The most prevalent skin problem all around the world is acne. It is a long-lasting inflammatory skin disease, presenting with whiteheads, blackheads, pimples, cysts, and nodules, on the face and upper body. It starts appearing at puberty; women are more affected than men but men have a more severe disease.
Acne and pimples have the humour of breaking out at times when they are least needed. An occasional, solitary pimple is easily concealed by makeup. Water-based creams and cosmetic products are also helpful if it becomes too bothersome. But some individuals tend to have repeated or extensive acne, giving rise to irritation, depression, reduction of confidence, and many other problems. However, laser acne removal may help.
What actually Happens
To control acne, we must first understand the mechanisms behind it.
Skin is made up of layers and in-between these layers are glands that secrete the oily liquid called sebum. Sebum reaches the skin surface through pores in the skin. Some pores and glands are linked with hair follicles. The functions of sebum include clearing the pore and transporting dead cells to the surface. When these pores get blocked by clumps of dead skin cells, hair cells and sebum, the secretions are trapped inside the pores initiating an inflammatory response. Moreover, the stasis of secretions can become infected with the skin bacteria, called Propionibacterium acnes. The result: acne.
This brings us to the conclusion that for any type of medicine to work for acne, it should affect one or more of the three basic factors involved: sebum production, clogging of pores, and bacterial growth.
So what are the possibilities that can save us some embarrassing moments and give us a clear skin? There is no one-size-fits-all rule for treating acne; every skin reacts differently to the medicines. Some common methods of acne removal are as follows.
General Treatments for Acne/ OTC
Soap and water– Gently cleaning the skin up to twice a day, prevents new eruptions.
Face washes, cleansers, and topical solutions– Acne specific cleansing products and topically applied liquids, like creams, ointments, solutions, pads, foaming gels, etc., commonly contain the following compounds:
Benzoyl peroxide– Found in over-the-counter products for mild to moderate acne and prescribed forms for severe cases. It kills the bacteria involved with acne formation. It is recommended for use up to four times a week. As long as it is used, it will prevent new eruptions, but stopping its use can restart acne. Benzoyl peroxide acts as a bleaching agent, so it may cause skin irritation, dryness, and increased sensitivity to light.
Salicylic acid– enhances the skin shedding and opens pores. Salicylic acid is also available as OTC component and prescribed in concentrated forms. It prevents new crops if used continuously. Discontinuing its use can result in acne as the shedding may become improper again.
Sulfur– Prevents clogging of pores and inhibits the bacterial growth. Sulfur-containing compounds form part of OTC skin-care products that also contain alcohol, salicylic acid, and sodium sulfacetamide. But the use is limited because of its unpleasant odour and side effect of skin discolouration.
Topical Retinol– Increases cell turnover and prevents clogging of pores. It starts working in the deep layers of skin, so it may give a false impression of increasing acne, rather than cleaning from the root level. It takes 8-12 weeks for the results to show. It also prevents the formation of new acne. Even though retinol is a form of vitamin A, excess can have adverse effects, such as dry irritated skin, and increased skin sensitivity to light.
Retinols and benzoyl oxide have counteracting effects, so recommended to be applied at different times of the day.
Alcohol/acetone– Alcohol is antibacterial while acetone is a cleanser. These are available as a combination therapy in OTC anti-acne products. They do not act on acne but dry out skin and reduce sebum production. These are not recommended by dermatologists
Hot towel application on pus filled pimples encourages natural bursting.
Inflamed and red hot pimples should not be squeezed, unless done under guidance of doctor or nurse, under all aseptic techniques for required reasons
Squeezing or forcefully bursting pimples results in skin infections and leaves scar marks
Antibiotics-Clear the bacteria from the skin and reduce inflammation. Available in both forms; topical as gels, creams, and solutions, and systemic forms as tablets and caplets. Topical forms act directly on the skin but limited penetration and absorption does not help in deep-seated acne and infections. Systemic or oral antibiotics circulate throughout the body and are secreted into the glands, thus acting on the deep-seated acne.
Topical antibiotics include clindamycin and erythromycin, while oral options aretetracyclines, doxycycline, and minocycline.
Side effects include gastrointestinal upset, increased sensitivity to light, risk of yeast infections in women, and emergence of resistant bacteria.
Antibiotics take longer periods to work and are used in combination with pore de-clogging agents, like retinoids, and benzoyl peroxide.
Retinoids- mostly available as prescribed forms for two reasons; side effect profile and reserved therapy for severe forms of acne. Retinols are essentially vitamin A derivatives, available in topical, as described above, and oral forms.
Isotretinoin is used in severe cases of acne, and those not responding to other therapies. It is affects all three basic factors of acne. It is given with benzoyl peroxide and antibiotics.
Side effects include dry lips and skin, muscular and joint pains, headache, high triglycerides, liver damage, vision disturbances, hair loss, risk of depression, self-harm, and inflammatory bowel disease. Isotretinoin also has severe adverse effects in babies, so it is never given to pregnant and breast-feeding mothers and those trying to conceive and not on birth control. Used in combination like. Topical retinols have less side effects but high risk in pregnancy limits its use to mostly prescribed forms.
Azelaic acid– available as topical gel, foam, or cream. Azelaic acid has antibacterial and anti-inflammatory properties. It is recommended for rosacea type of acne and occasionally for mild acne.
Dapsone – a topically used antibacterial and anti-inflammatory medicine.
Oral contraceptives pills (OCPs)- commonly called birth control pills. OCPs are used exclusively in females because these contain female hormones and they counter the effects of male hormones. The effect takes months to show. The side effects of hormonal medications include nausea, vomiting, menstrual changes, breast tenderness, and risk of spontaneous blood clot formation.
Spironolactone/Aldactone– not recognized for acne. It’s an oral drug that affects salt composition of urine and hormone production. It indirectly blocks the glands from making sebum and is used particularly in those who have acne at time of menses and menopause.
Clascoterone– new medication approved for topical application in acne. It is usable in moderate to severe acne. Its mechanism of action is not completely clear but it targets the hormones in both genders.
Triamcinolone– a steroid that is injected into the acne lesion to reduce inflammation and scar formation.
Disclaimer: All medicines are recommended to be taken only after the advice of a trained professional. Medicines can have allergic reactions, severe side effects and interaction with other medications or supplement.
Acne is affected by hormone levels, genetic susceptibility, lifestyle, and environmental conditions. Preventing acne is difficult, yet not impossible. In addition to the medicines listed above, tips to reduce new eruptions include:
- Using non-comedogenic, sensitive skin products, like sunscreens and makeup
- Using mild cleansers at least twice daily, alcoholic-free and nonabrasive
- Avoiding gritty scrubs and cleansers
- Avoid picking and squeezing pimples
- Maintain a healthy and balanced diet with an adequate amount of hydration and rest.
Acne is a skin issue affecting all and sundry, with resulting demoted confidence and self-esteem. Numerous skin-care products and medicines help prevent, conceal, and reduce acne. Every skin reacts differently to the products and is advised to consult a professional dermatologist before embarking on using one. Keeping a healthy hygiene and self-care routine makes an important step in controlling acne.