Acne is a common problem that affects about 90% of teenagers. The impact of acne may appear minimal to an observer but may be significant to the young person involved. Adolescence is a time of low self-esteem, high peer pressure, rebellion against authority, and struggles to establish independence.
Treatment of acne is aimed at preventing the formation of comedones, papules, and pustules and reducing inflammation. Treatment is preventive, not curative, improvement may be slow and medication should only be changed after 2 months of therapy, or if there is skin irritation from the topical product.
Some basic principles for acne treatment include:
- Washing the affected area twice daily with a mild cleanser and water
- Acne products should be applied to all affected areas rather than just individual spots.
- Avoid applying oily cosmetics such as foundation or sunscreen.
- Picking or popping pimples only increases inflammation and potential for scarring.
MILD ACNE can often be treated with topical treatments that can be obtained over the counter (OTC). Much of early acne treatment is trial and error, finding the right product that works best for an individual patient.
Suitable topical agents for mild acne that can be obtained without prescription include:
- Antiseptic washes with triclosan or benzoyl peroxide
- Mild salicylic acid preparations to exfoliate and unclog follicles
- Benzoyl peroxide creams/lotions/gels
When OTC products alone are not sufficient topical antibiotics can be used in combination with prescriptions comedolytics.
MODERATE ACNE requires the addition of oral medication when the acne is more inflamed or if there is inadequate response to topical medications. This is usually prescribed for 3-6 months in addition to the topical agents described above. Oral medications include antibiotics as well as, for females, oestrogens and anti-androgens found in some contraceptive pills. When oral antibiotics are discontinued, control should be maintained long term by continuing topical therapy.
SEVERE ACNE may require treatment with isotretinoin under the care of a dermatologist. This should be used for cystic, scarring acne that has not cleared with oral antibiotics used over adequate time periods.
As your General Practitioner, I will help to assess the situation, medicate where necessary and ensure the patients’ comfort and well-being. Through the years of experience and taking on board the feedback from our patients, IMC is well placed to find the best expert help in our network of specialists should it be deemed necessary.
By Dr Kaye McMullan
MBBS (Western Australia, Australia)