The need for treatment
Acne, though not physically dangerous, can threaten the psychological
and mental framework of the sufferer, especially if there is residual
permanent scarring of the skin. Nowadays, with a variety of systematic
treatment techniques available and newer ones being constantly
researched, acne can be treated with success.
However, in order to treat the disorder effectively it is imperative
that it is graded in order of severity and type as acne differs
from one sufferer to the next. How severe the acne is, can be
determined by the number, type and distribution of lesions present.
Currently there are about 25 methods used to grade severity and
19 for counting lesions.
However, acne can be classified into two broad types:
- Non inflammatory
or purely comedonal
- Inflammatory (papules, pustules and nodules)
Before treating acne it is recommended that a thorough knowledge
regarding the family and medical history of the individual is
obtained. Also, the therapeutic process will benefit from facts
about the past responses to treatment if there were any. Emphasis
should be put on treating the severest of lesions present as this
will automatically cure the less severe ones as well.
The patient should be willing to follow the methods of treatment.
To facilitate cooperation, certain myths regarding diet and cleanliness
needs to be clarified. Also, the patient should understand that
during the early phase of treatment there is a chance of acne
flaring up and that the desired result can only be achieved after
a certain period of time by following a disciplined though simple
regimen. Picking the pimples will only worsen the infection and
the medical application is to be put on the entire affected area.
Mild comedonal acne
Since these consist only of non inflammatory comedones, topical
retinoid therapy is usually used. This eliminates mature comedones
and prevents the formation of new ones. Treninoin, isotreninoin,
adapalene, tazarotine, and retinaldehyde are some topical retinoids.
Azelaic acid and salicylic acid are not retinoid drugs but they
can also be used in a similar way. Physical treatments are required
to remove large comedones by the process of extraction and sometimes
electrocauterization in a clinic.
Mild papopustular acne
This type is characterized by few comedones as well as a very
few inflammatory papsules and pustules. These are responsive to
topical retinoids and antibacterials like benzoyl peroxide, which
helps to eliminate P. acnes bacteria. Topical antibiotics such
as clindamycin and erythromycin are also effective.
This type is characterized by many comedones, moderate amounts
of pustules and few small nodules. There may or may not be residual
scarring of the skin. Moderate acne can be treated using oral
antibiotics, hormonal therapy and oral retinoids. The drug treatment
should be systematic. Oral antibiotics like erythromycin and tetracycline
and trimethoprin can also be sued to treat P. acnes by stopping
In women with moderate papopustular acne including small nodules,
oral antibiotics and topical retinoids should be used with hormonal
therapy to produce the desired results. Women who suffer from
acne due to ovarian or adrenal hyperadrogenism may experience
hirsutism, excessive sebum secretion and acne in adulthood and
worsening before menstruation. For such cases hormonal therapy
is effective. This therapy consists of antiandrogens like cyproterone
actate, spironolactone or flutamide, which prevent androgen production
from the ovaries or adrenal glands.
Patients who suffer from excessive sebum secretion, gram negative
folliculitis, which exhibits itself in the form of innumerable
painful inflammatory nodules and severe scarring, should be treated
with oral isotretinoin. However, before administering isotretinoin,
a blood lipids test, liver function tests and complete blood count
should be obtained. Also, patients must be told about the neurologic
ophthalmologic, mucocutaneous and gastrointestinal side effects
Physical therapies include aspiration of deep inflamed lesions
in cysts and sinus tracts, phototherapy and photodynamic therapy.
Scars can be treated depending on the size, shape, number and
location of the lesions as also the skin type of the patient.
Treatment includes collagen injections, fat transfer, chemical
peeling, laser resurfacing, skin surgery, dermabrasion and steroid
In order to cure acne permanently, it is imperative that treatment
is maintained by the use of topical retinoids even after effective
treatment. Also, noncomedogenic cosmetics should be used, which
lessen and hide the erythema thereby making the skin appear better.
Patients on isotretinoin require moisturizers to prevent drying
skin due to effect of this drug.
Treatments used target one or a combination of known mechanisms.
Combining more than one treatment generally leads to optimal results
as several mechanisms of acne development can be targeted simultaneously.
Patients may need adjustment of therapies based on their level
of improvement and tolerance to the treatment. Thus, with so many
methods available it is hoped that patients will overcome the
physical and mental trauma associated with acne.