The conventional, allopathic treatment of acne vulgaris happens through drugs that are used locally and orally. Given the increasing resistance of acne producing bacteria, it is recommended to minimize prolonged use of antibiotics topically or orally in the treatment of acne. In the presence of many comedones, topical application of a retinoid is usually the first choice. In the presence of numerous papules and pustules, benzoyl peroxide is effective in mild to moderate dosage and does not cause resistance. In more severe forms, oral antibiotics may be indicated. To minimize resistance problems, it is recommended not to prescribe antibiotics alone - rather a combination with benzoyl peroxide or a retinoid is better. Oral contraceptives are a treatment option if the woman wants contraception.
In severe acne, systemic treatment with isotretinoin should often be considered with all the precautions that includes among others, contraception.dermatological condition most frequently encountered in adolescents and young adults. It is an inflammatory dermatosis that is partly explained by the proliferation of acne causing bacteria, a multiplication and abnormal differentiation of keratinocytes (with formation of comedones) and an increase of seborrhea (oil secretion) under the influence of androgens.
For many years, antibiotics have occupied a central place in the management of acne, but the significant increase in the resistance of acne causing bacteria in recent years needs reviewing of the recommendations in acne treatment. This article discusses the role of different drugs in the treatment of this condition and proposes some guidelines based on clinical presentation and severity of acne.
Topical retinoids are tretinoin, adapalene and tazarotene. These derivatives of vitamin A prevent the formation of comedones by normalizing desquamation of follicular epithelium. They are used in forms of acne with a predominance of comedones, as well as to enhance the effectiveness of antibiotic treatment or to consolidate the results obtained after systemic therapy. The main side effects of topical retinoids are pruritus, erythema, rashes, skin bleaching and phototoxicity - a worsening of acne can be observed during the first few weeks of treatment. Retinoids are contra-indicated in women who are pregnant or planning a pregnancy. [Editor's note: The speciality based tazarotene (0.05% and 0.1%) available in Belgium (Zorac®) is registered for the treatment of mild to moderate psoriasis, but not acne].
The main antibiotics used orally in acne are tetracycline (300-600 mg), doxycycline and minocycline (100-200 mg). Macrolides are no longer first choice. Antibiotics exert both an antibacterial effect against acne causing bacteria as well as have an anti-inflammatory effect. Minocycline and doxycycline have similar efficacy in this indication and appear more effective than tetracycline. With minocycline, it should take into account the risk of side effects such as liver damage, possibly severe lupus with arthralgia and reactions during prolonged treatment, as well as its high cost. Doxycycline is associated with a greater risk of phototoxicity. Tetracyclines are contra-indicated during pregnancy. The efficacy of antibiotic therapy should be evaluated after 3 months and in case of an improvement, antibiotics may be extended up to 6 months in general, but always in combination with local treatment with benzoyl peroxide or retinoids. In the absence of results after 3 months, the antibiotic should be discontinued and an alternative treatment (eg isotretinoin) should be considered. As mentioned above, it is recommended to administer concomitant antibiotics topically and orally.
For women in whom contraception is desired or indicated for another reason (eg. Irregular cycles), the prescription of oral contraceptives alone or in combination with other acne treatments may be useful . Although it does not seem to be of much difference in efficacy between oral contraceptives, preference is often given to contraceptives containing a progestin with the least androgenic properties (eg. Desogestrel, gestodene or norgestimate ). In case of insufficient efficacy, an oral contraceptive containing 2 mg cyproterone acetate and 0.035 mg ethinyl estradiol is opted for. Hormonal treatment should be continued for at least 2-4 months.
In severe cases, cyproterone acetate at 10 mg per day for the first 15 days of the cycle, may be offered for women in combination with an oral contraceptive. [Editor's note: In Belgium, cyproterone acetate is the only anti-androgen used.]
