Skinpatient.com
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Skinpatient.com |
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Here's a personal view !!! The treatment of acne is multi- faceted and targeted mainly by the type of acne lesions the patient has The following 4 approaches is used
The last approach is the one mainly used in the over the counter treatment of acne Drying and peeling agents This is the oldest method used to treat acne Sulfur, salicyclic acid, resorcinol and benzoyl peroxide are peeling agents. These peel the outer layers of the skin and breaks the comedones up. This results in a natural reduction in severity of acne The preparation, whatever it may be is applied continuously until a mild dryness sets in and the skin starts to peel. If the peeling is intolerable then the treatment is stopped. Benzoyl peroxide This is present in varying strengths in many OTC preparations. The main effect is antibacterial while some effect is also keratolytic (dissolving the outer layers of the skin) Long-term use also reduces the size of the sebaceous glands Water based gels are less irritating while alcohol based gels are more irritating but more effective if tolerated. This is is also available as soap It is important to note that benzoyl peroxide is a bleaching agent and it may bleach the clothes!!! Treatment is started with 2.5 % and slowly increased to 5 and even 10 %. The frequency of application is also varied till a mild peeling effect is noted Topical TRETINOIN Until this was available the OTC products had a field day. This has been in use for more than 20 years It is mainly effective against comedones It acts against micro comedones, which is the starting ground for all types of acne lesions. It destroys the plugs and breaks it down and expels the plug. The no of comedones and the formation of new comedones are reduced and there is a marked decrease in acne I t may be noted that the skin may be more irritable after this treatment. Astringents and alcohol and acne soaps may not be tolerated after this treatment ADAPALENE SYNERGISM This is a new approach and the combination of tretinoin and topical antibacterials are used. Tretinoin enhances the penetration of the antibiotics into the skin. Aknemycin plusTM contains both tretinoin and erythromycin. Oral antibiotics This is the first step in the ladder after a trial of topical treatments. This is usually tried for 3- 6 months These act by reducing the population of Propionibacterium acnes in the sebaceous follicles. However antibiotic resistant P acnes have been isolated recently indicating a worrying trend. The drugs commonly used are tetracyclines, minocycline, doxycycline and erythromycin ISOTRETINOIN ROACCUTANE ®
or ACCUTANE ® This is the closest that is available to a cure at the moment. It reduces the sebum production by about 90 %; decrease the size of the sebaceous glands inhibits the formation of the microcomedone by reducing the follicular wall keratinization (reduces the sticking of the cells that form the plug that blocks the opening of the sebaceous follicle). It also reduce s the no of bacteria Propionibacterium acnes in the glands. Thus it acts on all areas that worsen acne and more important the effects last even after treatment is stopped. Pregnancy must be avoided during and for a month after treatment, as it is a potent teratogen. It has even been used in infants recently! While this drug had been reserved for severe acne in the past, recently the indications have been increased so that more people are getting the benefits. This is only available by prescription by Dermatologists. The recently added indications include moderate acne, patients who scar easily, people with late onset acne .(thirties) The drug is given on 0.5 mg to 1 mg per kg body weight for 4 months. Some patients require repeated courses ANTIANDROGENS Androgens are the main hormones that stimulate sebum production. In some people antiandrogens may be used to reduce sebum production. Spironolactone, Dianette ® and cyproterone acetate are used. In this Dianette is an oral contraceptive that has additive effects of reducing acne
Intralesional steroids are injected into large cysts about 0.1 to 0.3 ml of triamcinolone acetonide is injected for a rapid resolution of acne cysts. Multiple cysts can be injected at one time Acne surgery options Comedone removers: A small loop of steel is placed and pressed around the comedone. A smooth and continuous pressure is applied and the soft whitish material is removed from the centre of the comedones. This may be done at home or a beauty centre. Scar treatment This is best done when the acne is inactive or at least low grade for some time. As scars tend to improve with time delay in treatment may sometime mean no treatment is required at all. Dermabrasion In this a high speed rotating abrasive metal cylindrical brush is used to peel the superficial layers of the skin. When the skin heals the resulting smooth scar hides any previous scars Side effects include severe scarring and loss of colour Scar revision Some deep scars may be removed by local surgery Collagen injections Bovine or porcine collagens may be injected below the skin to lift the depressed scars |
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