The role of a physician
The goal of acne therapy is to get rid of existing lesions
and prevent the formation of new ones. Most treatments resolve existing acne lesions and,
with continuous use, discourage new ones from forming.
Acne is treated by interfering with the way acne develops.
Acne occurs when androgen hormones cause sebaceous glands to grow and produce more sebum.
In concert with this change, there are changes in the skin lining the hair follicle to
which sebaceous glands are attached. The skin cells of the follicle lining shed more
quickly, in clumps, and are sticky. These cells and increased sebum output are likely to
cause clogged pores that can become comedones. Finally, a kind of bacteria, P. acnes,
which is a normal resident on the skin, invades the clogged follicle and begins to
multiply rapidly. The result is acne in all its forms.
Given the way acne occurs, acne treatments do one or more
of the following:
Sometimes, two or more acne products are used to treat
different acne causes. Check with your dermatologist or pharmacist before you combine acne
products. This section will outline the various treatment options for acne.
The role of the dermatologist
Just about every case of acne can be cleared up, but
sometimes it takes a dermatologist's help. Moreover, there is absolutely no reason why
acne should get so bad or last so long as to cause scars--not with the products available
today.
Should YOU see a dermatologist for your acne? To answer
this question, take an honest look at your acne and its effect on your life. If any of the
following apply, make an appointment:
- You are dissatisfied with the results you have gotten from
nonprescription acne products
- Your acne is interfering with your enjoyment of life
- You have acne scars in addition to acne lesions
- You have large, painful acne bumps
- You are dark skinned and acne is causing dark patches to
appear
Basic guidelines for treating acne
Regardless of the treatment you're using, you should follow
the following guidelines unless your dermatologist instructs you otherwise:
1. Do NOT pop, squeeze or pick at acne. This can make acne
worse by spreading inflammation. Comedones should be removed only by an experienced health
professional. With appropriate treatment, acne should go away without squeezing.
2. Gently wash your face twice a day with a mild soap and
pat dry. Vigorous washing and scrubbing can irritate your skin and make acne worse. It
will not clear up acne on its own--the acne needs to be treated with appropriate acne
products.
3. Use "noncomedogenic" cosmetics and toiletries.
4. Avoid things that can aggravate your acne, such as oils,
airborne grease, irritating clothing or sporting equipment, and so on.
5. Give the acne products enough time to do their job. Ask
a dermatologist or pharmacist for more information about how long a particular product
needs before the acne begins to clear up.
6. Some acne products can increase the skin's sensitivity
to sunlight and ultraviolet light from tanning booths. Use protective clothing and
sunscreens and avoid tanning booths (which are probably good ideas in any case).
Remember, see a dermatologist if you are not satisfied with
the results you get from your acne treatments.
Nonprescription
products
Cleansers. There are many cleansers,
soaps, washes and so on advertised for acne. Most special cleansers are unnecessary if the
acne is being treated properly otherwise. Some may even aggravate acne. Be careful that
vigorous scrubbing and washing does not irritate the skin.
Ketsugo. Ketsugo eliminates the cause of shiny skin, open pores,
blackheads, whiteheads, pimples and acne by gently reducing the skin's overproduction of
oil. It keeps pores free from clogging, even under make-up. A smoother, cinarer complexion
can be seen within weeks. Isolutrol, a revolutionary compound extracted from shark liver
which has the amazing ability to regulate excessively oily skin.
Benzoyl peroxide. Benzoyl peroxide works
by destroying the bacteria associated with acne, P. acnes. It usually
takes about 2 weeks to work and it must be used continuously to keep acne at bay until you
outgrow getting acne. This is because it does not affect sebum production or the way the
skin follicle cells are shed, and when you stop using it, the acne comes back. It is
available in a wide range of vehicles: creams, lotions, gels. It often works quite well
for milder cases of acne.
Salicylic acid. On the skin,
salicylic acid helps to correct the abnormal shedding of cells. For milder acne, salicylic
acid helps unclog pores to resolve and prevent lesions. It does not have any effect on
sebum production or P. acnes, It must be used continuously,
just like benzoyl peroxide, since its effects stop when you stop using it--pores clog up
again and the acne returns. Salicylic acid is available in many acne products, including
lotions, creams and pads.
Prescription products
Because prescription drugs must be ordered by a
dermatologist, your own dermatologist is the best source of information about specific
products and the treatment of your acne.
Antibiotics. Antibiotics may be used
on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the
skin of P. acnes, There are several topical products
available in creams, gels, pads and lotions. Topical antibiotics are limited in their
ability to penetrate the skin and clear more deep-seated P. acnes, whereas
systemic antibiotics circulate throughout the body and into sebaceous glands. Systemic
antibiotics, therefore, often cause more side effects than topicals, but they can be used
for more severe kinds of acne.
Antibiotics do not address the other causative factors in acne and
may take several weeks or months to clear up acne. Antibiotics are usually used in
combination with other drugs that "unclog" follicles. Orally taken (systemic)
antibiotics for acne should not be used during pregnancy, and some may reduce the
effectiveness of oral contraception pills, risking a pregnancy during treatment. Be sure
you get all the facts about any antibiotic your dermatologist prescribes.
Vitamin A derivatives. Vitamin A derivatives,
called "retinoids," have numerous effects on the skin. Other drugs that work
like vitamin A have similar effects. Topical retinoid preparations help unclog pores to
clear up moderate-to-severe acne by normalizing the way the skin grows and sheds. They can
be used in combination with other acne products, such as benzoyl peroxide, and oral
antibiotics. However, the dermatologist's instructions should be carefully followed.
An oral retinoid is available that reduces sebum output, improves
the shedding of skin and reduces the P. acnes population of the skin--the only
medication that intervenes in all the causes of acne. It will often clear
severe nodular acne, even if the acne has not responded to other treatments. This product
can have long lasting results, but it can also cause significant side effects in some
people. In addition, it has been shown to cause birth defects if taken during pregnancy. A
course of treatment completed in the past has no effect on future pregnancies, but the
drug should not be used by a women who believes she may become pregnant during treatment.
A person taking this drug should carefully follow the dermatologist's direction.
Oral contraceptives. Oral contraceptives,
being female hormones, help to counteract the effect of male hormones (androgens) on acne.
Because they are female hormones, however, their use is limited to female patients. It
should be pointed out that the use of some systemic antibiotics, which should not be used
during pregnancy, may reduce the effectiveness of oral contraceptives as birth control.
Oral contraceptives contain combinations of hormones, and some combinations are more
effective than others in clearing acne. The maximum benefit of oral contraceptives on acne
occurs in 3 to 4 months.
Other medications. Anti-inflammatory
medications called corticosteroids may be injected by a dermatologist directly into severe
inflamed acne lesions to help heal the lesions.
A dermatologist is the best source of information as to
which one is right for an individual case of acne.
Other treatments
Other treatment methods. A
dermatologist may use a variety of in-office procedures to remove severe lesions and to
express (push out the contents of) comedones. A skilled physician is the best one to
remove acne lesions and pimples--a non-expert risks spreading inflammation, making acne
worse and increasing the risk of scarring.
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