Sunday, June 17, 2007

Acne Treatments

There is no cure for acne. However, there are a wide variety of treatments designed to keep acne under control. The main reason why so many diverse acne treatments exist is that acne is caused and/or exacerbated by several different factors. Each acne treatment targets one or several of these factors. Another reason for the wide variety of acne treatment is that due to the complexity of acne causes no acne treatment appears to work for everyone. On the other hand, most people eventually find an effective treatment or a combination of treatments to control their symptoms.

Both prescription and over-the-counter acne treatments are available.

Exfoliation with AHA and BHA

Exfoliation is a common component of acne treatment programs. It is rarely effective on its own, but may be modestly useful in conjunction with other treatments. Since exfoliation removes dead, hardened outer skin cells, it improves the penetration of subsequently applied topical treatments. Whether exfoliation helps clear dead cells from deep inside the pores is debatable, but if it does, that would be helpful too. Common exfoliating agents used in acne include alpha-hydroxy acids (AHA) and beta-hydroxy acids (BHA). Overall, BHA, particularly salicylic acid, appears to be more useful because they also reduce sebum production.

Topical Antibacterials

Since bacterial growth (particularly of P. acnes) in pores is a factor in the developments of acne, topical bactericidal agents have been used as a treatment. The most common such agent is benzoyl peroxide, which is a strong oxidizer that kills bacteria by generating oxygen free radicals. The strong suite of benzoyl peroxide is that bacteria do not develop resistance to oxygen. Hence, if benzoyl peroxide works for you, it is likely to continue working as long as you use it. The downside is that free radicals are damaging not only to bacteria but to your skin as well: they cause irritation, dryness, cell damage and accelerate the rate of skin aging. Unfortunately, for many people, benzoyl peroxide is only effective topical treatment. In that case, it is prudent to find the lowest possible effective concentration. Concentrations of benzoyl peroxide as low as 2.5% may be effective, especially if combined with other treatments.

Other topical antibacterials that have been used for acne include triclosan, chlorhexidine gluconate, colloidal silver and tea tree oil.

Topical antibiotics

Topical antibiotics have an important advantage over benzoyl peroxide in that they kill acne-causing bacteria in a more targeted way, causing minimal collateral damage to the skin. Antibiotics most commonly used for topical acne treatment include erythromycin, clindamycin and tetracycline. Topical antibiotics are about as effective as oral ones but with far fewer side effects. However, if acne is present over large areas of the body, oral antibiotics may be easier to use. Antibiotic treatment for acne may not be sustainable over the long term because bacterial resistance may develop to any and all of these drugs.

Oral antibiotics

Oral antibiotics used to treat acne include erythromycin, tetracycline or their analogs (oxytetracycline, doxycycline, minocycline or lymecycline). Oral antibiotic appear to be about as effective as topical antibiotics but produce a variety of side effects, such as diarrhea, dysbacteriosis, colitis and others. The advantage of oral antibiotics over topicals is the ease of use, especially when acne affects large areas of the body. Also, occasional cases unresponsive to topical antibiotics would respond to oral administration. Antibiotic treatment for acne may not be sustainable over the long term because bacterial resistance may develop to any and all of these drugs.

Next Article: Continuation of Acne treatments….

Acne treatments 2

Hormonal treatments

Androgens are a major factor in acne and reducing the levels and/or blocking/counterbalancing their action would generally improve acne. However, such treatments are inappropriate in men due to sexual and other side effects. In women, some estrogen/progestin contraceptive combinations were shown to reduce acne. Antiandrogens, such as cyproterone, alone or in combination with estrogens are even more effective. However, antiandrogens may sometimes affect sex drive and produce other side effect even in females. There is some evidence that topical antiandrogens (such as 5% topical spironolactone) may be modestly effective in acne.

Topical retinoid

Retinoid are active metabolites of vitamin A and their analogs. They improve acne by reducing sebum production an altering the lifecycle of epithelial skin cells. Treatment with topical retinoid often causes temporary increase in acne outbreaks during the first several weeks of treatment. Retinoid may also cause skin irritation, dryness and flaking. Also, retinoid cause sensitivity to UV light and should not be used without a thorough sun protection.

Oral retinoid

Oral retinoid, such as isotretinoin (Accutane), are among the most effective acne treatments. They work by reducing production of sebum, altering the lifecycle of epithelial skin cells and possibly modifying other acne-causing factors as well. Isotretinoin has been shown to be highly effective in severe acne and can either improve or clear over 80% of patients. A course of treatment usually takes 4-6 month and, just like topical retinoid, may cause an initial flareup. As opposed to virtually all other acne treatments, isotretinoin often leads to long-term remission of acne. In those who relapse, recurrences tend to be milder.

Despite high effectiveness and durability of improvements, oral retinoid are infrequently used and are the treatment of last resort. Common side effects include dry skin and nosebleeds (due to dry mucosa). Less frequent side effects include liver damage, permanent skin texture changes, and elevated blood triglycerides. The drugs have been linked to cased of depression and psychosis. Oral retinoid should never be used in women who are or may become pregnant due to the high risk of birth defects.

Other treatments

Topical azelaic acid: Azelaic acid (Azelex, Finevin, Skinoren) reduces sebum production possibly by partly blocking the effects of androgens. It inhibits the formation of comedones and may help in mild comedonal acne.

Topical tea tree oil: The oil of tea tree (Melaleuca) has both antibacterial and anti-inflammatory effects and in further studies was shown to be as effective as topical antibiotics with no side effects reported till date.

Topical Niacin amide: In a few small studies, 4% niacin amide gel was shown to be equally or more effective than topical antibiotics. Niacin amide is a form of (Vitamin B3). The effects are said to be due to the anti-inflammatory action of topical niacin amide.

Heat therapy: Directed targeted heat (Zeno device) delivered to the area where an acne lesion is just beginning to form appears to make lesions milder and shorter-lived. The method does not seem to work on cystic acne.

Oral Vitamin B5: Oral Vitamin B5 (Pantothenic Acid) taken orally in large doses as calcium pantothenate has been claimed to improve acne. This has not been rigorously studied, however.

Tomorrows Article: Pigmentation disorders……….

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