Once you have acne, there are several options available for people to help reduce this potentially disfiguring problem. Of course, prevention is the best medicine, and one should always remember the steps one can do to try to prevent acne from forming. However, once it invades your face and body, here are some steps to take for better skin.

Steps for Acne Treatment

1. Reduce the bad effects of hormones on the skin

2. Reduce the extra sebum and oiliness of the skin

3. Reduce the dead cells within the follicles and cause comedones

4. Reduce the bacteria that can infect the comedones

5. Reduce the inflammation that can lead to scarring

REDUCE THE BAD EFFECTS OF HORMONES ON THE SKIN

The biggest hormonal culprits that induces acne are androgens which are “male” type hormones. We don’t necessarily want to take these away from people because they help build our bodies up to give our bodies that beautiful shape we want. However, we may be able to manipulate them in such a way to make them work for our skin instead of against our skin.

During adolescence, these androgenic hormones begin their work on building our bodies and helping us grow. This is the time many people begin having acne problems. Therefore, if we can do something during this stage in our lives, we may be able to help prevent acne scarring and suffering that can disfigure us for life.

For girls, one of the best methods to manipulate these hormonal problems is to overpower the androgens being produced in their bodies with more estrogenic, or female-type hormones. A combination of female hormones can help suppress the secretion of androgens from the ovaries. Estrogens stimulate collagen and help give women that softer smoother look to their skin. There is always a battle in their bodies between which hormone prevails and wins the war. Recruiting more estrogen can help turn the tide, so one of the initial treatments of acne for young girls is estrogen.

One of the easiest methods of hormonal therapy to help overpower the androgens being secreted within her body are birth control pills. Whether a girl is sexually active or not, she could benefit from taking the pill in multiple ways. Not only will her acne get better, but her menstrual cycle could also become more tolerable with more regularity, less bleeding, less cramping, and even less PMS.

In order to obtain these medications, she must visit her doctor, such as her gynecologist or family physician. They can prescribe this hormonal therapy for her, but can also prescribe other treatment that treat and improve acne problems.

REDUCE THE EXTRA SEBUM AND OILINESS OF THE SKIN

Practicing good skin hygiene is the key to reducing the effects of excess sebum and oils on the skin. Wash your skin, but don’t over wash. It’s not the dirt on the skin that causes acne; it’s the sebum that plugs the pores. Excessive scrubbing and washing wont make acne go away. Over washing may simply irritate the areas and dry the skin, which could stimulate formation of even more sebum.

Thus, wash your face twice a day with gentle soaps and water. You should use products especially formulated for acne cleansing. Avoid products with high alcohol content that can also dry the skin excessively, stimulate more sebum, irritate inflamed areas, tear your skin, and potentially aggravate your acne. Get in the habit of washing regularly with the correct soap and technique.

Don’t squeeze or pick acne lesions. These simply can worsen acne by forcing bacteria and sebum deeper into the skin causing more inflammation and infection. It can also increase the damage to the surrounding skin resulting in a potentially permanent acne scar. Your hands can carry bacteria to the follicles, so excessive toughing of your face, including rubbing or even resting your chin in your hands can drive bacteria into your pores and worsen the acne.

When you exercise, make sure you shower afterwards. The vigorous movements you do during exercise generate heat and sweat. Clothing and equipment on the skin can cause friction. These can trap moisture and secretions within the skin creating ideal breeding grounds for the growth of bacteria to worsen acne. Thus, showering off immediately after exercising can indeed help.

Maintain a program of daily oil control. Every day you should use preparations that decrease the oils on the skin to help prevent the buildup that results in acne. You should use a preparation that is properly balanced for your skin and one that leaves your skin looking radiant instead of oily. Use an agent that keeps your pores from clogging while keeping your skin shiny throughout the day. Persistence and maintenance are keys to successful acne treatments.

REDUCE THE DEAD CELL WITHIN THE FOLLICLES THAT CAUSE COMEDONES

Treatments that encourage the peeling of the top layer of the skin help to open plugged follicles and help reestablish the normal skin-cell replacement cycle. The sebum and exfoliating cells are thus less likely to plug the pores which could lead to formation of comedones that could become infected and inflamed. Unclogging pores can help resolve and prevent further acne lesions.

