdominal pain or diarrhoea in around 5% of patients. Bacterial resistance may mean your
antibiotics no longer work.
If this happens consult your Doctor for a different treatment. This also applies to topical
antibiotics.
Tetracycline 500mg
bd Doxycycline
100mg/day Minocycline
100mg/day Erythromycin 500mg
bd Trimethoprim 200mg
bd Lower doses are relatively
ineffective and may lead to bacterial resistance. If you take a contraceptive
pill and antibiotic tablets together, there is a small risk that the
contraceptive pill will be less reliable. So if it is important that you do
not get pregnant, you should use barrier methods of contraception in
addition to the pill while you are taking antibiotics. Please discuss this with your
Doctor. If you are trying to become
pregnant, you must inform your Doctor. If you do become pregnant while
having treatment, you must make an appointment to see your Doctor or
dermatologist immediately.
Please Note; pregnancy is completely contraindicated while on oral
isotretinoin and for four weeks after stopping. Birth defects have been attributed
to this drug. Always discuss
this issue with your Doctor – many other drugs are not safe for the
unborn. The ordinary contraceptive pill
has little or no effect on acne.
However,your Doctor can prescribe one particular pill (Dianette)
that is very effective, but only to females who are not showing the
expected improvement with antibiotics. Dianette is prescribed for 18
months and should be used in conjunction with topical creams. The side effects of Dianette are
no different from those of the ordinary contraceptive
pill. Adapalene gel is a topical retinoid-like
drug for the treatment of mild to moderate acne vulgaris. Unlike
tretinoin, adapalene is a naphtholic acid derivative and causes less skin
irritation. Adapalene is more effective than the highest concentration of
tretinoin gel (0.025%) in the treatment of acne
vulgaris Adapalene reportedly penetrates deeply into the hair follicle. Adapalene possesses potent anti-inflammatory and comedolytic properties . Adapalene is used when comedones, papules and pustules predominate Tretinoin (topical retinoic
acid) is an analogue of vitamin A.
A cream or gel is applied once or twice daily for a minimum of two
months. Tretinoin works by
stimulating the division of fibroblast cells deep within the skin. This proliferation helps push
spots up and out, to such an extent that initially skin may appear worse –
lumpy and inflamed – before improving dramatically. It also reduces the number of
horny skin cells around the mouth of the hair follicle, allowing discharge
of the comedone and restoring the free flow of sebum. Tretinoin is used when comedones,
papules and pustules predominate.
The majority of users show a 70% response over three to six months
of treatment. The side
effects of excessive use of Tretinoin results in thin, shiny, red skin
with soreness and peeling.
There may be occasional photo irritation when the skin is exposed
to ultraviolet light. Again
combination treatments are being brought out – Isotrexin is a combination
of Isotretinoin and Erythromycin. Oral isotretinoin (an analogue
of vitamin A) is only prescribable by hospital specialists. It is normally used for patients
with severe cystic or conglobate acne, for those who have not responded to
several courses of antibiotics because of bacterial resistance and those
whose acne is making them seriously depressed. Repeat courses are not normally
recommended. It reduces
bacterial numbers, preventing comedone formation, damps down inflammation
and reduces sebum secretion.
Within two weeks of starting treatment, sebaceous follicles have
shrunk significantly in size and there is a rapid reduction in the amount
of sebum secreted. There is
also a rapid drop in the numbers of Propionibacterium on the skin, a
decline that persists after treatment is stopped. Side effects of treatment with
systemic retinoids are unfortunately common: a.
Facial redness in
66% of patients. b.
Conjunctivitis in
33% of patients. c.
Eczema in 30% of
patients. d.
Muscle and joint
pains in 35% e.
Headaches in 16%
of patients f.
Dry mucous
membranes, cracked lips and nose bleeds, raised blood cholesterol and
triglyceride levels, raised blood levels of some liver
enzymes. Rare side effects:
Seizures, abnormal blood
clotting (from low platelet count) and hearing problems. Despite this long list of possible
complications, treatment under close hospital supervision is SAFE
and can transform the appearance and emotional state of patients with
severe acne. Monthly blood
tests and supervision are necessary throughout
therapy.
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