Acne is probably the most frequent dermatological consultation and one of the most dissatisfying skin disorders. Fortunately any patient, with the right treatment, can be helped to clear up most acne lesions.
At what age can I suffer from acne?
Acne can affect any age from newborns to adults over 50 years old. We must discard the idea that acne is a consequence of age (puberty) and therefore it will necessarily disappear after a while and does not require treatment. By treating the problem of acne from the beginning we will avoid the appearance of scars, which, once established, are difficult to eliminate.
The success of acne treatment will depend on the appropriate therapeutic selection according to each patient, the type of acne lesions and the duration of the acne. Factors such as age, work, presence of concomitant diseases and medication, the possibility of pregnancy and hygienic habits should be evaluated. In the dermatological visit we can establish a specific treatment program against acne that can be modified later according to the evolution.
What types of acne treatments are available?
In recent years, new anti-acne treatments have been incorporated, which are very important in the management of patients, especially those with severe and scarring acne. Acne treatment is divided into topical therapy, systemic therapy and physical therapies for acne and scarring.
Topical therapy is useful in:
- mild and recent acne (basically teenagers with few “pimples “and few “pus pimples “that when they go away do not leave a scar).
- moderate acne in combination with oral therapy
- as maintenance therapy after systemic acne treatment.
The most commonly used topical agents are: benzoyl peroxide, topical retinoids, topical antibiotics, salicylic acid, azelaic acid and alpha hydroxy acids. These products can be used alone or in combination and in different concentrations. Occasionally “more intense” topical treatments to be performed in the physician’s office (peelings) may be useful.
Systemic therapy includes:
- Oral antibiotics: used mainly in inflammatory acne. Basically antibiotics of the tetracycline and macrolide groups are used. Long-term antibiotic treatments are not currently prescribed because oral isotretinoin is available for persistent and/or severe cases.
- Hormonal therapy: oral contraceptives, especially those combining an estrogen with an anti-androgen progestogen, are useful and sometimes even necessary in women whose acne is clearly related to hormonal alterations or associated with irregularities of the menstrual cycle.
- Oral isotretinoin: it is the “great anti-acne agent”. When used well, it minimizes side effects and is very well tolerated. Currently we tend to use lower doses than those previously used. Its problem is that it is teratogenic, and pregnancy should be avoided during the treatment and one month after.
Physical therapies for acne and scarring: Surgical excision of comedones (blackheads) microcysts and acne cysts.
Photodynamic therapy: may be useful in the few cases of inflammatory acne in which oral treatment is contraindicated.
Treatment of scars. Lately, the fractional ablative laser has been used, which greatly improves acne scars and significantly shortens the recovery time.