Now that you understand how acne lesions develop, treatment will seem much more logical. As was previously mentioned, treating acne is an individualized endeavor which needs to be coordinated by you and your dermatologist. Treatment regimens are developed through trial-and-error, and your dermatologist will need to see you at regular intervals in order to assess how your lesions are progressing and what medication side effects you may be experiencing. Below are brief descriptions of some agents used to treat acne, although it is not intended to be a comprehensive list.
Topical agents (in other words, you apply them directly to your skin)
If you have ever had a pimple, chances are you have tried some of the over-the-counter preparations available at your local pharmacy. These products usually contain benzoyl peroxide or salicylic acid.
Benzoyl peroxide is an antibacterial agent that works by killing P. acnes. It can be applied as a cream, gel, or wash, and is available in concentrations ranging from 2.5% to 10%. A higher concentration is not necessarily better, but it is more likely to dry and irritateyour skin. Benzoyl peroxide can also bleach clothing, so use it with caution!
Salicylic acid is a keratolytic, which means that it breaks down the cells in your skin, called keratinocytes. By breaking down skin layers, salicylic acid can relieve clogged pores. Like benzoyl peroxide, salicyclic acid can lead to dry and irritated skin.
Benzoyl peroxide and salicylic acid should not be used together, because this combination is extremely drying. It is important to apply the individual agent to the entire affected area and to apply it even when you do not have acne in the region, as neither product rectifies all of the causes of acne. In other words, you should apply the product regularly to avoid future breakouts. Many people find it easy to apply benzoyl peroxide in the morning, when they wash their face.
Your dermatologist may prescribe topical agents that work to even out your skin.
Tretinoin is composed of retinoic acid and vitamin A. It is known as a comedolytic because it prevents the development of comedones. It is quite obvious that preventing the primary acne lesion can prevent acne progression. Tretinoin can be very irritating, so gradual initiation is advised. A pea-sized amount should be applied before bedtime and at least half an hour after washing your face. You can begin by applying it every three nights and gradually increasing, as tolerated, to every night. You should limit your exposure to sunlight, as tretinoin will increase your sensitivity to the sun (in other words, you will become more likely to burn).
Adapalene works by slowing the accumulation of skin cells, which helps to prevent the plugging of the pores. It is sometimes prescribed instead of tretinoin because many patients find it to be less irritating.
Your dermatologist may prescribe a topical antibiotic, such as clindamycin, to augment the antibacterial properties of benzoyl peroxide. Clindamycin is rarely prescribed in isolation, and prepared combinations of clindamycin and benzoyl peroxide are usually prescribed.
Believe it or not, your acne may worsen after you start topical treatment. This occurs because some agents initially irritate the skin, while others uncover lesions that were previously hidden. Do not be discouraged! Patience is key in the treatment of acne, and you will need to wait a few weeks before your complexion begins to clear.
Systemic agents
Sometimes, acne cannot be controlled via topical measures alone. If you continue to have acne despite an optimized topical regimen, if your acne is extensive on your chest and back, if you have experienced scarring from acne, or if your acne is predominantly of a nodular or cystic nature, your dermatologist may try systemic agents. These agents are only available by prescription, and have more side effects than topical agents.
Antibiotics work by fighting bacteria, and are used for inflammatory acne. Different antibiotics are administered in different ways and have unique side effects. Your dermatologist will counsel you appropriately when a new antibiotic is initiated.
Isotretinoin is a potent treatment which exists for severe acne. Although its mechanism of action is unknown, it has been shown to decrease the amount of oil produced by sebaceous glands, decrease skin renewal, and lower the amount of bacteria within follicles. Common side effects include extensive dryness, manifesting most commonly as chapped lips and accompanied by dry nose and dry skin. Your dermatologist will need to draw your blood at regular intervals to monitor systemic changes, such as increased liver enzymes and increased plasma lipids. Most importantly, isotretinoin is a powerful teratogenic, which means that it can cause severe birth defects. Women of child-bearing age must not become pregnant while taking isotretinoin. For this reason, the federal government has implemented a stringent initiation and prescription system (iPledge) to regulate the proper use of isotretinoin.
Although most people find that their acne eventually goes away, if and when this will occur is impossible to predict. Some people will continue to experience acne outbreaks as adults while others will not experience any outbreaks past adolescence. Finally, it is important to keep in mind that acne can and will flare even under optimal treatment. Long-term acne treatment involves patience and persistence!
REFERENCES:
Marks JG, Miller JJ. Pustules. In: Lookingbill & Marks’ Principles of Dermatology. 4th ed. Elsevier Inc; 2006:171-176.
Wolff K, Johnson RA, “Section 1. Disorders of Sebaceous and Apocrine Glands” (Chapter). Wolff K, Johnson RA: Fitzpatrick’s Color Atlas & Synopsis of Clinical Dermatology, 6e: http://www.accessmedicine.com/content.aspx?aID=5185601.