These lectures are not meant to replace your physician and are
simply provided as a free educational service to all our visitors.
If you feel that you have a skin problem, please see your doctor.
Acne is a condition, not a disease. Because it is a condition,
we can control it through treatment, but it will not be "cured".
The treatment used for acne, in most cases, will need to be continued
for a long period of time, even years. It requires being patient
and faithful in treatment. The "cure" of acne occurs spontaneously
and according to a timetable which is different for each person.
One cannot gaze into a crystal ball and predict when this will
occur for a particular patient. If your acne is doing well under
treatment, and stopping or slacking off of skin care is followed
by a return of the condition, it means that your body still has
not corrected its tendency to have acne, and treatment must continue.
RECOMMENDED SKIN AND SCALP CLEANSING FOR ACNE PATIENTS
Wash with warm water, soap and your fingertips. Do not use a brush,
wash cloth or sponge. Rinse with warm water and pat dry. This
entire procedure should take less than one minute. It used to
be felt that the more vigorous the washing and scrubbing the better.
However, now most dermatologists feel that washing should be a
gentle, non-irritating process. It is important the irritant nature
of the soaps does not preclude the acne patient from using the
topical medication. Thus, it is a good idea to use a non-irritating
acne wash that is gentle to the skin while initiating topical
treatment for acne. A good example of this is
PanOxyl
Bar 5 and PanOxyl Bar 10. These are 5% and 10% benzoyl peroxide
therapeutic acne treatment in a rich lathering, mild surfactant
cleansing base. Since there are many different forms of acne,
it is important for your dermatologist to tailor your treatment
to the type of acne that you have. Some of the various forms of
acne include: comedonal acne, pustular acne, and nodulocystic
acne. Each type is manifested by a slightly different appearance.
It is not unusual for a patient to have more than one type of
acne. Comedonal acne is characterized by the presence of whiteheads
and blackheads. There are certain topical medications that are
geared towards the treatment of these lesions specifically. For
instance, topical tretinoin (Retin-A) has long been considered
the standard of treatment for comedones or whiteheads and blackheads.
Recently, however, some newer topical medicines have been developed
to attack these lesions. Pustular acne appears just how it sounds.
The presence of small pustules or tiny red pimples characterizes
this form of acne. A recommended treatment is
Rezamid
Acne Lotion. The classic approach to this form of acne depends
on the severity. If it is mild, often over the counter benzoyl
peroxide lotions or washes may be effective. However, in cases
where pustular acne is more severe, benzoyl peroxide washes may
not be enough. In this instance, topical antibiotics play a significant
role. Topical erythromycin gel 2% is a traditionally used approach,
for example. There are many new topical medicines that are quite
effective at treating acne. Still, pustular acne may be so severe
that topical medicines need to be used in conjunction with oral
medications. Classically, oral tetracycline has been used to treat
acne. There are side effects and limitations with this form of
acne. Tetracycline should not be used in pregnant females, children
less than 8 years of age. Also, tetracycline may cause sun sensitivity,
mild stomach upset, vaginal yeast infections and occasional headaches.
Tetracycline needs to be taken on an empty stomach. However, there
are many newer formulations of oral antibiotics that limit these
restrictions and are quite effective. For very severe acne, systemic
isotretinoin has become the treatment of choice. This medicine
is very effective at treating resistant cases as well as severe
cases of pustular and comedonal acne. This medication requires
careful monitoring by a skilled dermatologist. Nodulocystic acne
is characterized by large, tender, red, and purple acne "bumps"
or cysts under the skin. It can be quite severe, disfiguring and
emotionally upsetting. Often this form of acne will not respond
to traditional topical treatments nor traditional antibiotics.
It is in these severe cases, that systemic isotretinoin becomes
the treatment of choice. It is quite effective most of the time.
It requires monitoring by a dermatologist skilled in using this
medication. It is important to dispell some myths surrounding
acne. On the whole, acne does not seem to be related to the consumption
of chocolate or fried foods. Also, avoidance of "picking" and
"popping" of lesions is particularly important to minimize the
risk of scarring.
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