ACNE TREATMENT REVIEWS RECOMMENDED

Acne is a common skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne most commonly causes spots to develop and appears on your face, neck, chest, back and shoulders. Acne can be distressing and annoyingly persistent because the spots range from whiteheads and blackheads which are often mild, to inflamed pus-filled pustules and cysts. Acne lesions heal rather slowly, and when one begins to resolve, others seem to crop up.
So depending on its severity, acne can cause emotional distress and lead to scarring of the skin. But the good news is that effective treatments are available and the earlier treatment is started, the lower your risk of lasting physical and emotional damage.

Acne can take the following forms:

Noninflammatory lesions

• Comedones (whiteheads and blackheads) are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones (koe-muh-DOE-neez) are open at the skin surface, they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads slightly raised, skin-colored bumps.

Inflammatory lesions

• Papules are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.
• Pustules (pimples) are red, tender bumps with white pus at their tips.
• Nodules are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.
• Cysts are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.

When to see a doctor

Acne usually isn't a serious medical condition. But you may want to seek medical treatment from a dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin. If acne and the scars it may have left are affecting your social relationships or self-esteem, you may also want to ask a dermatologist if your acne can be controlled or if your scars can be diminished.

What to do if I have acne?

Keeping your skin clean is important to prevent new spots fromdeveloping. Wash the affected area twice a day with a mild soap or cleanser, but do not scrub the skin too hard to avoid irritating it. 

Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions and gels to treat spots are available at pharmacies. If you develop acne, it’s a good idea to speak to your pharmacist for advice.

If your acne is severe and appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are available on prescription.

Why do I have acne?

It is thought that acne is linked to the changes in hormone levels during puberty. Acne occurs when the hair follicles become plugged with oil and dead skin cells

The glands in the skin begin to produce excessive amounts of an oily substance known as Sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the openings of the hair follicles onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles and form together as a soft plug, creating an environment where bacteria can thrive.

This blocks small holes in the skin through which hairs grow (hair follicles), causing blackheads and whiteheads.
Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin, which are the openings of the sweat Normally harmless bacteria that live on the skin can then infect a blocked follicle, causing pus-filled papules or cysts.
There is no evidence that diet, poor hygiene or sexual activity play a role in acne.
Read more about the causes of acne  including some common acne hree factors contribute to the formation of acne:

• Overproduction of oil (sebum)
• Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin
• Buildup of bacteria

Factors that may worsen acne

These factors can trigger or aggravate an existing case of acne:

• Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives can also affect sebum production.
• Certain medications. Drugs containing corticosteroids, androgens or lithium are known to cause acne.
• Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips, which increase blood sugar — may trigger acne.

Who is affected and What are the Risk Factors involved:

Acne is very common in teenagers and younger adults. About 80% of people between the ages of 10 and 32 will be affected by acne.
Acne is most common between the ages of 14 and 17 in girls, and between 16 and 19 in boys.
Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne usually disappears when a person is in their twenties.
In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.

Hormonal changes in your body can provoke or aggravate acne. Such changes are common in:

• Teenagers
• Women and girls, two to seven days before their periods
• Pregnant women
• People using certain medications, including those containing corticosteroids, androgens or lithium

Other risk factors include:

• Direct skin contact with greasy or oily substances, or to certain cosmetics applied directly to the skin
• A family history of acne — if your parents had acne, you're likely to develop it, too
• Friction or pressure on your skin caused by various items, such as telephones or cellphones, helmets, tight collars and backpacks
• Stress doesn't cause acne, but if you have acne already, stress may make it worse

Diagnosing Acne

Your Dermatologist will be able to diagnosis acne by looking at your skin. This will involve examining your face, chest and back for the different types of spot, such as blackheads or sore, red nodules.
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:

• When did you first develop acne?
• Does anything in particular seem to trigger an acne flare, such as stress or — in girls and women — your menstrual cycle?
• What medications are you currently taking, including over-the-counter and prescription drugs as well as vitamins and supplements?
• In girls and women: Do you use oral contraceptives?
• In girls and women: Do you have regular menstrual periods?
• In girls and women: Are you pregnant, or do you plan to become pregnant soon?
• What types of soaps, lotions, hair products or cosmetics do you use?
• How is acne affecting your self-esteem and your confidence in social situations?
• Do you have a family history of acne?
• What treatments have you tried so far? Have any been effective?

