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
