Acne treatment
Acne is a common
problem in Malaysia. It is not only common in teenagers, it is also happens in
adults at the age of 20’s, 30’s and even 40’s.
Although all acne has
its roots in the same process which is hormonal fluctuations that stimulate oil
production. Not all acne is equally severe and not all cases of acne will
respond to the same types of treatments.
Types of acne
Most cases of acne fit
within one of three main categories as follow:
1. Comedonal acne.
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Comedonal acne. This is a type of mild
acne that involves blackheads and whiteheads. It forms because a component of skin oil called sebum with
old skin cells block the skin pores. Comedonal acne usually appears on the
forehead, nose, and chin.
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2. Inflammatory acne.
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Inflammatory acne. This form of acne
happens when the area under the “plug” (the blackhead or whitehead) becomes
reddened and inflamed.
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Treatments
The type of treatment
that works will depend both on the kind of acne and the additional factors that
trigger acne outbreaks.
Treating Mild to Moderate Comedonal and
Inflammatory Acne
Most cases of mild
comedonal acne occur in teenagers and young adults, and these can usually be
treated with topical creams and gels. The most common of these are retinoids,
like Retin-A and Differin. They work by
unblocking the clogged pores.
Dermatologists will
often combine a topical retinoid with an oral
antibiotic, such as doxycycline, tetracycline, minocycline or erythromycin, which kills the
bacteria that cause inflammation around the blocked pores.
This type of treatment
works on teenagers, who usually have a period of a year to four years when
they’re breaking out because of changing hormone levels and increased oil
production, and in some cases, genetics.
Each of the antibiotics has its own set of
side effects -- doxycycline causes sun sensitivity, and tetracycline can cause
yellowing of teeth in children.
Mild to moderate
comedonal acne can often be aggravated by external triggers, like hair gels and makeup. Patients are advised
to stop using these products when they have this acne.
Treating ‘Hormonal’ Acne
Many cases of
inflammatory acne are "hormonal" in nature where they occur in
teenage girls and women, and are aggravated by hormonal fluctuations like those
that occur during the menstrual cycle. For this group of women, dermatologists
often prescribe either oral contraceptive pills or another medication called spironolactone.
The oral contraceptives available in Malaysia
that is specifically approved by the FDA for the treatment of acne in women are
Yaz and Diane-35. Only pills that combine the female hormone estrogen with the synthetic
version of the male hormone progesterone, progestin, can
stabilize hormonal fluctuations where it can treat acne.
Oral contraceptives are a very effective
treatment for acne in many women; however, it may take some time to work. Patients
are advised to take the pills for at least three months before judging their
impact. That’s when the studies found a significant difference between placebos
and oral contraceptives. Many patients continue
to get further benefit at about 6 months. This is not an overnight process.
Some women may prefer
not to use oral contraceptives, or should not take
them because they are smokers or otherwise at high risk. These women, as well
as those who only get partial acne relief from contraceptives, are often
prescribed a drug called spironolactone.
This medication is a
diuretic – in other words, a "water pill" that causes frequent
urination.
It also blocks receptors for male hormones, which modulates the hormonal surges
that can stimulate oil production, causing acne. Spironolactone is an off label
indication which is not approved by the FDA to treat acne. This is because as a
generic
drug, there is little
motivation for a manufacturer to pay for the trials needed to go through the
approval process. However, most dermatologists agree that it works well as an
acne treatment.
Treating Severe Inflammatory or Cystic Acne
When acne does not
respond to the standard topical retinoids and oral antibiotics, patients have two
other choices: the drug isotretinoin, or one of several
procedure-based treatments for acne that involve using laser or light treatment
to reduce inflammation and kill acne-causing bacteria.
Isotretinoin is an
extremely powerful treatment for acne, often clearing up severe, scarring
breakouts that had not responded to any other treatments within a matter of a
few months.
But it also carries
lots of risks and side effects, including inflammatory
bowel disease,
ulcerative
colitis,
liver damage, bony
malformations, depression (in men), and a virtual certainty of severe birth
defects
for the babies of women who take isotretinoin while pregnant.
Patients who are
taking isotretinoin need to be counseled properly about all of these risks
involved. This drug will impairs wound healing, so if a patient with severe
cystic acne begins taking the drug, those cysts typically resolve with scars. It
gets rid of the underlying problem, but the patients will heal with permanent
scars.
The alternative to
isotretinoin for people with severe, stubborn acne is a treatment involving
laser/light therapy. The two main options are:
1. Photodynamic
therapy.
In this technique, a prescription liquid is applied to the patient’s face,
chest, or back where the acne is. Then a light or laser is applied to activate
the medicine. This medication can kill bacteria and over a few months, it can
help reduce the size and activity of the oil glands.
2.
Isolaz.
This treatment combines a vacuum with a broadband light. The vacuum cleanses
pores and extracts excess oil, while the light helps destroy the acne-causing
bacteria as well as reducing the activity of the oil gland.
In a nutshell, for
people with the most severe acne who’ve failed all other treatments,
isotretinoin or laser treatment will be the final choices.
