Acne Treatments and Remedies
There are a myriad of products sold for the treatment
of acne, many of them without any scientifically proven effects. However,
a combination of treatments can greatly reduce the amount and severity
of acne in many cases. There are four types of treatments that have
been proven effective:
Killing the bacteria that are harbored in the blocked
follicles. This is done either by the intake of antibiotics like tetracyclines,
or by treating the affected areas externally with bactericidal substances
like benzoyl peroxide or erythromycin.
However, reducing the P.acnes bacteria will not, in
itself, do anything to reduce the oil secretion and abnormal cell
behaviour that is the initial cause of the blocked follicles. Therefore,
acne will generally reappear quite soon after the end of treatment—days
later in the case of topical applications, and weeks later in the
case of oral antibiotics.
Reducing the secretion of oils from the glands.
This is done by a great daily oral intake of Vitamin
A derivates like isotretinoin over a period of a few months. The product
is sold by Roche under the names Accutane in USA and Roaccutane in
Europe. Isotretinoin has been shown to be very effective in treating
severe acne and is effective in up to 80% of the patients. The drug
has a much longer effect than anti-bacterial treatments and will often
cure acne for good. The treatment requires close medical examination
by a dermatologist since the drug has many known side effects (which
can be severe).
At the end of the initial treatment, about 25% of
patients need to take a second treatment for another few months to
obtain desired results. The most common side effects are dry skin
and nosebleed. It can also permanently damage the liver and, some
studies suggest, cause depression. Because of this, the drug is typically
used given a last resort after milder treatments have proven insufficient.
The drug also causes birth defects if women become pregnant while
taking it. For this reason, female patients are required to either
use birth control or vow abstinence while on the drug.
Normalizing the follicle cell lifecycle
A group of medications for this are topical retinoids
such as Tretinoin (brand name Retin-A), Adapalene (brand name Differin)
and Tazarotene. Like Accutane/Roaccutane, they are related to Vitamin
A, but they are administered as topicals and generally have much milder
side effects. They can give significant irritation of the skin, but
are probably rather less nasty than Accutane because less of it circulates
in the bloodstream.
The retinoids appear to influence the cell creation
and death lifecycle of cells in the follicle lining. This helps prevent
the hyperkeratinization of these cells that can create a blockage.
Retinol, a form of Vitamin A, has similar but milder effects and is
used in many over-the-counter moisturizers and other topical products.
Exfoliating the skin
This can be done either mechanically, using an abrasive
cloth or a liquid scrub, or chemically. Common chemical exfoliating
agents include salicylic acid and glycolic acid, which encourage the
peeling of the top layer of skin to prevent a build-up of dead skin
cells which combine with skin oil to block pores. It also helps to
unblock already clogged pores.
Note that the phrase "peeling" is not meant
in the visible sense of shedding, but rather as the destruction of
the top layer of skin cells at the microscopic level. Depending on
the type of exfoliation used, some visible flaking is possible. Moisturizers
and anti-acne topicals containing chemical exfoliating agents are
commonly available over-the-counter.
Phototherapy
It has long been known that short term improvement
can be achieved with sunlight. However studies have shown that sunlight
worsens acne long-term, presumably due to UV damage. More recently,
visible light has been successfully employed to treat acne- in particular
intense blue light generated by purpose-built fluorescent lighting,
or lasers. Used twice weekly, this has been shown to reduce the number
of acne by about 64% [1].
The mechanism appears to be that the porphyrins generated
by the P.Acnes, under irradiation by blue light, generate free radicals
damaging, and if consistently applied over several days, ultimately
kill the bacteria [2].
Since porphyrins are not otherwise present in skin,
and no UV light is employed, it appears to be safe, and has been licensed
by the U.S. FDA [3].
However, the equipment is relatively expensive; several hundred US
dollars upwards (c. 2004), and works best for mild-moderate acne.
Benzoyl peroxide and the topical retinoids
These may be the best compromise between cost effectiveness
and genuine effectiveness and negative side effects in many cases.
The topical retinoids are relatively new and not as widely used as
the other treatments as of the year 2004. It is highly advisable to
ask a dermatologist about the tradeoffs between these treatments for
any individual case.
