Acne

What is ACNE?

Acne is an inflammatory condition of the skin. It begins in adolescence and continues into adulthood. Acne often diminishes in time, but in some cases it continues to persist into later years.

Acne is triggered by the production of androgens. Sebaceous (oil) glands mature and produce more sebum. At the same time, there is a thickening (hyperkeratinisation) of cells lining hair follicles. This thickening of cells and increased sebum production lead to plugging of hair follicles. These follicles enlarge to open pores (blackheads) or closed pores (white heads). As the sebaceous glands enlarge and produce more sebum (oil), skin bacteria called Propionibacterium Acne infects these oil glands causing papules, infected pustules or nodules – some nodules are large and are called nodulocystic.

The face, neck, chest and back are the most commonly affected areas.

Acne Treatments

There are many treatments available for the management of acne, many without scientific evidence. Generally speaking most treatments require approximately 2 to 3 months of regular use to show improvement. Some treatment regimes work better for some individuals, essentially because some causative factors predominate in some individuals.
Topical Bactericidals

Benzoyl Peroxide is the most commonly used agent – rubbed twice a day on to the affected area. It works as a keratolytic agent (dissolves the keratin plugs in the pores) and kills the bacteria. It, however, can cause dryness and itching of the skin but this can be countered by using a light non greasy moisturiser. Caution must be exercised using Benzoyl Peroxide as it is a bleaching agent.

Topical Antibiotics

These may be just as effective as oral antibiotics and do have the added advantage of avoiding possible side effects of oral antibiotics such as stomach upsets and will not affect the oral contraceptive pill.

Oral Antibiotics

Low dose oral tetracyclines or erythromycins are the commonly used antibiotics. They are probably best used in conjunction with a topical bactericidal agent (Benzoyl Peroxide) or a topical retinoid, as antibiotics on their own do not reduce the sebum production or unblock pores. Antibiotics also may cause drug resistant bacteria.

Hormone Treatments

In women the oral contraceptive pill may be useful, especially when contraception is also required. An oral contraceptive containing the anti-testosterone, Cyproterone, is probably more effective in controlling acne that the traditional oestrogen-progesterone pill. Spironolactone is another medication that can be used to manipulate hormone levels.

Topical Retinoids

These are vitamin A derivatives and they help to reduce hyperkeratinisation and thus plugging of the pores. They may cause dryness and redness of the skin, but this can be managed by introducing these agents very slowly and using a non-greasy moisturiser.

Oral Retinoids

This is a vitamin A derivative and a very powerful treatment for acne. A course of treatments for 4 to 6 months is required, with a response rate of about 80%. About 25% of patients relapse after one treatment. It can only be prescribed by a dermatologist and requires regular blood tests and constant supervision by a dermatologist. Common side effects are dry skin and nose bleeds, while women of childbearing age have to have contraception as the drug causes birth defects.

Laser Treatment 

Our multisystem M22 Lumenis laser has an acne filter for treating inflammatory acne ie acne with a red base. The laser works by exciting compounds within acne bacteria – porphyrins. These compounds when excited by the laser light, damage the bacterial wall thus killing them. The laser beam may also reduce sebum (oil) within the oil glands in the skin.

A series of 3 to 5 treatments at 3 week intervals will be required.

Complications of Acne

The most severe complication is disfiguring scarring and pigmentation, the latter being more common in individuals with darker skin tones. Scarring is difficult to treat and may respond to laser resurfacing in very light skin-toned individuals.

Loss of self esteem is also a recognised complication.

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