Isotretinoin is a derivative of vitamin A, which inhibits the secretion of sebum (the body oils) and prevents the formation of comedones by normalizing desquamation of follicular epithelium. Isotretinoin is indicated in severe nodulocystic acne and other forms of acne rebellious to conventional treatment. The recommended dose is 0.5 mg / kg / day, which may possibly be increased after one month up to 1 mg / kg / day. The optimal treatment regimen consists of a cumulative dose of 120-150 mg / kg and for a cure, a treatment period of several months is usually necessary. [Editor's note: Due to variations in individual efficacy and side effects, the treatment is usually started with lower daily doses (0.3 to 0.5 mg / kg), and then the dose is individually adjusted.] In case of a relapse after discontinuation of treatment, it is recommended to wait two months before starting a new treatment. Side effects of isotretinoin are numerous: dry lips, skin and eyes, alopecia, decreased night vision, headache, neck pain, musculoskeletal pain, hyper-calcemia, central nervous system disorders and psychiatric disorders. Rare cases of benign intracranial hypertension have been reported, some with the concomitant use of tetracyclines. Isotretinoin can also cause elevated liver enzymes and triglycerides - blood tests are therefore recommended before initiation of treatment, after one month, then every 2 to 3 months and the concomitant use of vitamin A is to be avoided. Isotretinoin is teratogenic and effective contraception is required throughout the duration of treatment and for one month after stopping it. Caution is also advised during blood donations.
Mild to moderate acne, especially with comedones
Adapalene or tretinoin, at the rate of one application per day is the treatment of choice. Effect occurs within 12 weeks. Adapalene 0.1% causes less skin irritation than tretinoin 0.05% and its cost is also lower. Azelaic acid (2 applications per day) is less effective but may be offered in case of contra-indication of retinoids. Oral contraceptives may be offered if the woman wants contraception.
Mild to moderate papular and pustular acne
This form of acne is usually treated locally by benzoyl peroxide (1 to 2 applications per day), an antibiotic (2 applications per day) or retinoid (1 application per day). Benzoyl peroxide is the first choice here as it is effective, costs less and there is only a low risk of resistance development. As mentioned above, it is inadvisable to prescribe a topical antibiotic alone and it should be prescribed preferably in combination with benzoyl peroxide or a topical retinoid. Antibacterial treatment is usually continued for at least two to three months - in the absence of effects after this period, it is necessary to review the treatment. For women who want contraception, oral contraceptives may be useful.
Moderate to severe papular and pustular acne
Treatment is usually based on the administration of oral antibiotics (eg. Doxycycline or minocycline 100-200 mg per day), in combination with topical benzoyl peroxide or a retinoid. The administration of antibiotics alone is not recommended. Treatment is often required for several months, but in case of lack of results after 3 months, the treatment should be reviewed. In case of failure, isotretinoin may be considered. For women who want contraception, the administration of oral contraceptive cyproterone acetate may be considered.
Severe nodulocystic acne
The severe nodulocystic acne and other severe forms of acne like acne fulminans, pyoderma, facial acne conglobata and acne recalcitrant to treatment require systemic treatment (oral antibiotics, isotretinoin, hormonal treatment) .
Should we stop treating acne during the summer?
This question has been asked by several experts in dermatology and their responses can be summarized as follows. Almost all acne medications are photosensitizing (either phototoxic or photoallergic) and should be used with caution in sunny periods. The decision to treat or not treat acne during the summer depends on several factors: initiation or continuation of treatment, amount of sunshine, severity of acne and so on.
As regards local treatment, it may be preferable to enforce it only in the evening and possibly use a preparation or product under less irritating doses (eg. Adapalene instead of tretinoin).
With regard to oral treatments, it is recommended not to initiate treatment phototoxicity (eg. Tetracycline or isotretinoin) when sun exposure is anticipated, for example, before going on vacation. When treatment is already underway, it may possibly be pursued by reducing the dose, as phototoxicity is dose-dependent. In all cases, it is recommended to use a sun protection during the day and avoid prolonged exposure to sunlight.
us take the big question head-on. Does homeopathic treatment give
permanent relief from those recurrent pimples? The answer is a big yes,
but the treatment is quite different from the conventional ones.
