Acne

• Acne is typically triggered during adolescence by a group of sex hormones, known as androgens. You've probably heard the term RAGING HORMONES well, there's a lot of truth to that! Following puberty, our hormones, just like our bodies, are growing and becoming active.
• Excessive androgen secretion during this time causes the sebaceous glands to become more active. That's where the problem lies, because when these glands become more active, the excess oil that rises to the surface of the skin combined with dirt and debris can become infected. That infection causes inflammation and acne formation.
  

ACNE TREATMENT :

   Different treatments work at different levels of the disease process. The goal of therapy is to reduce the formation of new lesions and treat the existing condition to prevent scarring. The treatment recommended will vary according to the type of acne and the severity of the condition, but other factors such as tolerance to products and potential adverse effects may be considered. Finally, because acne is often multifactorial, combination therapies may be required to achieve effective treatment.

   Topical medications, oral medications and combination therapies are used in the therapeutic management of acne.

Oral medications

If the acne is more severe or resistant to topical medications as initial therapy, the use of oral agents may be necessary. Several agents are available:

Hormonal Agents

Hormonal treatment includes estrogen/progestin containing oral contraceptives, such as Tri-Cyclen®, and those which contain an antiandrogen (male hormone). Diane-35® is an example of the latter which contains ethinyl estradiol and cyproterone acetate. It is intended for women with severe and recalcitrant acne, especially those which are accompanied by seborrhea and mild forms of hirsutism (excess hair on face, chest, abdomen). While it is effective in treating acne, when taken as recommended it provides reliable contraception with a profile similar to that of other oral contraceptives.

Androgens are the most important hormones in the development of acne. This condition may be caused by an increased production of androgens or an increased sensitivity to these hormones. Diane-35 reduces the production of androgens which results in a decrease of sebaceous gland secretion. Therefore, less sebum is produced and the skin may begin its process of healing. Nausea is usually the most common adverse reaction which may occur during the first cycle. Breast tenderness, headache, nervousness and photosensitivity have also been reported. Estrogen/progestin combinations are contraindicated during pregnancy and your doctor should perform a thorough medical risk assessment before prescribing these products.

Oral antibiotics

Oral antibiotics are usually used in the treatment of moderate to severe inflammatory acne or for acne which is resistant to topical therapy. Tetracyclines (tetracycline, minocycline, doxycycline) and erythromycin are the most prescribed antibiotics. Antibiotics treat the bacterial infection associated with acne by inhibiting the growth of bacteria. Photosensitivity manifested by an exaggerated sunburn reaction has been observed in some individuals taking tetracyclines.

Isotretinoin

Isotretinoin (ex.: Accutane®) is reserved for certain types of severe acne. Patients with other forms of acne for whom the risk of scarring is great and who have not responded to topical and oral antibiotic therapy should be considered for this treatment. Isotretinoin inhibits secretion of sebum and decreases bacterial growth. Liver function tests should be monitored before treatment and at regular intervals during therapy. Because of its possible teratogenic effects, use in women of childbearing age requires appropriate contraception.

Topical medications

Acne may be treated with topical medications, such as creams, lotions, cleansers or gels, that are applied directly to the skin. Topical therapy remains an important and often essential ingredient of acne treatment programs. This type of therapy is usually preferred in mild to moderate cases 2 and includes different agents which are classified accordingly to the mechanism of action.

Agents which reduce the abnormal sloughing of dead skin in the sebaceous follicle ducts

a) Vitamin A derivatives (tretinoin, topical isotretinoin)

Tretinoin and isotretinoin are both related to vitamin A and play a role in regulation of specific cell growth of the skin. They are effective comedolytic (e.g. destroy comedones) agents intended for application as creams, lotions or gels, and should be kept away from eyes, nose, mouth, and other mucous membranes because of their irritant effect. Skin irritation and redness may occur with those products. It is also important to note that excessive exposure to sunlight should be avoided during treatment.

b) Salicylic acid preparations

It is probably the oldest agent currently used to treat acne. It is available in different preparations, often presented as cleansing solutions or medicated pads. Salicylic acid is a weak comedolytic agent which may be an alternative for patients who are intolerant to other treatments.

c) Alpha-hydroxy acids (glycolic acid)

These agents have been reported to reduces the formation of comedones. They are available in various concentrations and formulations. Skin irritation and redness may occur with these products.

Antibacterial agents

a) Benzoyl peroxide

Benzoyl peroxide, a potent oxidizing agent, significantly reduces bacteria known to cause acne. A disadvantage of benzoyl peroxide is that it may cause redness and desquamation of the skin.

b) Topical antibiotics

Topical antibiotics are also effective in the treatment of acne because of their antibacterial effect. Erythromycin and clindamycin are the antibiotics most commonly used in current topical preparations. Those agents usually cause less irritation than benzoyl peroxide or tretinoin agents.

Combination therapies

Finally, because the cause of acne may be multifactorial, combination therapies may be used for control of acne. Therefore, oral medications may sometimes be used in combination with topical therapy for an additive effect.

In conclusion, the pathogenesis of acne is often complex and management may include a combination of modalities that depends on the type acne lesions. The treatment should be accompanied by very gentle cleansing, since abusive scrubbing and cleansing can counteract the best treatments. Remember that a well-informed patient is most likely to be compliant 2 and it is essential to see your physician who will determine the most appropriate treatment for your condition: the key to all successful acne treatment.