Guidelines for effective acne treatment

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)

The Treatment

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.

Moderate acne

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 its growth.

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.

Severe acne

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 of isotretinoin.

Physical therapy

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 injections.

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.