Acne treatment

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.

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.

2. Inflammatory acne.

Inflammatory acne. This form of acne happens when the area under the “plug” (the blackhead or whitehead) becomes reddened and inflamed.

3. Cystic acne.

Cystic acne. This is the most severe form of acne, cystic acne develops as the result of an infection in the area of the outbreak. Cystic acne often runs in families. It is very painful and cause disfiguring, permanent scarring.

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.