Options for acne treatment

The goals of acne treatments are to repair existing wounds, prevent new lesions from developing, prevent scarring, and reduce as much as possible the psychological stress, awkwardness and humiliation of acne.

Drug treatment of acne is intended to lessen several aspects that contribute with acne: the anomalous clumping of cells in the follicles, improved oil creation, growth of bacteria and inflammation associated with acne.

Depending on the severity of the patient's acne, the physician will prescribe one of several over-the-counter (OTC) medicines or topical (administered on the skin) or systemic (oral) medicines. The doctor may recommend using more than one topical medicine or combining oral and topical treatments.

In order to handle mild inflammatory acne, physicians generally advise OTC or topical prescription. Topical therapy must be rubbed directly onto the acne lesions and on to the whole area of affected skin.

The most widespread topical OTC medicines used for the treatment of acne are benzoyl peroxide, resorcinol, salicylic acid, and sulfur. Benzoyl peroxide works best at eliminating the bacteria P. acnes and in reducing oil production. Resorcinol, salicylic acid, and sulfur help break down blackheads and whiteheads. In addition, salicylic acid makes it easier to reduce the shedding of cells lining the follicles of sebaceous glands. Topical OTC medications are available in various presentations, such as gels, lotions, creams, soaps, or pads.

Some OTC acne medicines may cause side effects such as skin irritation, burning, or redness. Although side effects lessen or disappear after persistent use of the treatments for some people; severe or lasting side effects should be reported to the doctor.

Topical or systemic medicines, alone or in combination, may be prescribed for the treatment of moderate to severe inflammatory acne cases.

As regards to prescription of topical medicines, treatment of acne most commonly includes antibiotics, benzoyl peroxide, tretinoin, adapalene, and azelaic acid. Antibiotics and azelaic acid help discontinue or slow the development of bacteria and lessen inflammation. Tretinoin, a retinoid, unplugs existing comedones, allowing other topical medicines to enter the follicles. Other retinoids, like tazarotene or adapalene, help reduce comedo formation.

Prescription topical medicines are available as creams, lotions, solutions, or gels, which the physician will prescribe considering the patient’s skin type. Since creams and lotions offer moisture, they are likely to be good for people with a sensitive type of skin. Gels and solutions are usually alcohol based, and therefore, tend to dry the skin.

In the beginning, the skin may look worse before improving. Some of the most usual side effects of the treatment of acne include stinging, burning, redness, peeling, scaling, or discoloration.

As regards prescription of oral medicines, physicians frequently prescribe oral antibiotics for patients with moderate to severe acne. Oral antibiotics help control acne by restraining the development of bacteria and reducing inflammation. In many cases, oral and topical medicines may be combined; most commonly, benzoyl peroxide can be prescribed together with clindamycin, erythromycin, or sulfur. Tetracycline, minocycline, and doxycycline are other common antibiotics used for the treatment of acne.

Common side effects include increased tendency to sunburn, upset stomach, faintness or light-headedness, and changes in skin color. Tetracycline is not given to pregnant women as there is significant side effect risks for the unborn child.

For treatment of severe inflammatory acne cases, isotretinoin, a retinoid, may be prescribed for use. Isotretinoin is an oral drug that reduces the size and activity of the sebaceous glands in order to diminish oil production, and therefore, the growth of bacteria.

Isotretinoin is very effective in preventing scarring. However, it can provoke birth defects. That is why it is mandatory that women are not pregnant and avoid pregnancy during treatment of acne with this drug.

Other kinds of treatment of acne in women include hormonal therapy. Hormonal therapy is useful to treat acne in women that is due to an excess of androgen hormones. The doctor may prescribe an antiandrogen, a drug which reduces excessive oil production. Antiadnrogen drugs include spironolactone, cyproterone acetate, and flutamide. Possible side effects of antiandrogen drugs include irregular menstruation, tender breasts, headache, and fatigue. Women using anti androgens must also use birth control to avoid pregnancy. Birth control pills can themselve help to treat acne when the condition is mild.

A treatment of acne alternative to drug therapy may include removal of the patient’s comedones or injection of cortisone directly into lesions in order to reduce the size and pain of inflamed cysts and nodules.

In case of scarring, surgical treatment of acne may be suggested. Irregular scars may be corrected by a superficial laser. Laser treatment may also be used deeper into the skin to tighten underlying tissue and to "plump out" scars. Dermabrasion is another kind of treatment of acne usually used in combination with a subsurface laser. Another option for treating deep scars is the transfer of fat taken from other parts of the body.