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Benzyl peroxide is a good product for reducing active acne
lesions and also has anti-inflammatory properties. It is found
in well-known products such as ‘Pro-activ’ but
is also available more inexpensively over-the-counter at your
local pharmacist. It is available in concentrations up to
10%. The higher the concentration, the more flaking and irritation
to the skin. Therefore, commencement should be with the lower
concentrations.
Retinols, derivatives of Vitamin A, are also used in the
treatment of acne. Retinols work by increasing the natural
turnover rate of the skin. Therefore there are less dead skin
cells at the surface of the skin and less blockages as a result.
This property of retinols also means that skin texture and
fine wrinkles also improve. The downside of retinols is the
initial response of the skin, or the ‘retinoic response’.
Skin can usually appear red, flaky, lumpy, and irritated for
up to one month after commencement of retinols. Starting slowly
is important to reduce these side effects. Sunscreen is also
imperative with the use of retinols as they can initially
exacerbate sun sensitivity. Retinols should not be used in
pregnant mothers, those planning to be pregnant, or those
who are breast-feeding.
Examples of Vitamin A derivatives include prescription-only
variants such as Stieve-A, and Retin-A. Cosmedix also has
a range of retinols of varying strength. Although more expensive
than their prescription-only variants, they have the added
property of being ‘chirally correct’. Each molecule
has a left and a right-sided version, like a pair of hands.
In the case of retinols, the left sided version is more active
and less irritating to the skin. Cosmedix has more of the
left sided version of the molecule and is therefore ‘chirally
correct’.
Microdermabrasion
Microdermabrasion is another method of helping to physically
remove dead skin cells from the surface of the skin and reduce
pore blockage and acne. It is especially effective for comedones
(blackheads). It also helps with the penetration of skin care
products. Microdermabrasion also improves lymphatic drainage
of the face.
Make-up/foundation
Make-up is also implicated in the cause of acne. Foundations,
even those claiming to be ‘oil-free’ can physically
block pores and cause acne. This often leads to a vicious
cycle of applying make-up to cover acne lesions, and in turn
this causes more acne, leading to the use of more make-up.
Acne due to make-up use is termed ‘acne cosmetica’.
Mineral make-up does not block pores, and instead sits on
top of the skin. At The Victorian Cosmetic Institute, we recommend
Glo-minerals foundations as they have anti-oxidants and anti-inflammatory
properties as well as being a mineral make-up. Importantly,
they also have a SPF factor to help prevent aging and post-inflammatory
hyperpigmentation from acne lesions (see below).
Antibiotics
Antibiotics have also been widely used in the treatment of
acne. Antibiotics work by reducing the acne-causing bacteria
(including Propionobacterium acnes) at the surface of the
skin. Antibiotics are most suited to inflamed acne lesions.
They do unfortunately also affect the rest of the body as
well as the skin, and can result in side effects such as oral
and vaginal thrush, diarrhoea, liver function abnormalities,
and sun sensitivity. Minomycin has also been associated with
hyperpigmentation when used for prolonged periods. Antibiotics
such as doxycycline, minomycin, clindamycin, trimethoprim,
trimethoprim plus suxamethoxazole (Bactrim), are commonly
prescribed for prolonged periods. The author does not believe
in the long-term use (greater than 2 months) of antibiotics
for acne as their efficacy is low and the potential side effects
can be significant. Penetration into the skin can also be
minimal. With widespread use of antibiotics for acne, there
is increasing resistance of the acne-causing bacteria to the
commonly used antibiotics, resulting decrease in their effectiveness.
Topical antibiotics are another option for the treatment
of acne. Common examples of topical antibiotics include erythromycin
(Eryacne gel) or clindamycin (Clindatech lotion). As for oral
antibiotics, they require a prescription from a doctor. The
advantage of topical antibiotics is they have no systemic
side effects, and can have some anti-inflammatory properties.
Hormonal treatments
Particular hormones, in particular androgens, have also been
known to increase oil and sebum production and exacerbate
acne.
For females, options for controlling the hormones that cause
acne include particular variants of the oral contraceptive
pill. The variants that are of particular use are the ones
containing Cyproterone acetate or Aldactone. The trade names
of the pill containing these ingredients include; Dianne-35
and Yasmin. Cyproterone acetate and Aldactone work by helping
to switch off the androgenic hormones, or the hormones that
increase oil/sebum production and cause acne. Aldactone can
also be used without the pill in those females who do not
want to be on the pill. It is, however, not compatible with
pregnancy, so it is not suitable for those females who are
attempting to fall pregnant or who are pregnant.
Oral Isotretinoin/Roaccutane
Roaccutane, or oral isotretinoin, also a derivative of Vitamin
A, is the gold standard in the treatment of acne. Prescribed
only by dermatologists, it is mostly used for severe forms
of acne only, as it has a number of significant side effects.
Generally, a six-month course is prescribed, and involves
taking a tablet or two each day. The side effects from Roaccutane
are the main problem with treatment and include; dry skin,
dry eyes, dry lips, cracked lips, hair loss, mood changes,
and liver function abnormalities. Pregnancy must be completely
excluded during treatment with Roaccutane, as it is known
to cause serious birth defects.
Photodynamic therapy
Recently, there have been advances in the treatment of acne
that do not involve drugs with significant side effects, and
can be highly effective. Photodynamic therapy is such a treatment
that targets sebaceous gland activity. Being a localised treatment,
it only has localised side effects, ie on the treated skin.
There has been some studies showing that it may be as effective
as Roaccutane in some cases. Photodynamic therapy works by
placing a substance called 5-aminolevulenic acid on the skin,
which is attracted specifically to the sebaceous glands, and
then activating the substance with a light source or laser.
This specifically disrupts the function of the sebaceous glands
and reduces their activity and the acne they cause. The results
can last up to a year and some people require no further treatments
for acne after their initial treatments.
Sunscreens
Sunscreens are important to help reduce pigmentation after
an acne lesion has passed. However, some sunscreens themselves
can cause acne by blocking pores. At The Victorian Cosmetic
Institute, we recommend Reflect sunscreen from Cosmedix. Reflect
is a spray on, non-oily sunscreen with Titanium Dioxide.
Overall, acne is a problem that has many arms of treatment.
The more of these that can be implemented, the greater the
chance of success. There are a number of treatments now that
are an alternative to Roaccutane and its side effects, although
it still remains the gold standard in acne treatment. Acne
is a problem not just only of teenagers, but also of people
in their twenties, thirties and forties. It is an important
issue to address in all cases, as not only does successful
treatment resurrect lost confidence, but prevents scarring
that is often irreversible.
Dr. Gavin Chan (MBBS)
The Victorian Cosmetic Institute
Level 6, 200 High St
Lower Templestowe 3107
(03)88500655
www.thevictoriancosmeticinstitute.com.au
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