Treatments of Acne
In most adolescents acne clears spontaneously with minimal scarring. Reassurance and explanation along the following lines helps greatly:
(1) The lesions can be expected to clear in time.
(2) It is not infectious.
(3) The less patients are self conscious and worry about their appearance the less other people will take any notice of their acne.
It helps to give a simple regimen to follow, enabling patients to take some positive steps to clear their skin and also an alternative to picking their spots.
Patients with acne should be advised to hold a hot wet flannel on the face (a much simpler alternative to the commercial “Facial saunas”), followed by gentle rubbing in of a plain soap. Savlon solution, diluted 10 times with water, is an excellent alternative for controlling greasy skin. There are many proprietary preparations, most of which act as keratolytics, dissolving the keratin plug of the comedone. They can also cause considerable dryness and scaling of the skin.
Exfoliating the skin
This can be done either mechanically, using an abrasive cloth or a liquid scrub, or chemically. Common chemical exfoliating agents include salicylic acid and glycolic acid, which encourage the peeling of the top layer of skin to prevent a build-up of dead skin cells which combine with skin oil to block pores. It also helps to unblock already clogged pores.
Blue and red light therapy
It has long been known that short term improvement can be achieved with sunlight. However, studies have shown that sunlight worsens acne long-term, presumably due to UV damage. It is a helpful additional treatment in the winter months.
Oral treatment
The mainstay of treatment is oxytetracycline, which should be given for a week at 1 g daily then 500 mg
(250 mg twice daily) on an empty stomach. Minocycline or doxycycline are alternatives that can be taken with food. Perseverance with treatment is important, and it may take some months to produce an appreciable improvement. Erythromycin is an alternative to tetracycline, and co-trimoxazole can be used for Gram negative folliculitis. Tetracycline might theoretically interfere with the absorption of progesterone types of birth control pill and should not be given in pregnancy.
Topical antibiotics
Erythromycin, the tetracyclines, and clindamycin have been used topically. There is the risk of producing colonies of resistant organisms.
Antiandrogens
Cyproterone acetate combined with ethinyloestradiol is effective in some women; it is also a contraceptive.
Synthetic retinoids
For severe cases resistant to other treatments these drugs, which can be prescribed only in hospital, are very effective and clear most cases in a few months. 13-cis-Retinoic acid (isotretinoin) is usually used for acne. They are teratogenic, so there must be no question of pregnancy, and can cause liver changes with raised serum lipid values. Regular blood tests are therefore essential. A three month course of treatment usually gives a long remission. Recently topical isotretinoin gel has been introduced.
Residual lesions, keloid scars, cysts, and persistent nodules can be treated by injection with triamcinolone or freezing with liquid nitrogen. For severe scarring dermabrasion can produce good cosmetic results. This is usually carried out in a plastic surgery unit.
