How is acne treated?

No treatment is needed for the occasional pimple or two, but if acne causes you distress, something should be done about it. Many different treatments are available, but not each is appropriate for everyone. It is therefore important to keep appointments with your health care provider so that, together, you can determine the right treatment for you. Treatment usually shows an effect only after six to eight weeks.

Home
To prevent acne from getting worse:

• Wash your face twice a day with a gentle soap. Washing your face more often than that may irritate and dry your skin. Avoid hot water. Using hot water can make your acne worse.
• Do not use facial scrubs, astringents and masks unless your doctor has recommended them, because these generally irritate the skin and aggravate acne.
• Do not squeeze, pick, scratch or rub your skin. Squeezing pimples aggravates acne.
• Avoid extreme stress – if necessary, seek counselling and follow a stress management programme. Stress cannot cause acne, but may aggrevate it.

Medication

There are many over-the-counter medications (creams, lotions, and gels) available. Many of them contain benzoyl peroxide, alpha-hydroxy acids or salicylic acid. These medications should be water-based and hypoallergenic.

Use Cetaphil lotion as a cleanser.

For non-inflammatory acne the treatment of choice is tretinoin (Retin A, retinoic acid), a vitamin A derivative, or adapalene (Differin) or benzoyl peroxide 5% (Panoxyl) in the evening. Both Retin A and Panoxyl may cause redness, burning and scaling (= irritation effect), and sensitivity to sunlight. When this occurs, apply the medication every second evening until the skin settles.

Other drugs that can be used include salicylic acid, tazarotene, and topical antibiotics.

For mild inflammatory acne a topical antibiotic (such as Eryderm) may be added for application in the morning.

For moderate inflammatory acne a systemic (oral) antibiotic, such as tetracycline, is the treatment of choice. Minocycline is preferred by most dermatologists (dosage 50 mg to 100 mg per day). Alternative systemic antibiotics include erythromycin, clindamycin and sulphonamides. Topical treatment (tretinoin included) should be continued to combat inflammation.

Be aware though that antibiotics may make women susceptible to yeast infections.

The tetracycline group of drugs causes yellowing of the teeth if taken after the third month of pregnancy.

These drugs should be stopped if you become pregnant and only started again following the completion of breast-feeding.

Tetracyclines must not be given to children before the permanent teeth have erupted because these drugs can cause yellow discolouring of permanent teeth.

For marked inflammatory acne (deep, chronically inflamed cysts), the drug isotretinoin (Roaccutane) may be prescribed. This drug has potentially severe side-effects during pregnancy and the treatment must be monitored.

The cure rate is between 70 and 80% after five months of treatment. All forms of treatment should be continued for a minimum of three months.

If the condition shows improvement the current therapy regimen may be continued. If not, modification of treatment should be considered.

An anti-androgenic contraceptive pill (Diane-35) may be useful in some women with inflammatory acne.

Triamcinolone, a type of corticosteroid, may be injected directly into cysts. This drug may darken the skin around the lesion.

Surgery
Dermatologists can surgically remove scars associated with acne. Three techniques are available: dermabrasion, chemical peeling, and laser resurfacing. These treatments are used to remove scarred skin, exposing the underlying, unblemished skin layers.

Other
Controlled exposure to ultraviolet light, as prescribed by a dermatologist, may control outbreaks of acne in some cases.

Reviewed by Professor H.F Jordaan, MBChb, MMed (Derm)