Written by: Ayesha Khan, MBBS
In a Nutshell
- Acne (or acne vulgaris) affects individuals of all age group but is most prevalent at the time of puberty
- Management primarily involves around topical or oral antibiotics, retinoids, and hormonal treatments
- Cosmetic procedures like laser therapy, chemical peels and photodynamic therapy are helpful in more severe cases
What is acne?
Acne is a common skin condition that affects almost every teenager but can affect individuals of all age groups. It is classified as a disease of hair follicles of face, chest, and other parts of the body.
Acne (also referred to as acne vulgaris) is characterized by 3 varieties of skin lesions:
- Blackheads or comedones
- Inflammatory papule
- Pus filled pimple or pustule
In severe acne, people often develop a fourth variety of skin lesion, known as cyst or boil.
The pathophysiology of acne revolves around increased sebum production by sebaceous glands of skin at the time of puberty under the influence of hormones. This increased sebum production coupled with changes in the maturation of skin cells (due to puberty hormones) can lead to clogging of skin pores or follicles. These clogged pores cause inflammation and eventually leads to papule and then pustule formation (characterized by debris of dead skin cells, oil, and bacteria). If left alone, these pustules or pimples resolve on other own. In some cases, these pimples/ pustules leave a scar or cosmetic disfigurement (such as open/ enlarged pores, pitted skin etc.)
Evidence-Based Treatment Regimen
For mild acne: Doctors and dermatologists recommend adopting a good skin care regimen if your acne is mild and non- bothersome. This includes washing your face with a medicated soap or facewash twice a day, according to your skin type and avoid unnecessary touching of face. It is also important to identify dietary or environmental triggers that may cause flaring of acne.
For Moderate to Severe Acne: For more serious acne that is unresponsive to traditional remedies, your doctor may advise you over the counter and/or prescription medications. These include:
- Topical Treatments: This includes gels, creams and lotions that contain antiseptic or antibacterial ingredients like Benzoyl Peroxide. Apply it on active lesions at least twice a day (make sure your face is clean/washed and dry). Generally, a 6-week treatment is sufficient to see results.
- Topical retinoids: These agents include Adapalene and Tretinoin - available in the form of creams, lotions or gels and exert their action by exfoliating the skin (i.e. removing dead cells). Ideally, these should be applied once a day (at bedtime) on clean and dry skin for at least 6 weeks.
- Topicalantibiotics: Topical antibiotics are advised to kill bacteria that is causing infection or inflammation of your skin follicles. Topical antibiotic course is usually advised for 6-8 weeks. You can apply topical antibiotics before bedtime.
The side effects of above 3 topical treatments are generally similar; and may range from mild stinging sensation to dryness of skin, irritation, redness, peeling and increased sensitivity to sunlight. It is recommended to avoid intense sun exposure without proper sunscreen, while you are on these treatments.
- Azelaic acid: For individuals who are sensitive to above 3 options, Azelaic acid can be used as an alternative option. It works as an antiseptic as well as exfoliative agent to remove dead skin cells. Benefit over other topical treatment include minimal sensitivity to sunlight.
- Antibiotic tablets: These include antibiotics like Erythromycin (if you are pregnant or breast-feeding) or Tetracyclines (not advised to pregnant or breastfeeding women). Most people start to see some results within 6 weeks of starting the therapy. Depending on the response to treatment, your doctor may advise a course of 4-6 months.
- Hormonal Treatments: The combined oral contraceptive pills are usually advised to adult women, especially those who are experiencing acne flares due to hormonal imbalance.
- Cosmetic Procedures: To improve the cosmetic appearance of skin, your dermatologist may suggest cosmetic procedures like chemical peel, photodynamic therapy, dermabrasion etc.
Speak to a dermatologist if you are experiencing severe acne that is followed by scarring or if you have developed painful nodules.
It is noteworthy that most acne treatments take at LEAST 2-3 months before you start to see any improvement. So, be patient.
Strength of Evidence: C
Acne is multifactorial and therefore treatment is not one size fits all. The interventions discussed in the article are based on recommendations and best practices suggested by the National Health Services, American Academy of Dermatology and American Association of Family Physicians.
Acne is a common cosmetic issue that primarily affect teenagers at the time of puberty but can affect adults as well. Treatment modalities depends on the age of patient and severity of acne. For moderate to severe acne, dermatologists recommend a combination of topical plus oral antibiotic. To reduce scarring and minimize the risk of recurrence, cosmetic procedures like photodynamic therapy and chemical peels can be employed.
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- American Academy of Dermatology - Severe acne
- NHS - Acne treatment
- American Family Physician - Diagnosis and Treatment of Acne