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.