Initially, one should use one of the over the counter medications to exfoliate the skin. Formulations containing salicylic acid or glycolic acids may help. These mild acids peel the skin and encourage the sloughing of dead skin cells by destroying the superficial layer of skin cells and allowing these dead cells to be removed with proper skin hygiene.

Other peeling agents include benzyl peroxide, resorcinol, sulfur and retinoid (vitamin A acid). If one agent is not helping, one should try another. Always give each option an adequate trial to see if it is effective for your particular problem without excessive unwanted side effects.

If these over the counter options are not adequate, further peels can be done with stronger agents. These treatments include chemical peels using a variety of substances that are more effective in peeling the skin to unplug the pores. In addition, they also can smooth the skin, stimulate collagen formation, decrease unwanted pigmentations, and leave your skin with a fresher look. Ask your doctor about chemical peels and the options available to you.

REDUCE THE BACTERIA THAT CAN INFECT THE COMEDONES

The bacteria that causes acne is called Propionobacterium acnes, or P. acnes. By killing these bacteria using topical and oral antibiotics, we can reduce the inflammation that can progress to scarring and disfigurement of the skin. This process can take several weeks or months to show an effect so people must be patient when they use them. Even when one sees marked improvement, it is not a “cure”, since the bacteria can recur and continue to cause problems unless their numbers on the skin are reduced on a continual basis.

Some over-the-counter preparations contain benzyl peroxide which has mild antibacterial properties. Starting with topical agents is a good idea since you can try them without seeing a physician. Use them as directed on their labels. They take time to work and doubling up on them or using them more frequently won’t make your skin clear up twice as fast.

If OTC medications are not helpful, you should consider visiting your physician and be evaluated. Your physician can then give you a prescription for stronger antibiotics and you can have your skin evaluated regularly with this medical supervision. Your progress can be monitored, side effects can be lessened, inappropriate treatments can be discarded, and successful outcomes can be achieved.

Some of the common antibiotics used include tetracyclines, erythromycin and clindamycin. Whether applied topically or given orally, these antibiotics have been shown to be very beneficial in treating acne over time. They may need to be used over a long period of time so visiting your physician may be a necessary event to rid yourself of embarrassing acne inflammation.

Most of the time, antibiotics help clear the skin without unwanted side effects. However, one must be aware of some of the potential unwanted effects that might occur when taking them. Photosensitivity (higher risk of sunburn) is a side effect of many of these agents, so one must use sun screen and be very careful of excessive sun exposure. Some women develop vaginal yeast infections when they take antibiotics, but these are usually adequately treated with over the counter vaginal creams. If a woman is trying to become pregnant, she should not take tetracycline antibiotics for in may cause discoloration of the developing child’s teeth. Other potential risks are development of resistance strains to these antibiotics. However, overall, the wonderful acne-improving benefits one receives from taking them outweigh any potential unwanted side effects. Discuss these with your physician before you begin therapy with them.

Another mode of acne therapy is the use of ultraviolet (UVa) light therapy. This therapy involves exposure of the acne skin to UV light which helps reduce action by killing the P. acne bacteria via a different mode of action. Through their natural metabolism, P. acne produce a compound called porphyrine. Porphyrines absorb the wavelengths of light (~415 nm), which results in making the porphyrine to fluoresce. This starts a biochemical process which releases oxygen and separates it from the bacteria, killing it or slowing its growth. This anti-bacterial effect of these lights result in a reduction of the inflammation in the skin pore by eliminating the cause of the inflammation, i.e. the bacteria. Thus it treats the acne very well with minimal to no side effects.

Using Intense Pulse Light (IPL) therapy in the UVa light wavelength spectrum helps treat the skin to reduce the inflammatory effects of acne. In addition, using IPL in the red light range can help rejuvenate and heal the skin. Red light therapy is commonly used in standard classical medicine. A frequent use is to stimulate the wound healing process and for reducing the scar formation after operations. It relaxes and stimulates blood circulation in compromised tissue.

