Acne is a long term problem which may go on for many years. Therefore, the management of acne should be comprehensive. Besides medical treatment, it is also important to avoid aggravating factors and to have proper skin care.
Acne Skincare
- Cleanser
A suitable skin cleanser should provide good cleansing and yet not causing dryness to the skin (e.g.: Cetaphil oily skin cleanser, Avene Clenance cleanser). For patients with very oily skin, oil-control emulsions or moisturizers may help to reduce oiliness on skin (e.g.: Avene sebum regulating emulsion, LaRoche-Posay Efficlar Active Matt Moisturizer).
- Moisturizers
Many anti-acne medications cause dryness as a side effect. If dryness occurs when applying the medication, a moisturizer should be applied. A non-comedogenic moisturizer that does not clog up the pore should be chosen. The moisturizer should be applied 10 to 15 minutes apart from the medication. (eg: Cetaphil moisturizing cream or lotion, LaRoche-Posay Toleriene Fluide, Avene Skin Recovery Cream).
- Cosmeceuticals
These are over-the-counter products that can alter some of the mechanics of acne formation. Some of the more commonly used cosmeceuticals are:
- Salicylic acid: has peeling effect which helps to unblock some of the blocked pores, also has anti-inflammation effect. It is oil soluble and able to penetrate to the more oily part of skin to loosen up the scaly plugs that block the pores. Salicylic acid can be incorporated into cleansers, moisturizers and foundations.
- Glycolic acid: has peeling effect which helps to unblock blocked pores.
- Lactobionic acid: has peeling and antioxidant effect, also moisturizing therefore has low irritation problem.
- Zinc: anti-inflammation effect.
- Retinol: may be converted to the more active retinoic acid in the skin.
- Niacinamide: has both oil reduction and exfoliation effect.
Medications
- Over the counter products
Mild acne can be managed with over the counter products, besides the cosmeceuticals, other over the counter products may contain compounds such as benzoyl peroxide or tea tree oil. If acne does not clear with over the counter products, one should seek medical consultation. If the acne condition is severe with multiple or deep painful lesions, it is best to seek treatment early to prevent scarring.
- Prescriptive Medications
The medications for acne ranges from topicals (eg: antibiotics, retinoids) to oral medication (antibiotics, hormonal therapy, isotretinoin). The choice of medications will depend on the severity of acne, the response to previous medications, the side effects profile of medications and the patient's preference. Medication is usually prescribed for a minimum period of several months for effective control of acne.
- Topical antibiotics
- Topical antibiotics work by reducing the bacterial load within the oil glands and also by exerting anti-inflammation effects.
- Some of the commonly used topical antibiotic preparations include clindamycin (which may come in gel, lotion or solution, such as Clindagel, Dalacin-T), erythromycin (may come in solution or gel, such as Eryacne, Eryderm, Benzamycin gel (which also contains benzoyl peroxide).
- Topical retinoids
- Topical retinoids work mainly by smoothening the lining of the oil ducts and reducing the inflammation occurring in the oil glands.
- The commonly used topical retinoids (vitamin A derivatives) include adapalene (Differin® gel or cream), tretinoin (may come in gel, cream or solution, such as Retin A®, Retacnyl® ), and isotretinoin (cream or gel, such as Isotrex® )
- Maintainance therapy: After active acne is controlled, regular use of topical retinoids (eg: Differin) can help prevent relapses of acne by gently unclogging the blocked pores.
- Oral antibiotics
- Besides reducing the bacterial load within the oil glands, oral antibiotics also have anti-inflammation properties.
- Oral antibiotics that are used for treatment of acne include the cycline antibiotics (e.g. tetracycline, doxycycline and minocycline), erythromycin and occasionally sulphur based medication (e.g. sulfamethoxazole and trimethoprim). The antibiotics used for acne have been available for clinical use for a long time and many generic forms of the medications are available.