Homeopaths realise the truth in skin disorders. All forms of pimples
(acne) are due to an internal disorder - thus the usage of external
application does not yield permanent results. Internal
homeopathic medication is often the best natural option to stop the
recurrence of acne and that too without side-effects. Medically
speaking too, acne results out of an internal disorder. It is a
disorder resulting from the action of hormones on the skin's oil glands
(sebaceous glands), which leads to plugged pores and the outbreak of
lesions commonly called pimples or acne. They usually occur on the
face, neck, back, chest, and shoulders. An important causative factor
is an increase in hormones called androgens (male sex hormones). These
increase in both boys and girls during puberty and cause the sebaceous
glands to enlarge and make more sebum (oil). Hormonal changes related
to pregnancy or starting or stopping birth control pills can also cause
acne - another factor is heredity or genetics. Researchers believe that
the tendency to develop acne can be inherited from parents. For
example, studies have shown that many school-age boys with acne have a
family history of the disorder. Certain drugs, including androgens and
lithium, are known to cause acne. Greasy cosmetics may alter the cells
of the follicles and make them stick together, producing a plug. The
following factors also influence the growth of acne: Changing hormone
levels in adolescent girls and adult women two to seven days before
their menstrual period starts; friction caused by leaning on or rubbing
the skin pressure from backpacks, or tight collars; environmental
irritants such as pollution and high humidity; squeezing or picking at
blemishes, hard scrubbing of the skin, etc.
Medicines for acne- Belladonna: It is very useful in an acute flare-up where pus formation hasn't started and acne is red and fiery looking. 30c potency of Belladonna taken internally 3-4 times a day can be used to treat this acute stage. Pulsatilla: It is often the most indicated medicine in the treatment of acne in girls. Acne associated with menstrual abnormalities are often best treated with Pulsatilla. It is strongly indicated in a mild, yielding and sensitive personality with a weeping disposition. Sulphur: No other medicine is more effective than Sulphur, which covers nearly all kinds of acne. Dirty unhealthy skin and abuse of cosmetics are leading indication for its use. It is very useful in stopping the recurrence of pimples. Sulphur is a very deep acting medicine and should be used only in consultation with an experienced homoeopath. Hepar sulph: Hepar sulph. is very appropriate for treating acne that has an easy tendency to develop into pustules (filled with pus), as well as where acne is very painful to touch. Silicea (also called Silica): It is often indicated in cases of long-standing acne along with general low resistance and is often used for its scar-dissolving properties. Developing a natural resistance towards acne: Once the acute flare-ups have been attended to, one would like a natural resistance towards acne. A thorough constitutional treatment by an experienced homoeopath would do the needful.
Typically, acne or pimples appear on the face, neck, chest, back, shoulders and the areas of the skin with the largest number of functional oil glands. Frequently, people with acne or pimples have a variety of lesions. The comedo (plural: comedones) - the basic acne lesion, is simply a plugged, enlarged sebaceous (oil producing) follicle. Acne or pimples can take the following forms :
There can be prominent unsightly scars after resolution of acne or pimple lesions - these can also be set right with the proper homeopathic treatment.
The following are the commonly recognized types of acne :
Nobody is completely sure what causes acne. Experts believe the primary cause is a rise in androgen levels - androgen is a type of hormone. Androgen levels rise when a human becomes an adolescent. Rising androgen levels make the oil glands under your skin grow; the enlarged gland produces more oil. Excessive sebum can break down cellular walls in your pores, causing bacteria to grow.
Some studies indicate that susceptibility to acne could also be genetic. Some medications which contain androgen and lithium may cause acne. Greasy cosmetics may cause acne in some susceptible people. Hormone changes during pregnancy may cause acne to either develop for the first time or to recur.