Dr. Clive Anderson
ACNE IS the most common skin disorder. It affects nearly 85 per cent of people at some time in their lives. While neither life threatening nor physically disabling, it has a devastating effect on the sufferer, as it commonly occurs at a time of evolving self-esteem and high concern about appearance.
Often the effect of this condition on the teenager or adult is underestimated. Acne patients report depression, anxiety, embarrassment, social inhibition and even psychosomatic symptoms including pain and discomfort.
The acne lesion occurs in the sebaceous glands. These glands are most numerous on the face and scalp. An abnormality in the process of cell renewal in the outlet of these glands results in dead cells sloughing off in groups forming a plug. This serves to prevent sebum from escaping from the gland. The sebum and dead cells accumulate below the skin. A comedone is formed. These are either closed comedones, whiteheads or open comedones, blackheads. A particular bacteria (P. acnes) enjoys these surroundings and happily reproduces in the plugged gland, producing products that inflame the skin.
Acne bumps often heal leaving spots and scars. These are frequently more distressing to the patient than the acne lesions.
COMPLICATED TREATMENT
Most persons try the whole range of over-the-counter (OTC) products before seeking help from the dermatologist. The treatment of acne is complicated, and despite what the infomercials on television insist and popular magazines print, there is no magic bullet that works for everyone. The mere fact that so many acne cures exist is testimony to the fact that none is perfect.
The first step in successful acne treatment is good hygiene. Acne is not caused by dirt or dust on the face and excessive washing will not help and may make the acne worse by over drying the skin and causing a rebound over secretion of sebum. Abrasive cleansers may irritate the skin and allow for the entry of bacteria. Harsh soaps, perfumed soaps and antibacterial soaps make the skin more sensitive to irritation from acne medications. Wash two to three times daily using a mild soap and the fingers only. Pat dry gently.
Acne products may dry the skin requiring the use of a facial moisturiser. Look for products that are labelled 'non-comedogenic' or 'non-acnegenic'. These products often contain a sunbloc which is useful to counter the increased sun sensitivity that often occurs with the use of acne medication. Early irritation of the skin is a common side effect occurring within the first two weeks.
Apply a facial moisturiser after medication during the day
The selection of medication will depend on the type and severity of the acne, and the skin type of the patient. Topical products include those that normalise the process of keratinisation at the mouth of the sebaceous gland and so help to prevent the formation of the plug. These are the products that contain benzoyl peroxide and salicylic acid, popular in OTC formulations. Others in this group are the prescription products called the retinoids, Retin-A, Stieva-A, Isotrex and Differin. Benzoyl peroxide also exerts an antibacterial effect, significantly reducing the numbers of P. acnes on the skin.
Topical antibacterial agents, such as Cleocin-T, Steimycin solution, Clindet gel reduce bacterial count and inflammation in the acne lesion. Some products combine the two groups allowing them to act synergistically.
Oral antibiotics act by killing P. acnes and reducing inflammation. Tetracycline has been used as the preferred antibiotic since 1951. It is safe and inexpensive, but should not be taken with foods containing calcium or iron as they reduce the absorption of the drug. Doxycycline and Minocycline, both in the Tetracycline family are excellent alternatives to tetracycline.
NO CURE
These treatments do not cure acne, but serve to prevent the breakouts until the acne burns itself out. How long that may take varies from person to person and is measured in years not months.
The only drug that offers the possibility of a cure is isotretinoin (Ro-Accutane). This derivative of vitamin A works by decreasing the size of the sebaceous gland and the sebum production. This drug has several potentially dangerous side effects and patients on isotretinoin require close supervision. It has, unfairly, been cited for causing depression and suicidal ideation.
Oral contraceptives with low androgenetic activity have been found to be useful in treating acne, especially where there is a flare associated with the menses.
An orderly selection of medications and skin care products along with good patient education to dispel the many myths are necessary for the proper care of this devastating condition.
Dr. Clive Anderson is a dermatologist and venereologist; email: yourhealth@gleanerjm.com.
