The treatment of acne depends on the type and severity of lesions and on the patient’s response to treatment. I wish it were an easy recipe to whip up and everyone with a specific type of acne outbreak would be treated along one specific course of treatment. Below are listed the various methods of treating acne.

Topical therapy

Comedonal acne is treated very well by removing the unhealthy surface of the skin and unplugging follicles. These treatments allow antibacterial agents and agents used to reduce inflammation to better penetrate the skin. This can also be accomplished with a series of microdermabrasion treatments and light chemical peels or with a topical retinoid. These treatments often irritate the skin when first applied, causing what appears to be a worsening of the condition. Significant improvement is noticed within 6 weeks, as the skin progresses through it’s natural cycle, and can continue to improve for three to four months beyond that. Beyond that, topical application of medication can be reduced, depending upon the patient’s response. Azaleic acid, clindamycin, erythromycin, and sulfur agents all have antibacterial or antiinflammatory activity. Azaleic acid can also help the hyperpigmentation that some times occurs in acne.

I have chosen tazarotene as a topical retinoid for many purposes, but with it’s use in acne, it can be applied with a short contact method, where it is applied for up to five minutes and then washed off.

Antibiotics and retinoids are less effective in the treatment of acne, once inflammation turns to the development of cysts and nodules. Beta hydroxy acids, such as salicylic acid and lactic acid, can be used to begin decreasing outbreaks. Resorcinol lotions are also helpful. Vitamin B cream can reduce the inflammatory response in acne breakouts. A more aggressive treatment process may include light therapy. A combination of blue and red light is used at Timeless Skin Solutions (Clear XL 100).

Oral agents

Oral antibiotics and isotrenitoin can be added if the above treatments are not found to be effective. The seriousness of side effects make using these agents a much more complicated decision. Androgens increase in the prepuberty period, causing enlargement of sebaceous glands which produce increased amounts of sebum, which can become blocked and cause the formation of acne. Cleansing facials can begin the process of unblocking the pores. For females, the use of contraceptives (Yasmin being a common recommendation) have been found to decrease acne breakouts. Contraceptives with just the hormone progesterone can exacerbate acne. Sprinonolactone can be used if there is androgen excess. The use of contraceptives with oral antibiotics caution is advisable as concerns have been raised about the decreased effectiveness of contraceptive activity. Oral Vitex has shown promise in reducing the outbreaks of acne in both men and women.

Phototherapy

Light therapy can reduce the amount of bacterial activity and inflammatory activity in the skin. Porphyrins are natural products of p acnes, the bacteria most commonly found in acne lesions. Exposure of the bacteria to blue light (405-420nm) causes the peroxidation and subsequent killing of bacteria. A minority of patients do not respond to this therapy. A low-fluenced pulsed-dye laser appears to be an effective treatment for inflammatory acne and can result in reduction of inflammation for up to twelve weeks after a single treatment. Adding near infra red light, promotes circulation and oxygenation of the tissue to accelerate healing. Light therapy can be boosted with a topical medication called Levulan ™, althought there is a greater likelihood of significant acne flaring, the clearing of inflammatory acne is overall accomplished more quickly. Acne scarring is treated with the 1064 laser.

Follicular forehead papule treatment

Occassionally acne is seen in isolation on the forehead and/or shoulders. This can be do to an overgrowth of Pityrosporum and responds to topical antifungal treatment such as selenium sulfide. But, a fully penetrating oral antifungal such as oral ketaconazole can be used with greater success.