Acne is vexing whatever form it is in. Acne scars are even more troublesome and distressful. Acne treatment must consist of safe management, lessening of the psychological burden via social and emotional help, and clearing mistaken beliefs regarding the disease. Acne treatment should begin earlier in order to reduce the possibility of scarring or unfavorable psychosomatic outcomes / psychological morbidity. It must target to decrease non-inflammatory acne that may lead to the inflammatory acne, diminishing the population of Propionibacterium Acnes and prevent acne scars. In addition, management should be according to the individual, the form and severity of acne and the person’s capacity to utilize medicine, and his/her psychological status.
Topical/ Local Treatment To Treat Mild Acne
The use of topical retinoids is preferred in the management of acne. They help to prevent the new pimple formation as well as decrease the number of pimples. Retinoids are especially useful for non-inflammatory acne. In fact, they also have anti-inflammatory properties and thus can be used for the management of inflammatory lesions. They can be use as a single therapy or can be combined with the antibiotics. Retinoids also show good results when they are used as maintenance following treatment. In general, tretinoin and adapalene are best recommended topical retinoids. They work to correct skin cells and therefore indirectly help in improving the barrier function of these cells against pathogenic bacteria, UV radiation, heat, etc.
Topical antibiotics are also applied to treat acne. They are primarily used for inflammatory acne of mild to moderate type. The most commonly prescribed topical antibiotics are erythromycin and clindamycin. In addition, Benzoyl peroxide also works against acne and is effective for mild acne treatment. It also does not develop resistance against acne causing bacteria. For that reason its use is preferred in combination with oral and local antibiotics in order to reduce the risk of bacterial resistance. Additionally, these topical retinoids enhance the penetration of other local medications and also reduce the acne marks following the resolution of acne lesions. It is important to avoid heat and sun exposure while using retinoids because they can increase the sensitivity to sunlight.
In order to treat comedonic acne salicylic acid is used since it has anticomedonal properties. However, it is not as potent as topical retinoids but is still effective.
All these topical agents are available in different strengths and formulations. For oily skin drying preparations like gels, solutions and washes are preferred whereas for dry skin lotions, ointments, and creams are best suited.
Oral Therapies For Treatment Of Moderate Acne
Acne of moderate severity including some forms of acne vulgaris requires the use of oral antibiotics in addition to the topical one. The oral antibiotics having most effective results are erythromycin and tetracycline (such as minocycline and doxycycline). Mostly erythromycin is preferred where tetracycline is contraindicatory, for instance, in pregnancy, children younger than 8 to 12 years of age and during breast feeding. Tetracycline is considered first line and is also inexpensive. It is also chosen over erythromycin owing to the greater resistance reported with the erythromycin use. Trimethoprim/sulfamethoxazole is used as a third line agent when erythromycin or tetracycline is resistant or contraindicated.
Acne vulgaris is treated for up to three months depending upon the severity. If no or little response occurs, then alternative oral antibiotic is advised or topical retinoids are recommended for maintenance therapy. After resolution of acne antibiotic dose is reduced and topical therapy is advised for a longer duration. Topical retinoids are enough to stop recurrence of acne in the majority of people especially if the acne is mild or moderate in severity. However, there is a severe form of acne which is not easily treated by oral antibiotics. How to get rid of such acne one needs to know about the vitamin A analogue, i.e. isotretinoin (accutane).
Treatment of Severe Acne
Persistent acne or severe acne that has shown poor response to combined topical and oral therapy necessitates treatment with isotretinoin (accutane). Isotretinoin is given orally and is FDA-approved for the management of severe intractable acne. It is a constituent of the retinoid class and is associated with vitamin A. Accutane can singly manage all the four major factors behind acne and also lead to everlasting remission. Dryness is a common accutane side effects but it is settled with treatment withdrawal or decreasing the dose. This medicine is prescribed by dermatologists only and people should be informed about a pregnancy prevention program before its use. A pregnancy test before treatment is compulsory since this medicine has harmful effects on the fetus. Other common accutane side effects are headaches, muscle pains, gastrointestinal upset, and dryness of eyes and of mucous membranes of nose and mouth. Laboratory monitoring of liver enzymes, fasting lipid profile, and a complete blood count is essential during therapy.
