Acne Treatment

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Acne Treatment
There is no single disease which causes more
psychic trauma, more maladjustment between
parents and children, more general insecurity and
feelings of inferiority and greater sums of
psychich suffering than does acne
vulgaris Sulzberger and Zalderms, 1948
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Acne Treatment

• Is difficult
• Requires complete patient compliance
• Acne is managed rather than cured

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Acne Treatment

• Requires an individualised approach
• Aim to prevent new lesions
• Assist existing lesions heal without scarring
• Treat scars

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Four Basic Factors

• All work together to produce comedones
• Hormones
• Increased sebum production
• Changes inside the follicle follicular
  keratinization
• Bacteria -anaerobic

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Treatment Approach

• Reduce sebaceous overactivity
• Reduce the possibility of gland obstruction
• Dissolve the keratin plugs
• Prevent infection
• Treat infection
• Reduce inflammation
• Manage hormones

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Treatment Options

• Microdermabrasion
• Glycolic Peels
• Laser or IPL
• Murad Enzyme Mask
• Topical retinoids (Stieva A)
• Oral Antibiotics
• Isotretinoin

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Microdermabrasion

• Exfoliates epidermis
• Encourages circulation
• Reduces keratin plugs
• Not ideal for patients with a large amount of
  active acne
• Improves acne scarring

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Glycolic Peels

• Encourages healthy exfoliation
• Improves general texture of skin
• Can help with uneven pigmentation

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Laser

• Exact action unknown
• Thought to stun the sebaceous gland
• Stimulates (PPIX)
• Decreases bacteria
• Can improve acne scarring through collagen
  stimulation

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Murad Enzyme Mask

• Fruit enzymes disolve dead cells and keratin
  plugs
• Anti-inflammatory
• Ideal to start a treatment program

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Topical Retinoids

• Stieva A 3 strengths
• Encourages normal exfoliation
• Works in both epidermis and dermis
• Reduces oil production
• Problems include dryness and redness
• Retinol or retinaldehyde available OTC
• Tretinoin prescription
• Adapalene (Differin) related
• Effective for mild to moderately severe acne

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Oral Antibiotics

• Topical antibiotics no longer encouraged
• Reduce the number on bacteria on the surface of
  the skin and in the follicles
• Anti-inflammatory
• Tetracycline, Minocyline, Doxycycline
• Erythromycin
• Trimethroprim
• Co-trimoxasole

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Antibiotics side effects

• Allergy
• Photosensitivity doxycyline
• GI disturbance 5 (nausea, colicky, diarrhoea)
• Thrush - 5
• Bacterial resistance
• Possible increased chance of failure of OC

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Oestrogens and Antiandrogens

• Diane 35 or Spirolactone

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Benzyl Peroxide

• Commonly used in OTC acne products
• Safe for children, adults and during pregnancy
• Reduces the number of surface bacteria and yeasts
• Oxidising keratolytic, and comedolytic
• Anti-inflammatory

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Benzyl Peroxide (Problems)

• Drys the skin
• Can lead to contact dermatitis
• Bleaches any clothing that it touches

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Isotretinoin

• Treatment of choice for severe acne
• Similar to Vitamin A
• Reduces oil content of the skin
• Inhibits P. acnes
• Available from Dermatologist only

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Isotretinoin (problems)

• Teratogenic - Contraception required
• Flare of acne on commencement
• Conjunctivitis, blepharitis, eczema, paronychia
• All patients develop dry skin, mucosal dryness
• Aching joints and muscles
• Headache and fatigue
• Mood change and depression (rare)

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Prevent Scarring

• Highest priority
• Most scarring is preventable
• Only inflammed lesions will scar
• When there is redness and inflammation aggressive
  treatment is required

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Scarring

• Considerable variation in scarring between
  individuals
• Frequently from Nodular cystic acne
• Also from more superficial inflammed lesions

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Prevention of acne scars

• Only sure method treat the acne early in its
  course and as long as necessary
• Decrease inflammation

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Treatments for acne scars

• Objective to give a more acceptable physical
  appearance
• Laser
• Dermal Fillers
• Microdermabrasion
• Skin Surgery

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Treatments for postinflammatory pigmentation

• Careful sunprotection
• Hydroquinone
• Superficial chemical peels

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Points to Remember

• Persistance and compliance is vital
• Individualise treatment
• Review progress regularly
• Allow the treatment time to work

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Suggested Web Sites

• www.murad.com
• www.dermnetnz.org
• www.derm-infonet.com (AcneNet)