Acne Skin Care Treatment
Information
Acne is the most common
skin disease affecting adolescents. Some eighty-five percent of
high school students will have some form of acne. Ten percent of
those with adolescent acne will continue to suffer from acne into
their mid twenties and early thirties. Adolescent females experience
the worst skin conditions between the ages of 14 and 17 while male
acne is usually more severe the acne peaks between the ages of 16
and 19. Acne continues to affect some 6-8 percent of individuals
into late adulthood.
Acne is believed to be
secondary to the obstruction of specialized follicles which are
located mainly on the back, chest and face. Excessive amounts of
a substance called sebum (white thick oily substance) are produced
by the sebaceous (oil) glands. These follicles slough off an excessive
number of cells, the sloughed cells often obstruct the opening of
the follicle. This can cause an inflamed lesion known as a comedo.
Comedos are later infected with a local bacteria, Propioni bacterium
Acnes. The lesion subsequently produces the the classic signs of
redness and swelling of the infected area.
Acne is classified
into several types including the following:
Acne Vulgaris
(most common acne) - condition of the sebaceous glands of the skin.
Sebaceous glands surround each hair follicle and produce sebum,
(white thick oily substance), produced to lubricate the hair. Acne
Vulgaris usually appears one to two years prior to puberty and is
prompted by stimulation of the facial sebaceous glands the male
hormones, androgens.. Women also produce small quantities of these
male hormones contributing to their acne. Recent studies have suggested
that those individuals with acne have an increased sensitivity to
the androgens rather than increased levels of the hormones.
Comedonal Acne - refers
to the pattern of acne in which most lesions are comedones or blackheads
that are located on the chin and/or forehead of the patient. Open
comedones are blackheads secondary to the presence of surface pigment
(melanin) as compared whiteheads that are closed comedones that
contains particle such as dirt. The cells lining the sebaceous duct
proliferate excessively in this form of acne blocking the sebaceous
duct forming a comedone.
Infantile Acne -
effects newborn babies that often get mild acne primarily on their
faces. Infantile acne generally affects the cheeks, chin and forehead.
As with other forms of acne infantile acne is more common amongst
male and usually only lasts a few months. However, infants with
severe infantile acne are more prone to develop acne vulgaris near
puberty.
Acne Conglobata
- is a severe form of acne affecting the face, chest and back. Acne
conglobata is a severe form of acne vulgaris. Acne conglobata is
characterised by multiple inflamed and un-inflamed nodules and scars.
The acne may be associated with Hidradenitis suppurativa, a condition
in which similar boil-like lesions occur in the armpits, groins
and under the breasts.
Acne fulminans
- is a rare and very severe form of acne conglobata associated with
systemic symptoms. The acne almost always affects males.nearly always
affects males. Often the acne is precipitated by the use of Testosterone.
Acne Fulminans is
usually charaterized by the following:
Topical
Treatments Options
Topical treatments for acne include a wide variety of creams, lotions,
gels or solutions. These products use a combination of benzoyl peroxide,
alphahydroxy acids, antibiotics, salicyclic acid, or retinoids (vitamin
A derivatives) such as tretinoin, isotretinoin and adapalene.
A popular over the counter
treatment for acne is benzoyl peroxide, which has proven to be extremely
effective in many individuals with mild acne. Individuals with acne
should continue to follow a regular treatment regimine. Remember,
acne can take up to several months to develop, therefore, it is
important to continue treatment even thought there are no any active
lesions present.
If the over the counter
treatment options do not provide relief from the acne individuals
may need to consult with their physician to use prescription topical
preparations. Most prescription topical preparations contain a vitamin
A derivative such as tretinoin, isotretinoin.
There is often some confusion
between the different forms of Retin-A on the market. Currently,
you will see literature on Retin-A, Retin-A Micro and Renova. All
three of these brand name medications contain the same active ingredient
Tretinoin. The difference in the three products is the vehicle by
which the Tretinoin is delivered topically to the skin.
Retin-A - There
are three different forms of Retin-A., cream, gel and liquid. They
are available in different strengths that are available from your
physician. Retin-A (tretinoin) is indicated for topical application
in the treatment of acne vulgaris. Although the exact mechanism
of action is unknown, Retinis thought to loosen and expel existing
acne plugs in the skin and prevent new lesions from forming. It
directly attacks the primary cause of acne, the plug.
Retin-A Micro (tretinoin
gel) microsphere, 0.1% - was approved by the U.S. Food and Drug
Administration on February 7, 1997, for the treatment of acne vulgaris.This
is the first prescription medication utilizing the Microsponge®
systems technology. Where as conventional formulations of topical
medications are intended to work on the outer layers of the skin;
releasing their active ingredients upon application, producing a
highly concentrated layer of active ingredient that is rapidly absorbed.
The Microsponge® systems can prevent excessive accumulation of medication
within surface layer of the skin. Thus, significantly reducing the
irritation of effective medication without reducing their efficacy.
Less than one-thousandth
of an inch in diameter, each Microsponge system can serve as a reservoir
or a closed container to protect certain substances from degradation
or absorption, and as an absorbent receptacle to collect undesirable
substances. Microsponge technology of entrapment of undesirable
substances is believed to contribute to the decrease in reported
side effects in the Retin-A Micro system as compared to more traditional
methods of delivering Tretinoin the active ingredient in Retin-A.