- Once started, it may take 4-8 weeks before the beneficial effects of antibiotics are appreciated. A course of antibiotic treatment may last for several months.
- Oral isotretinoin
- Oral isotretinoin works by reducing the oil production capacity of the cells that line the oil glands and by normalizing the lining of the oil ducts so as to reduce the possibility of blockage.
- The original oral isotretinoin used for severe acne is Roaccutane (or Accutane), some generic versions, such as Oratane and Nimigen are also available in recent years.
- A course of isotretinoin may take several months to complete. As a general guide, a person who is treated with isotretinoin should consume about 100-120 mg per kg body weight of medication at the completion of the course of treatment. For example, a 60kg person taking 30mg of isotretinoin per day will take 240 days to hit the target dose of 7200mg (60 X 120).
- The main side effect with oral isotretinoin is dryness of skin and lips. Patients should use moisturizing body lotion and lip balm to tackle the dryness problem. Some of the other side effects that have been reported include headache, joint pain, sun intolerance, mood changes and others.
- Simple blood tests, including serum lipids and liver function tests, may be carried out at baseline of treatment and repeated a couple of weeks later to make sure that there is no significant changes of these functions with the treatment.
- One of the most important precaution to be observed during isotretinoin treatment is contraception. It is known that pregnant lady who is treated with isotretinoin may give birth to baby with birth defects. In fact, after stopping isotretinoin, it is a good idea for the lady to avoid pregnancy for at least 1-2 menstrual cycles.
- Some patients may experience flaring of acne during the first 1-2 months of treatment. This can be minimized by concomitant use of antibiotic, blue light therapy or sometimes even a short course of oral steroid.
- Oral contraceptives
- A number of oral contraceptives are useful for ladies whose acne appear to be aggravated or precipitated by hormonal fluctuations.
- These contraceptives work by blocking the androgenic (one type of hormones) stimulation of the oil glands, thereby reducing oil production and removing blockage of the oil glands.
- Some of the contraceptives that have been used include Diane 35 and Yasmin. They are taken like other contraceptive pills, start taking on the first day of menstrual cycle (first day of bleeding) for a stretch of 21 days. This is then followed by a pill free period of 7 days when a menstruation bleeding will occur. After the 7 pill free days, patients will resume taking the next pack of medication.
- Some of the side effects include headache, gastric upsets, nausea, tension in breasts, intermenstrual bleedings, weight gain, depressive moods and facial pigmentation.
- Patients may need to use the treatment for 3 to 4 cycles before definite improvement is seen.
Procedures
What are Acne Procedures?
These are some simple office based procedures which can be carried out to reduce the acne activity.
Types of Acne Treatment Procedures
- Blue light therapy
The blue light (such as I Clear) has been used in recent years for treatment of inflammatory acne. The light works by reducing the bacteria, Propionebacterium acne within the oil glands, thereby reducing the inflammation. The treatment is carried out once to twice per week for at least 6-8 sessions. During the treatment, the light source is placed about one foot away from the skin and each side of the face will receive about 15 minutes of shining with the blue light. Patients may experience some warm sensation during the treatment and the treated areas may be slightly red and dry for a couple of hours.
- Microdermabrasion
Microdermabrasion involves removal of the superficial layer of the skin (stratum corneum) by light abrasion. The light abrasion is performed by jets of metallic crystals (such as zinc oxide or aluminium oxide crystals) or by roughened surfaces of a wand (some of the surfaces could be impregnated with diamond dusts). The ablated surface is then vacuumed off by negative pressure. This is useful in relieving blockage of oil glands, removing the ugly black heads, and preventing big pimples from forming. In addition, it also help to smoothen the skin and may also remove superficial blemishes, such as superficial pigmentation. The procedure takes about 15-30 minutes for a full face treatment. The skin may be red for a few hours post treatment, otherwise is associated with no down time. However, the effects are short lived and the procedure can be repeated every in 2-4 weekly.
Black heads on nose.
Unblocking of black heads with microdermabrasion.