Popping a pimple or any physical acne treatment should
not be attempted by anyone but a qualified dermatologist. Pimple popping
irritates skin, can spread the infection deeper into the skin and
can cause permanent scarring.
Future Acne Treatments
Lasers have been in use for some time to reduce the
scars left behind by acne, but research is now being done on lasers
for prevention of acne formation itself. The laser is used to produce
one of the following effects:
- to burn away the follicle sac from which the hair
grows
- to burn away the sebaceous gland which produces
the oil
- to induce formation of oxygen in the bacteria,
killing them
Since lasers and intense pulsed light sources cause
thermal damage to the skin there are concerns that laser or intense
pulsed light treatmnts for acne will induce hyperpignmented macules
(spots) or cause long term dryness of the skin. As of 2004, this is
still mostly at the stage of medical research rather than established
treatment.
Because acne appears to have a significant hereditary
link, there is some expectation that cheap whole-genome DNA sequencing
may help isolate the body mechanisms involved in acne more precisely,
possibly leading to a more satisfactory treatment.
(Crudely put, take the DNA of large samples of people
with significant acne and of people without, and let a computer search
for statistically strong differences in genes between the two groups).
However, as of 2004 DNA sequencing is not yet cheap and all this may
still be decades off. It is also possible that gene therapy could
be used to alter the skin's DNA.
Treatments For Acne Scars
Severe acne often leaves small scars
where the skin gets a "volcanic" shape. Acne scars are very
hard (and expensive) to treat and it is unusual for the scars to be
successfully removed completely.
In those cases, scar treatment may be appropriate.
The most commonly used forms of scar treatments are:
Dermabrasion. Dermabrasion involves
the removal of the surface of the skin with specialist equipment and
usually involves a general anaesthetic. The top layer of the skin
is removed to make the scar look less pitted. It makes the scar less
visible but does not remove it completely. It is useful when the scar
is raised above the surrounding skin, but is less effective with sunken
scars. Multiple treatments may be necessary to get the desired results.
This procedure is usually performed by a cosmetic surgeon.
Microdermabrasion is a newer technique
that has a similar effect to traditional dermabrasion, but is less
radical. While dermabrasion is a surgical procedure, microdermabrasion
is performed by blasting tiny crystals at the skin. Many dermatologists
and cosmetic surgeons offer this procedure.
Laser resurfacing. A laser is used
to burn off the top layer of the skin. This procedure is commonly
known by the brand names of the machines used to perform it, including
SmoothBeam. Many dermatologists and cosmetic surgeons offer this procedure.
Punch excision. The scar is excised
with a punch tool and the edges are sutured together. This procedure
is usually performed by a cosmetic surgeon.
Chemical peels (also known as acid peels).
A type of organic acid, most commonly glycolic, salicylic,
or lactic, is applied to the skin so that a smoother layer can surface.
Despite its unpleasant name, this procedure is painless if performed
properly and requires no anaesthetic. Peels are typically performed
several times over a period of weeks or months. The procedure can
also be beneficial for active acne. Many dermatologists and cosmetologists
offer this procedure, although the peels given by dermatologists are
generally of a higher concentration and therefore potentially more
effective.
Subcision. The scar is detached from
deeper tissue, allowing a pool of blood to form under the scar which
helps form a connective tissue under the scar, levelling it with the
surface. This procedure is usually performed by a cosmetic surgeon.
Dermal filler. The
scar is filled with an injectable dermal filler like Bio-Alcamid®.
Polyalkylimide is the active ingredient in Bio-Alcamid® (manufactured
by Polymekon, Brindisi, Italy) which is a 3% polyalkylimide suspension
in water used medically to treat soft tissue deficits like facial
lipoatrophy and lipodystrophy, Poland syndrome, Pectus excavatum (sunken
chest), gluteal atrophy, acne scars etc. Bio-Alcamid® is commercially
available since 2000 and used by doctors in Europe and Mexico. The
FDA has not yet approved its use in the United States. In Canada it
is available only under provisions of the Special Access Program,
which involves application