The novel acne treatment
entraps Tretinoin in Microsponge systems and formulates them into
a gel. The microspheres hold the medication in reserve, allowing
the skin to absorb small amounts of tretinoin over time. Dermatologists
who conducted the pivotal clinical studies believe this may be why
most Retin-A Micro patients experience little or no irritation.
The microspheres themselves remain on top of the skin and are easily
washed off when patients shower or wash their face. Retin-A Micro
also reduces the appearance of facial shine (oiliness) on the skin's
surface.
In clinical studies,
the overwhelming majority of Retin-A Micro patients experienced
little or no cutaneous irritation in four categories — erythema,
peeling, burning/stinging, and itching - at two weeks, the typical
peak irritation period for tretinoin.
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Renova (tretinoin
cream) 0.05% - approved by FDA in 1995, is clinically proven
to reduce fine facial wrinkles, fade brown spots and smooth surface
roughness. Clinical trial data suggest that the emollient (an agent
that softens and soothes the surface to which it is applied) system
used in Renova is significantly better than Retin-A's vehicle at
minimizing irritancy, the main limiting factor when treating photodamaged
skin with retinoids.
All three medications
contain the active ingredient Tretinoin, the difference is the delivery
system to the different layers of the skin. Retinol, should not
be confused with Retin-A, Retin-A Micro or Renova. Retinol is the
technical name for (preformed) vitamin A (vitamin A is created in
the body from beta-carotene). Cosmetics companies from Estee Lauder
to Neutrogena, Avon, and others all have their assortment of products
containing retinol or retinyl palmitate, and their claims mirror
those made for Retin-A and Renova. Retinol must become all-trans
retinoic acid to work like tretinoin, and that process requires
a series of steps and changes. The notion that the skin can perform
this action with retinol is unproven and considered by many to be
unlikely and has not been approved by the FDA for decreasing the
signs of aging.
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Renova Online (click here)
Oral
Medication Treatment Options
Acne that is more severe
or resistant to topical treatment can be treated with oral medications.
Oral antibiotics are effective in treating acne, however like topical
preparations, they do not cure acne, and may need to be taken for
a prolonged period of time.
Oral antibiotics i.e.
tetracycline, minocycline, doxycycline or erythromycin remain the
mainstay of oral treatment for acne that is resistant to topical
treatment. Maximum benefit may take several months, and the dose
should be adjusted to achieve and maintain satisfactory control
of acne. In addition, caution should be used when using antibiotic
treatment such as tetracycline secondary to increased sensitivity
to the sun.
Oral hormonal therapy
is often used effectively in females with acne. Women
who benefit most from hormonal treatment are typically in their
20s or 30s, and have a history of failed treatment, or an intolerance
to standard acne therapies (both topical and systemic). In addition,
many have a history of menstrual irregularities, premenstrual acne
flare-up, and facial oiliness. Hormonal treatment is generally not
used in the most severe forms of acne, nodular/cystic acne. While
certain popular oral contraceptive pills can result in an increase
in acne while other oral contraceptives can help improve
acne. The progesterone component of the pill largely determines
whether a brand of pill will exacerbate or improve acne.
When a woman in her late
thirties or early forties develops acne increased androgen production
is suspected. In almost all adult female patients with this condition,
supplemental progesterone clears the skin. One hypothesis is that
ovarian follicle depletion leading to progesterone deficiency results
in increased adrenal production of androgens. When progesterone
is re-supplied, androgen production goes down and the skin clears.
Other non-contraceptive
hormonal therapies including spironolactone are also used to treat
acne.
In females, oestrogens and antiandrogens such as Diane 35 or spironolactone.
Spironolactone
is a medication used primarily for the treatment of high blood pressure.
Recently it has been used to treat acne and excess hair growth in
women. Spironolactone and flutamide act by blocking the effects
of testosterone (androgen) on the oil glands and hair follicle.
It is the male hormone testosterone which triggers the acne. The
result is a reduction in oil production and facial hair growth,
and the improvement of acne and excessive hair growth.
Some patients also benefit
from the use of nonsteroidal anti-inflammatory agents such as ibuprofen
or naproxen.
Oral isotretinoin, a
vitamin A derivative, is also used in more severe cases of acne.
Oral isotretinoin, is commonly used to treat severe cystic acne,
and can be very effective in these severe and potentially scaring
cases of acne. Oral Isotretinoin is usually given for a 4-6 month
course which will improve a large number of individuals' acne. However,
many individuals will experience some recurrence of their acne,
which is often much less severe, but may require additional oral
isotretinoin treatment. Oral isotretinoin treatment is usually limited
to those individuals with severe acne secondary to the severe side
effects associated with the medication. Common side effects associated
with oral isotretinoin include: dry skin often resulting in dermatitis,
cracked dry lips, irritation to the nose and eyes.
Oral isotretinoin is
strictly controlled secondary to its potential effect on an unborn
fetus if taken during pregnancy. It is essential that all females
of potential child bearing age are counseled prior to treatment
and that these women be on a suitable contraceptive routine. Isotretinion
has no adverse effects on male fertility.
Physical
treatments for acne
The following is a brief
list of physical treatment options:
