Acne Treatments

 

What causes acne?

There are a number of contributors to the formation of acne. Excess oil and sebum production exacerbated by hormonal influences on sebaceous glands, as well as dead skin physically blocking pores can cause acne. A bacterium named Propionobacterium acnes has also been implicated as a cause of acne. All treatments for acne will address one or more of these issues.There have been no studies showing that acne is caused or exacerbated by your diet, contrary to the usual belief that certain foods can worsen acne.

 

What treatments are available?

Acne can be treated in a number of ways. The first step in treating acne is usually appropriate skin care.

 

Skin care

A good cleanser is the first step in the treatment of acne. A cleanser containing alpha-hydroxy acids or beta-hydroxy acids, such as those found in ASAP and Cosmedix skin care products, can help remove the oil and dead skin cells from the surface of the skin to prevent the physical blockage of pores and acne. Exfoliants with these ingredients can also be used. Beta-hydroxy acids (including salicylic acid) have the advantage of having anti-inflammatory properties and are more oil soluble making them penetrate oily skin better than alpha-hydroxy acids. For those with sensitive skin types, a gentle cleanser can be used and then active products like alpha-hydroxy acids or retinoids can be placed on the skin after as tolerated. Good gentle cleansers include the Benefit cleanser/Gentle clean Rx from Cosmedix or the Preparatory cleanser from Rationale.

Benzyl peroxide is a good product for reducing active acne lesions and also has anti-inflammatory properties. It is found in well-known products such as ëPro-activí but is also available more inexpensively over-the-counter at your local pharmacist. It is available in concentrations up to 10%. The higher the concentration, the more flaking and irritation to the skin. Therefore, commencement should be with the lower concentrations.

Topical retinoids, derivatives of Vitamin A, are also used in the treatment of acne. Retinoids work by increasing the natural turnover rate of the skin. Therefore there are less dead skin cells at the surface of the skin and less blockages as a result. This property of retinoids also means that skin texture and fine wrinkles also improve. The downside of retinoids is the initial response of the skin, or the ëretinoic dermatitisí. Skin can usually appear red, flaky, lumpy, and irritated for up to one month after commencement of retinoids. Starting slowly is important to reduce these side effects. Sunscreen is also imperative with the use of retinoids as they can initially exacerbate sun sensitivity. Retinoids should not be used in pregnant mothers, those planning to be pregnant, or those who are breast-feeding.


Hormonal treatments

Particular hormones, in particular androgens, have also been known to increase oil and sebum production and exacerbate acne.

For females, options for controlling the hormones that cause acne include particular variants of the oral contraceptive pill. The variants that are of particular use are the ones containing Cyproterone acetate or Spironolactone. The trade names of the pill containing these ingredients include; Dianne-35 and Yasmin. Cyproterone acetate and Spironolactone work by helping to switch off the androgenic hormones, or the hormones that increase oil/sebum production and cause acne. Cyproterone acetate (Androcur) and Spironolactone (Aldactone) can also be used without the pill in those females who do not want to be on the pill. It is, however, not compatible with pregnancy, so it is not suitable for those females who are attempting to fall pregnant or who are pregnant.
 


Oral Isotretinoin/Roaccutane

Roaccutane, or oral isotretinoin, also a derivative of Vitamin A, is the gold standard in the treatment of acne. Prescribed only by dermatologists, it is mostly used for severe forms of acne only, as it has a number of significant side effects. Generally, a six-month course is prescribed, and involves taking a tablet or two each day. The side effects from Roaccutane are the main problem with treatment and include; dry skin, dry eyes, dry lips, cracked lips, hair loss, mood changes, and liver function abnormalities. Pregnancy must be completely excluded during treatment with Roaccutane, as it is known to cause serious birth defects. 


Photodynamic therapy

Recently, there have been advances in the treatment of acne that do not involve drugs with significant side effects, and can be highly effective. Photodynamic therapy is such a treatment that targets sebaceous gland activity. Being a localised treatment, it only has localised side effects, ie on the treated skin. There has been some studies showing that it may be as effective as Roaccutane in some cases. Photodynamic therapy works by placing a substance called 5-aminolevulenic acid on the skin, which is attracted specifically to the sebaceous glands, and then activating the substance with a light source or laser. This specifically disrupts the function of the sebaceous glands and reduces their activity and the acne they cause. The results can last up to a year and some people require no further treatments for acne after their initial treatments.


Sunscreens

Sunscreens are important to help reduce pigmentation after an acne lesion has passed. However, some sunscreens themselves can cause acne by blocking pores. At The Victorian Cosmetic Institute, we recommend Reflect sunscreen from Cosmedix. Reflect is a spray on, non-oily sunscreen with Titanium Dioxide.