Lifestyle Choices

Most people will need advice from their doctor to help in the treatment of moderate or severe acne. Generally doctors will start with cheap, safe agents which have few side effects and only if these fail will they recommend medication to be taken by mouth.

Topical preparations (onto the skin)

Benzoyl peroxide

This has been around for more than thirty years but we do not yet know fully how it works. It loosens blackheads and kills bacteria but has other effects as well. It comes in strengths from two-and-a-half to twenty per cent and may be bought as a cream, gel or a wash. Examples are given in the previous section.

It is quite irritating to the skin for the first few days and may cause redness, dryness and scaling, but this varies between individuals. However, many people think that the redness it produces means that they are allergic to the preparation and so stop using it. Genuine allergy is very rare. If you persevere with treatment or perhaps stop for a few days and then start again, your skin will tolerate the benzoyl peroxide. It is best to start with a low strength and build up gradually. The full benefit of treatment is seen after several weeks and it can be continued for months or years.

Retinoic acid

Creams and gels containing this chemical are available and they help to loosen blackheads. They are not so good for inflamed acne spots. The chemical is marketed as Retin-A.

Topical antibiotics

Several antibiotics can now be applied to the skin directly e.g. erythromycin (Stiemycin), tetracycline (Topicycline) and clindamycin (Dalacin T). They penetrate the skin very well and kill bacteria in the follicles. Their main effect is in mild acne and some people find that after controlling more severe acne with other treatments they can keep it under control with a topical antibiotic. The lack of both staining and greasiness makes them popular lotions to use.

Oral therapy (taken by mouth)

Antibiotics

These are the mainstay of treatment for moderate or severe acne. Occasionally they may be required for people with minor acne who cannot tolerate topical preparations. Antibiotics kill bacteria but may have other effects as well. Only in the last few years have we reached a consensus on how much and for how long they should be taken. In the past they were often given in short courses or in low dosage. Studies have now shown clearly that high doses should be given and for four to six months.

Tetracyclines are used most often and have very few side effects. They must be taken with water or an empty stomach, usually about half an hour before a meal. Minocycline is a special form which may kill bacteria more quickly.Erythromycin is another antibiotic acting in a similar way. Occasionally it causes an upset stomach.

Hormones

We know that androgens are important as A cause of acne and it is logical to try to counteract their effects. Two hormones, namely ethinyl oestradiol and cyproterone acetate are contained in a pill called Dianette. They both reduce the effect of androgens in different ways and provide a treatment for acne as effective as tetracycline. The treatment can only be given to females and has the added benefit of being an excellent contraceptive.

Retinoids

One member of this group of drugs is called isotretinoin and has been available for a few years to treat acne. It is a powerful agent which not only dries up the sebaceous glands, but helps to prevent the formation of blackheads. It is reserved for the treatment of patients who have failed to respond to antibiotics. The length of a course is usually four months.

It is an expensive drug and has several side effects including marked dryness of the lips and skin around the eyes and nose. It can also cause serious abnormalities in the developing fetus, so it is absolutely crucial that females have a negative pregnancy test before treatment and use proper contraception if they are sexually active. Only isotretinoin gives an improvement which is maintained for up to eighteen months after finishing the course.

Treating acne scars

If lumpy scars develop (hypertrophic scars) they can sometimes be improved by the injection of a steroid preparation into the scar itself. Depressed scars are also difficult to treat but it is remarkable how much they improve with time. After the acne has settled the scars improve for up to five years. Very deep pit-like scars can sometimes be cut out: other treatments such as the injection of bovine collagen and dermabrasion are little used in the United Kingdom. Dermabrasion probably gives no better a result than natural healing but it speeds the process up.

Acne is very common and we now have good treatment for almost everyone, no matter how bad their problem. The treatment is always fairly lengthy and it is better if the individual follows instructions properly. Much can be done with simple remedies from the chemist but if this fails the doctor will have plenty of alternatives to help you. The psychological side of acne should not be forgotten because it can cause much distress but parents, doctors and your friends, will give you support and this, along with the treatment, will help you through your `acne years‘.

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