The only danger posed by
acne is the psychological and mental torture it gives its host especially
if permanent scars are to be noted on the skin, particularly on the face.
This drives medical researcher to look for ways to resolve the problem. Today,
various techniques offering successful systematic treatments of acne is available
as newer treatment methods are being researched and developed.
Treating acne effectively requires that its severity and type
must be graded since it varies from one person to the other. The
severity can be determined by considering the number and the type
and distribution of the lesions. Currently, there are 25 existing
methods used in grading the severity of acne and 19 methods for
counting lesions.
Acne can be classified into two types:
- Non inflammatory or purely comedonal
- Inflammatory (papules,
pustules and nodules)
The Treatment
As in any other ailments and diseases, obtaining and thoroughly
analyzing the family and medical history of the patient is helpful.
The data from the past about responses to treatments will give
the therapist an idea how to approach the problem. During the
treatment, it is necessary that the severest lesions be treated
first, as the treatment will cure the less severe ones in the
process.
It is imperative to clarify certain myths about diet and cleanliness
in order to facilitate willingness and cooperation of the treatment
from patient. It is in the patient’s best interests to be
informed that the initial physical reaction towards the treatment
might include acne flare-ups, and that the desired result may
take a while and require simple, disciplined regimens. It would
be good to forewarn the patient about the adverse effects of picking
the pimples as well.
Treatment based on severity
Mild comedonal acne
Mild comedonal acne is composed only of non-inflammatory comedones
and can be usually treated with topical retinoid therapy (examples
of which include treninoin, isotreninoin, adapalene, tazarotine,
and retinaldehyde). This treatment eliminates mature comedones
and prevents its formation. Some non-retinoids such as salicylic
acid and azelaic acid are also used for the same purpose. When
comedones become too large, physical treatment like extraction
and electrocauterization in a clinic becomes necessary.
Mild papopustular acne
Few comedones and few inflammatory papsules and pustules are
the main characteristics of mild papopustular acne. These characteristics
are responsive to topical retinoids and antibacterials like benzoyl
peroxide, clindamycin, and erythromycin—all of which help
eliminate P. acnes bacteria.
Moderate acne
Moderate acne is characterized by moderate amounts of pustules,
few small nodules, and many comedones with or without residual
scarring of the skin. Treating moderate acne using drug treatments
require systematic methods to be effective. Antibiotics, hormonal
therapy, and oral retinoids are used to treat moderate acne. Oral
antibiotics like erythromycin, tetracycline, and trimethoprin
are used to eliminate P. acnes by stopping its growth.
When using oral antibiotics and topical retinoids on women with
moderate papopustular acne including small nodules, it is recommended
that hormonal therapy be used along with the treatment to produce
desired results. Women who suffer from acne due to ovarian or
adrenal hyper-androgenism may experience hirsutism, excessive
sebum secretion, and acne in adulthood that worsens before menstruation.
This therapy consists of antiandrogens like cyproterone actate,
spironolactone or flutamide, preventing androgen production from
the ovaries or adrenal glands.
Severe acne
Oral isotretinoin is used for treatments of the patients suffering
from excessive sebum secretion and gram negative folliculitis
(exhibited as innumerable inflammatory nodules and severe scarring).
Prior to the administration of the drug isotretinoin, it is imperative
to obtain data of blood lipids test, liver function test and complete
blood count. Forewarning the patient about the potential side
effects of the drug in the form of neurologic, ophthalmologic,
mucocutaneous and gastrointestinal discomforts is advisable.
Physical therapy
Physical therapies for acne treatment include phototherapy, photodynamic
therapy, and aspiration of deep inflamed lesions that are found
in cysts and sinus tracts. The scars can be treated with collagen
injection, fat transfer, chemical peeling, laser resurfacing,
skin surgery, dermabrasion and steroid injection depending on
their size, shape, patient’s skin type, and the number
and location of the lesions across the affected area.
Continuous and maintained treatment of acne with topical retinoid
even after the initial treatment has taken effect leads to curing
acne permanently. Noncomedogenic cosmetics can be used to lessen
and hide the erythma making the skin appear better. Patients taking
isotretinoin medications require moisturizers to prevent skin
dryness.
The present treatment targets one or a combination of known mechanisms.
Optimal results can be achieved when treatments used to target
several mechanisms were targeted simultaneously ad the patient
needs only to adjust with the kind of therapies he is taking based
on their level of improvement and tolerance. Patients are expected
to overcome physical and mental trauma brought about by acne with
all the available treatments present.
