November 2002

Advice on Acne

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These lectures are not meant to replace your physician and are simply provided as a free educational service to all our visitors. If you feel that you have a skin problem, please see your doctor. 

Acne is a condition, not a disease. Because it is a condition, we can control it through treatment, but it will not be "cured". The treatment used for acne, in most cases, will need to be continued for a long period of time, even years. It requires being patient and faithful in treatment. The "cure" of acne occurs spontaneously and according to a timetable which is different for each person. One cannot gaze into a crystal ball and predict when this will occur for a particular patient. If your acne is doing well under treatment, and stopping or slacking off of skin care is followed by a return of the condition, it means that your body still has not corrected its tendency to have acne, and treatment must continue. 

Recommended Skin and Scalp Cleansing for Acne Patients
Wash with warm water, soap and your fingertips. Do not use a brush, wash cloth or sponge. Rinse with warm water and pat dry. This entire procedure should take less than one minute. It used to be felt that the more vigorous the washing and scrubbing the better. However, now most dermatologists feel that washing should be a gentle, non-irritating process. It is important the irritant nature of the soaps does not preclude the acne patient from using the topical medication. Thus, it is a good idea to use a non-irritating acne wash that is gentle to the skin while initiating topical treatment for acne. 

A good example of this is PanOxyl Bar 5 and PanOxyl Bar 10. These are 5% and 10% benzoyl peroxide therapeutic acne treatment in a rich lathering, mild surfactant cleansing base. Since there are many different forms of acne, it is important for your dermatologist to tailor your treatment to the type of acne that you have. Some of the various forms of acne include: comedonal acne, pustular acne, and nodulocystic acne. Each type is manifested by a slightly different appearance. It is not unusual for a patient to have more than one type of acne. Comedonal acne is characterized by the presence of whiteheads and blackheads. There are certain topical medications that are geared towards the treatment of these lesions specifically. For instance, topical tretinoin (Retin-A) has long been considered the standard of treatment for comedones or whiteheads and blackheads. 

Recently, however, some newer topical medicines have been developed to attack these lesions. Pustular acne appears just how it sounds. The presence of small pustules or tiny red pimples characterizes this form of acne. A recommended treatment is Rezamid Acne Lotion. The classic approach to this form of acne depends on the severity. If it is mild, often over the counter benzoyl peroxide lotions or washes may be effective. However, in cases where pustular acne is more severe, benzoyl peroxide washes may not be enough. In this instance, topical antibiotics play a significant role. Topical erythromycin gel 2% is a traditionally used approach, for example. There are many new topical medicines that are quite effective at treating acne. Still, pustular acne may be so severe that topical medicines need to be used in conjunction with oral medications. 

Classically, oral tetracycline has been used to treat acne. There are side effects and limitations with this form of acne. Tetracycline should not be used in pregnant females, children less than 8 years of age. Also, tetracycline may cause sun sensitivity, mild stomach upset, vaginal yeast infections and occasional headaches. Tetracycline needs to be taken on an empty stomach. However, there are many newer formulations of oral antibiotics that limit these restrictions and are quite effective. For very severe acne, systemic isotretinoin has become the treatment of choice. This medicine is very effective at treating resistant cases as well as severe cases of pustular and comedonal acne. This medication requires careful monitoring by a skilled dermatologist. Nodulocystic acne is characterized by large, tender, red, and purple acne "bumps" or cysts under the skin. It can be quite severe, disfiguring and emotionally upsetting. Often this form of acne will not respond to traditional topical treatments nor traditional antibiotics. It is in these severe cases, that systemic isotretinoin becomes the treatment of choice. It is quite effective most of the time. It requires monitoring by a dermatologist skilled in using this medication. It is important to dispell some myths surrounding acne. 

On the whole, acne does not seem to be related to the consumption of chocolate or fried foods. Also, avoidance of "picking" and "popping" of lesions is particularly important to minimize the risk of scarring.


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