Almirall
Acne

Acne treatments

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How to treat acne

There is not no single effective treatment for acne, so sometimes a combination of treatments is recommended. 

Since acne lesions take at least eight weeks to mature, the treatment must be maintained for a minimum of two to three months before deciding if it is effective. 

Acne pre-treatment evaluation

To decide the most appropriate treatment for acne for each individual, the following information is required the following information from the medical history and physical examination:

Clinical type and severity of acne

To determine the types of treatment required.

Skin type

Dry or oily, helping to choose a topical pharmacological vehicle. This choice is important because it conditions the effectiveness of treatment by affecting absorption and duration of action. Topical vehicles are the medication, such as ointment, cream, gel, lotion, spray or powder.

Presence of acne scars

This will indicate the need to consider a more aggressive therapy and treatment for acne.

Presence of post-inflammatory erythema or hyperpigmentation

This helps determine whether treatments for these signs should be considered.

Menstrual cycle regularity and history of signs of hyperandrogenism in women

To help determine the need for additional lab tests and hormone treatments.

Periodicity of the menstrual cycle and history of signs of hyperandrogenism in women

To help determine the need of additional lab tests and prescription of hormone treatments.

Skincare habits and previous acne treatments

To identify potential issues in skin care and previous treatments that may have worked or not.

Cosmetic products or other medications

To identify products that may favour the occurrence of acne.

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Principles of acne treatment

Acne treatment is mainly intended for key factors promoting the development of acne lesions: follicular hyperproliferation and abnormal desquamation of epithelial cells (keratinocytes),increased sebum production, excessive growth of Cutibacterium acnes, and the presence of inflammation.

The first choice for most cases of acne. Topical retinoids may cause redness in the skin and, during its use, it is recommended to apply sun protection factor (SPF) of 30 or higher.

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Approach to acne treatment

An example of a general approach to the initial treatment of acne based on the 2016 American Academy of Dermatology would depend on the patients' type of acne and their medical history (table).

General approach to treatment based on patient's type of acne:

  • Comedonal (Non-Inflammatory) acne: Topical retinoid (azelaic acid or salicylic acid)
  • Mild and mixed (Comedonal) Papulopustular Acne:
    • Topical antimicrobial treatment (benzoyl peroxide alone or benzoyl peroxide + topical antibiotic) + Topical retinoid
    • Benzoyl peroxide + topical antibiotic (for patients who do not tolerate retinoids or require a simplified treatment regimen)
  • Moderate and mixed papulopustular acne: Topical retinoid + Oral antibiotic + Topical benzoyl peroxide
  • Severe acne (e.g. Nodular Acne):
    • Topical retinoid + Oral antibiotic + Topical benzoyl peroxide
    • Monotherapy with oral isotretinoin 

Maintenance of acne treatment

Skincare is essential for the treatment of acne. For the treatment to be more effective, some habits must be followed.

Skin hygiene

The face should not be washed more than twice a day with warm water (not hot) and a mild facial cleanser without soap. It is not recommended to use face cloths or sponges or rub the face because this may worsen acne and damage skin. Pimples should not be squeezed because this may worsen acne and cause swelling and leave scars on the skin, or cause lesions to become infected.

Moisturizing creams

The use of a moisturizing cream reduces skin dryness and, therefore, desquamation. You must use creams with labels indicating that they are non-comedogenic to reduce the probability of skin pores becoming blocked.

Sun protection

Some acne treatments, such as retinoids or doxycycline, increase skin sensitivity to sunlight, so it is advisable to avoid excessive sun exposure and always use a sun protection factor (SPF) of 30 or higher, which blocks both ultraviolet A (UVA) and ultraviolet B (UVB) radiation. 

FAQs

References