The red light — as many trials of independent scientists have shown — stimulates the white blood cells to produce fibroblasts, a building block of new tissue, accelerating the healing process. Inflammations heal more effectively and swelling is reduced. This is precisely the effect that IPL therapies can take advantage of.

Acne Before and After IPL Treatments

REDUCE THE INFLAMMATION THAT CAN LEAD TO SCARRING

Inflammation is the body’s natural response to the presence of infected material in plugged pores. Your skin wants to remove the P. acnes bacteria with the debris around it and heal the skin. Unfortunately, this healing process can result in scarring if the inflammation is excessive. Therefore, reducing this inflammation is essential in treating acne to preserve natural appearing skin.

There are multiple agents and methods available to acne sufferers that have been shown to be very effective in treating this inflammatory process. Almost all of the best preparations are available by prescription only, so you must see your physician to get them. Topical and oral medications, laser treatments, and nutritional supplements may assist in this matter. A combination of several of these options may be the best solution to treat inflamed acne lesions and to help decrease nodule formation and scarring.

Topical agents include several options available by prescription. The main one to begin using is Tretinoin, sold under various names such as Retin-A®, Avita®, Renova®, or Vesanoid®. Tretinoin is retinoic acid, also called vitamin A acid. The exact mode of action of tretinoin is unknown. It decreases formation of comedones, stimulates mitotic activity and increases turnover of follicular epithelial cells. In essence, it increases the extrusion of the comedones and helps rejuvenate the skin to heal acne lesions.

Regardless of how it works, the fact is that it does work, and it works very well. The inflammation of acne lesions is remarkably reduced when tretinoin is used on a nightly basis. It is a basic treatment of acne that everyone should be using if they suffer from this condition. In addition, tretinoin has a proven track record of reducing the ill effects of aging on the skin and is therefore used in many other anti-aging regimens to help maintain more youthful looking skin.

Other agents are adapalene (Differin® ) and azelaic acid (Financae®). Adapalene has actions similar to tretinoin. Both products help unblock pores, reduce inflammation, modulate cellular differentiation, keratinization and inflammatory processes. All of these actions represent important features of the pathology of acne.

When the inflammation is severe and nodules with cysts develop, an oral Vitamin A preparation may be utilized called Isotretinoin (Accutane®, Amnesteem®, Claravis®, and Sotret®). Isotretinoin works by causing the oil glands in the skin to shrink. They thus produce less oil, with subsequent reduction in the formation of acne lesions. However, this should only be prescribed under strict guidelines by a knowledgeable physician since serious side effects may occur from taking this medication.

Once the inflammatory damages have occurred, scarring of the skin may result. There are many treatments available that will lessen this scarring, but none result in perfectly smooth skin. However, improvements are usually very welcome. Therapies to reduce the superficial layer of skin are utilized to help lessen these scars. These include laser therapy, dermabrasion, microdermabrasion and chemical peels. Each has its own risks and benefits, but all help when performed over time.

SUMMARY

In summary, the goals of the treatment of acne are many. We want to decrease sebum collections and excess clumping of cells forming comedones using multiple modalities including hormone therapy, exfoliating and cleansing agents. We want to kill the bacteria that cause inflammation with the use of antibiotics, topical compounds and UVa or IPL light therapy. After acne has begun its damaging process, we want to heal existing lesions, stop new lesions from forming, prevent scarring, and minimize the psychological stress and embarrassment caused by this disease. Drug treatments are many and are aimed at reducing many of the problems that play a part in causing acne. Other therapies include chemical peels to exfoliate and smooth the skin, and IPL (Intense Pulsed Light) therapies to further kill the bacteria and improve healing of the acne lesions. Only a visit to a knowledgeable physician will help you to find the right therapy for you.

Robert L. True, MD, FACOG, AACS Colleyville, TX817-399-TRUE Smart Choices for a Better Body: SmartLipo – Smart Breast Aug – Smart Tummy Tuck – Aesthetics – Gynecology – The True Wellness – Mommy Makeover