How many spots you have and how painful and inflamed they are will help determine how severe your acne is. This is important in planning your treatment.
Four grades can be used to measure the severity of acne:

• Grade 1 (mild) – acne is mostly confined to whiteheads and blackheads with just a few papules and pustules.
• Grade 2 (moderate) – there are multiple papules and pustules which are mostly confined to the face.
• Grade 3 (moderately severe) – there is a large number of papules and pustules as well as the occasional inflamed nodule. The back and the chest are also affected by acne.
• Grade 4 (severe) – there is a large number of large painful pustules and nodules.

Treatments for Acne

 Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve. Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all four. With most prescription acne treatments, you may not see results for four to eight weeks, and your skin may get worse before it gets better so do not expect to see results overnight.

Your  Dermatologist may recommend a prescription medication you apply to your skin (topical medication) or take by mouth (oral medication). Oral prescription medications for acne should never be used during pregnancy, especially during the first trimester.
Prescription medications that can be used to treat acne include:

• topical retinoids
• topical antibiotics
• azelaic acid
• antibiotic tablets and many more as below

The acne treatments include:

• Over-the-counter topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter (OTC) lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol, salicylic acid or sulfur as their active ingredient. These products can be helpful for very mild acne. OTC acne medications may cause initial side effects  such as skin irritation, dryness  that often improve after the first month of therapy.

• Topical treatments available by prescription.

If your acne doesn't respond to Over The Counter treatments, consider seeing a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available which work by killing excess skin bacteria.

Often, a combination of such products is required to achieve the best results. A number of benzoyl peroxide and antibiotic combination medications are available, including different dose combinations of benzoyl peroxide and clindamycin (Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin (Benzamycin). Dapsone gel (Aczone) is a newer acne treatment that's particularly effective in treating inflammatory acne. Prescription topical treatments for acne may cause skin side effects, such as stinging, burning, redness or peeling. Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication immediately

• Topical Antibiotics.

 For moderate to severe acne, you may need a short course of prescription oral antibiotics to reduce bacteria and fight inflammation. Since oral antibiotics were first used to treat acne, antibiotic resistance has increased significantly in people with acne. For this reason, your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve, or as soon as it becomes clear the drugs aren't helping — usually, within three to four months. In most cases, you'll use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance. Antibiotics may cause side effects, such as an upset stomach, dizziness or skin discoloration. These drugs also increase your skin's sun sensitivity and may reduce the effectiveness of oral contraceptives.

• Isotretinoin.

For deep cysts, antibiotics may not be enough. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. This medicine is reserved for the most severe forms of acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin is associated with severe birth defects, so it can't be safely taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment. In fact, the drug carries such serious potential side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Isotretinoin commonly causes side effects such as dry eyes, mouth, lips, nose and skin, as well as itching, nosebleeds, muscle aches, sun sensitivity and poor night vision. The drug may also increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels also.

 

Isotretinoin and Birth Defects
Isotretinoin will damage an unborn baby. If you're a woman of childbearing age:

• Don’t use isotretinoin if you are pregnant or you think you are pregnant.
• Use one or ideally two methods of contraception for one month before treatment begins, during treatment and for one month after treatment has finished.
• Have a pregnancy test before, during and after treatment.

You will be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if you are not currently sexually active.
If you think you may have become pregnant when taking isotretinoin, contact your dermatologist immediately.
Isotretinoin is also not suitable if you are breastfeeding.

Isotretinoin and Mood Changes
There have been reports of people experiencing mood changes while taking isotretinoin. There is no evidence that these mood changes were the result of the medication.
However, as a precaution, contact your dermatologist immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts.

Hormonal therapies

Hormonal therapies can often benefit women with acne, especially if their acne is associated with hormonal conditions such as polycystic ovary syndrome.
If you don't already use it, your GP may recommended that you start taking the combined oral contraceptive pill, even if you are not sexually active. This combined pill can often help improve acne in women.
Co-Cyprindiol
Co-cyprindiol is a hormonal treatment that can be used for more severe acne which doesn't respond to antibiotics. Co-cyprindiol helps reduce the production of sebum.
One will probably have to use co-cyprindiol for two to six months before you notice a significant improvement in your acne.
There is a small risk that women taking co-cyprindiol may develop breast cancer in later life.
For example, out of a group of 5,000 women who have not taken co-cyprindiol, you would expect 14 of them to develop breast cancer by the time they were 35. This figure rises to 16 or 17 for women who were treated with co-cyprindiol for at least five years in their early twenties.
There is also a very small chance of co-cyprindiol causing a blood clot which  is estimated to be around 1 in 2,500 in any given year in risk
It is not thought to be safe to take co-cyprindiol if you are pregnant or breastfeeding therefore women may need to have a pregnancy test before treatment can begin.
Other side effects of co-cyprindiol include:

• bleeding and spotting between your periods, which can sometimes occur for the first few months
• headaches
• sore breasts
• mood changes
• loss of interest in sex
• weight gain or weight loss depending.

• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Previfem, others), can improve acne in women. However, oral contraceptives may cause other side effects — such as headaches, breast tenderness, nausea and depression — that you'll want to discuss with your doctor. The most serious potential complication is a slightly increased risk of heart disease, high blood pressure and blood clots.
•  
• Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacteria that cause acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars. More research is needed to understand the most effective use of light and laser therapies in acne treatment, and experts currently recommend these approaches as stand-alone therapy only in people who can't tolerate approved acne medications. These therapies may be uncomfortable and may cause temporary skin problems that mimic a severe sunburn.
• Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in controlling acne. These cosmetic procedures — which have traditionally been used to lessen the appearance of fine lines, sun damage and minor facial scars — are most effective when used in combination with other acne treatments. They may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin.

Acne scar treatment
Doctors may be able to use certain procedures to diminish scars left by acne.  

• Soft tissue fillers. Collagen or fat can be injected under the skin and into scars to fill out or stretch the skin, making the scars less noticeable. Results from this acne scar treatment are temporary, so you need to repeat the injections periodically.
• Chemical peels. High-potency acid is applied to your skin to remove the top layer and minimize deeper scars. Some stronger peels reach even deeper into the skin.
• Dermabrasion. Usually reserved for more severe scarring, dermabrasion involves removing the top layer of skin with a rapidly rotating wire brush. Surface scars may be completely removed, and deeper acne scars may appear less noticeable. Dermabrasion may cause pigmentation changes for people with darker skin.
• Microdermabrasion. This newer acne scar treatment involves a hand-held device that blows crystals onto skin. These crystals gently abrade or "polish" the skin's surface. Then, a vacuum tube removes the crystals and skin cells. Because just the surface cells are removed, the skin isn't damaged. However, results are subtle and scars may still be noticeable, even after several sessions.
• Laser, light source and radiofrequency treatments. In laser resurfacing, a laser beam destroys the outer layer of skin (epidermis) and heats the underlying skin (dermis). As the wound heals, new skin forms. Less intense lasers (nonablative lasers), pulsed light sources and radiofrequency devices don't injure the epidermis. These treatments heat the dermis and cause new skin formation. After several treatments, acne scars may appear less noticeable. This means shorter recovery times, but treatment typically needs to be repeated more often and results are subtle.

Skin surgery. A minor procedure (punch excision) cuts out individual acne scars. Stitches or a skin graft repairs the hole left at the scar site.

Non-pharmaceutical treatments

Many treatments for acne do not involve medication.

These include:

• comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads
• chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it
• photodynamic therapy – where light is applied to the skin in an attempt to improve symptoms of acne

There is only limited evidence to support these types of treatment.

Natural Remedies

• Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly. Tea tree oil may cause a skin reaction known as contact dermatitis. There's also some concern that topical products containing tea tree oil might cause breast development in young boys. Don't use tea tree oil if you have acne rosacea because it can worsen symptoms.
• Alpha hydroxy acids. These natural acids — found in foods such as citrus fruits, sugar cane, apples and grapes — help remove dead skin cells and unclog pores when applied topically. Alpha hydroxy acids may also improve the appearance of acne scars. Adverse reactions to alpha hydroxy acids include redness, mild stinging and skin irritation.
• Azelaic acid. This naturally occurring acid is found in whole-grain cereals and animal products and has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments, including 5 percent benzoyl peroxide and oral tetracycline.
• Zinc supplements. The mineral zinc plays a role in wound healing and reduces inflammation, which could help improve acne. Taking a zinc supplement with food may reduce side effects, including a bad taste in your mouth and nausea. Zinc can also be added to lotions or creams and may reduce acne breakouts.
• Brewer's yeast. A specific strain of brewer's yeast, called CBS 5926, seems to help decrease acne but may cause migraines in susceptible people and may cause intestinal upset.

Therefore some more research is needed to understand the potential role of these and other dietary supplements in the treatment of acne.

All patients are advised to talk with their doctors or dermatologists before trying any natural remedy because they too have side effects and may therefore may intervene in the effectiveness of certain prescribed medications