Hormonal therapy is also effective in severe form of acne such as cystic acne or nodular acne. Spironolactone, oral contraceptives, and a combination of ethinyl oestradiol and cyproterone acetate are all recommended hormonal therapies for the treatment of acne. Spironolactone decreases production of sebum and improves acne and is mainly reserved for females who cannot use isotretinoin. Oral contraceptives reduce the production of ovarian androgens and treats acne, particularly the nodular one. Estrogen containing oral contraceptives are generally considered for treatment of acne in females with perimenstrual flare-ups or adult-onset acne. Pregnancy should be avoided while using these hormonal therapies, especially with cyproterone owing to its potentially harmful effects on the fetus.
Light & Laser Treatment
In addition to treatment with medicines, acne at present can be treated by laser and light therapies. These include photodynamic therapy, pulsed-dye laser and visible light therapies. However, these are for short term acne prevention.
Miscellaneous Therapies for Acne Treatment
- Chemical peels (retinoic acid & glycolic acid)
- Intralesional steroids (triamcinolone injections)
- Biofeedback-assisted relaxation
- Removal of comedones
- Surgical techniques (subcision and punch excision)
Treatment Of Acne Scars
Acne can sometimes lead to scarring of the skin and dark sports which are stubborn and not easy to vanish. Pimple popping can also cause scarring. These dark spots or acne scars are a consequence of inflammation that enhances increased production of pigment. They can last for many months and are mostly more annoying than the acne itself. These are best treated with above mentioned procedures.
- For atrophic scarring dermal collagen injection and laser resurfacing are preferred techniques.
- For hypertrophic scarring cryotherapy, microdermabrasion, use of silicone gels, intralesional steroid injection, chemical peels, excision, and topical corticosteroid creams are recommended.
How To Get Rid Of Acne With Natural Ingredients
There are various proven natural alternatives that help to get rid of acne and acne scars. For example;
Essential oils Use: A large number of essential oils are available with anti-inflammatory and antibacterial properties that can assist in clearing up acne quickly. Oils of lavender, rose, clove and cinnamon have properties to fight against acne bacteria. Likewise, lemongrass and rosemary have also shown to be effective in preventing acne. Gels comprising sweet basil, acetic acid, and orange essential oils help in healing of pimples.
- Green Tea: It can also be applied to the skin besides drinking it. It consists of tannins and flavonoids, and both offer protecting effects from acne causing bacteria and inflammation. Green tea is rich in such an antioxidant which has demonstrated to reduce sebum formation, fight inflammation, and prevent the growth of Propionibacterium acnes in individuals with acne-prone or oily skin.
- Aloe vera gel: when applied to the skin promotes healing of lesions, decreases inflammation and fights bacteria.
- Application of Papaya: Papaya comprises an enzyme which is known to reduce the inflammation. It also facilitates controlling of pus formation in acne.
- Baking Soda: It is a renowned home remedy for clearing up the pimples. Baking Soda offers antiseptic properties, works against bacteria and fungus and even removes excess oil. It also causes new skin cells growth and makes skin softer. It is quite beneficial for oily skin.
- Cinnamon and honey mask: Owing to anti-inflammatory, antioxidant, and antibacterial properties, this mask may prove helpful in preventing acne when applied to it. Honey is also helpful in oily skin as it sucks moisture from the skin devoid of restoring it.
- Blackheads Removal Techniques: Blackheads can be removed naturally at home. For example application of vinegar and cornstarch on the blackhead affected area can help remove them. Likewise, lemon, rose water, honey and baking soda when applied work as blackhead removal agents.
Dietary modification is also required such as avoiding foods with a high glycemic index, while consuming more foods containing omega-3 fatty acids and using fewer dairy products. The use of zinc, probiotics, and seaweed can also helps in removing acne.
A number of studies have shown that acne flares with stress. In order to reduce stress, one should seek help from the healthcare provider, perform relaxation techniques and bring change in lifestyle.
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