Acne Treatments

Acne can be of several types. It can range from mild forms such as blackheads and whiteheads or may be severe in the form of pustules or cysts.

Papules for example are inflamed lesions that are small, pink raised spots over the skin that are painful.

Pustules or pimples are white or yellow pus-filled lesions where as nodules are large, painful, solid bumps that lie within the skin.

Cysts on the other hand are deep, painful, pus-filled lesions that may leave a deep pit like scar after healing.

Treatment depends on the type of acne but preventive measures are similar for all types of acne.

For those with a few blackheads, whiteheads and spots

• Over-the-counter creams, ointments or gels containing benzoyl peroxide may be sufficient. Benzoyl peroxide helps prevent formation of the plugs that block the hair follicles and also kills the bacteria on the skin that can cause affected follicles to become infected. It is applied as a cream or gel once or twice a day. It can result in dry, itching and stinging sensation along with redness.

• In addition the affected areas of skin should not be washed more than twice a day. Very frequent washing can irritate the skin and worsen symptoms. The areas should be washed with mild soap or cleanser and lukewarm water.

• Blackheads and whiteheads should not be squeezed or pressed. This can lead to worsening and permanent scarring.

• Too much make-up and cosmetics should be avoided. Water based products are usually the best option. In addition makeup should be completely removed at bed time.

• For those with dry skin a water-based emollient may be used.

• Hair should be washed regularly and falling of hair over the face should be avoided.

A tube of Basiron (also sold as Benzac) from Galderma Laboratories, used for the treatment of acne. Its active ingredient is benzoyl peroxide.

For those with more severe and frequently recurring acne

• Treatment for acne may take time and dramatic improvement should not be expected especially in severe cases. Severe cases may include lesions over the face, chest, neck and back. These may be extensive, severely inflamed and are likely to leave permanent scars if not treated promptly and effectively.

• The preventive measures for blackheads and whiteheads and other milder cases of acne are applicable for severe cases as well.

• Medications may be useful in some individuals with severe acne. Some of the medications prescribed include:-

  • Topical or cream/ointment form of antibiotics/Oral antibiotics – A combination of oral antibiotics with topical antibiotics may be used in some patients with effective results. Antibiotics fight the bacteria that cause infections leading to acne. A six- to eight-week course is usually recommended. Topical antibiotics may cause mild irritation and burning sensation. Common topical antibiotics include Minocycline and oral antibiotics used include Tetracyclines like Doxycycline.

  • Topical or cream/ointment form of retinoids – These are one of the most effective agents to treat acne. They act by reducing the production of sebum and prevent plugging up of hair follicles. Tretinoin and adapalene are topical retinoids used to treat acne. They are available in a gel or cream and are applied at bed time. Topical retinoids are absolutely not to be used in pregnant women as they can cause severe damage to the unborn baby. Retinoids when applied over the affected area may cause mild irritation and stinging. Usually a six-week course is prescribed. After this the medication may be continued on prescription at lower frequency.

Isotretinoin is a form of retinoid. It helps to reduce the production of sebum and prevents plugging of the hair follicles. Isotretinoin also reduces inflammation and the presence of bacteria around the comedone. Isotretinoin is taken as a tablet and usually a 4 to 6 month course is necessary for treatment. Isotretinoin can also damage the unborn baby and one or two simultaneous methods of contraception is prescribed for one month before treatment begins, during treatment and for one month after treatment with Isotretinoin to reduce the risk of getting pregnant while on Isotretinoin therapy. Isotretinoin is also not suitable for breastfeeding mothers.

• Azelaic acid - This is used as an alternative to benzoyl peroxide or topical retinoids. This agent works by removing dead skin as well as the bacteria causing acne. It is available as a cream or gel and is prescribed twice a day.

• Hormonal therapy is useful in women with conditions like Polycystic ovary syndrome.