Acne: Basics to know and the treatment of acne

What is acne vulgaris?

Table of Contents (toc)

Acne, also known as acne vulgaris is a common skin disease and disorder characterized by muliple lesions in skin. It affects mostly face area but may also affect neck chest and back in severe cases. 

Acne contains both inflammatory or noninflammatory lesions spread around that area. 

Acne mostly affects 'pilosebaceous units' you which is the name for 'hair follicles'. 

Acne affects above mentioned area because these areas contain most of the oil glands. 

How does acne develop?

Acne is developed by following mechanism:

1. Clogging/blocking of opening in pilosebaceous unit

2. Excessive production of sebum (oil)

3. Infection of bacteria named: Cutibacterium acnes (Proprionibacterium acnes)

4. Subsequent formation of lesion or inflammation

Acne mostly affects the teenage and early adulthood population and most of the people get rid of acne by age of 25 or earlier. 

How is acne diagnosed?

After the lesions or acne is seen in the skin the physician carefully examines the skin. 

The common findings in  are:

1. Open comedo (black head)
2. Close comedo (whitehead)
3. Papules
4. Pustules
5. Nodules
6. Cyst formation
7. Abscess formation
8. Scarring in acne

Symptoms may also include discharge, pain and irritation of the lesions. 

As acne is more common in teenage to early adulthood and invilves face, acne maybe affecting the psychology of the person, independent of how severe the disease is. 

Diagnosis of acne

Diagnosis of acne is mostly clinical. Following diagnosis maybe made by the physician depending up on the severity. 

1. Comedonal acne
2. Mild acne
3. Moderate acne
4. Severe acne/Nodulocystic acne

No lab tests are generally required for acne. In cSe of treatment failure and severe acne ghe doctor may decide to perform necessary investigations and tests. 

Comorbidities:

Comorbidities like PCOS (POLYCYSTIC OVARIAN SYNDROME) and systemic disease like diabetes may need to be ruled out and the doctor may ask symptoms related to these disease and may even order necessary investigarions.

What other conditions can mimic acne?

There are few conditions similar to acne that doctor needs to rule out, includes acne conglobata, folliculitis, acneiform eruptions, etc. 

There a severe form of acne in which the infection of the bacteria causing acne spreads around whole body known as acne fulminans. It may need inpatient admission and treatment. 

Many other conditions like atopic dermatitis, other skin infections etc may coexis with acne which also should be carefully examined and accounted for cotreatment. 

Treatment of acne: 

Treatment of acne is simple in case of early treatment or less severe cases. 

What is the treatment of acne? 

Now lets talk about treatment of acne. Treatment of acne depends upon severity of the acne. The severity of acne decides which of the available treatment can be directed to particular patient. The medications can be given single or in combination if severe acne is to be treated. 

The drugs that are commonly available and recommend for treatment of acne includes:

1. Topical retinoids
2. Topical antibiotics
3. Systemic (oral ) retinoids
4. Systemic/oral antibiotics
5. Topical/systemic/oral steroids. 

Topical retinoids

They are first line of treatment. These medicines reduce number of comedones, open the pores and then control inflammation. This helps drainage of sebum as well as reduction in bacterial load. 

This also helps with prevention of scarring and reative hyperpigmentation as well. 

Commonly used topical retinoids include adapalene, tazarotene, and tretinoin. 

These medicines are applied on e daily in well washed dry skin. Side effects of retinoids include skin peeling, irritation, and redness. This should resolve by a week or two. The person using these drugs should be gentle with their skin and can ise non comedogenic moisturizer for prevention of dryness and irritation. 

• As they make the skin thin one should well protect their skin from sun and stay protected by application of sunscreen or staying inside. 
• Other measures like protective covering while going outside also help.
• If the side effects like irritation and peelings is persistent, alternative day dosing can be done.
• Amount should be minimal with vey thin layer formation in skin and should not be applied to eyes. 

Topical antibiotics:

Topical antibiotics commonly used for acne vulgaris include: clindamycin, erythromycin, minocycline,benzoyl peroxide and dapsone.

These drugs have antibacterial as well as anti-inflammatory effect on skin.

This antibiotics should  never be used alone but are used in combination with topical retinoids. This is done to prevent the antimicrobial resistance.

Other topical medicine include antiandrogen drug like clascoterone. It is a topical androgen receptor inhibitor and hence it reduces action of androgen in skin.

Systemic antibiotics:

Oral antibiotics commonly prescribed for acne include Doxycycline, minocycline, tetracycline, sarecycline.  Previously erythromycin also used to be prescribed but it is less prescribed now due to resistance. Occasionally oral clindamycin, azithromycin and sulfamethoxazole is also used. 

Hormonal therapy:

Antiandrogen agents like spironolactone can be useful for controlling acne. Similarly, estrogen helps in reducing production of sebum helping with treatment of acne. 

Oral isotetrinoin:

It is a systemic retinoid which is highly effective in treatment of moderate to severe acne vulgaris. It has anti inflammatory, and antibiotic role . 

For dose of isotetrinoin refer here.

Warning: Isotetrinoin is teratogenic. It may cause birth defects. Hence, pregnancy should be strictly avoided during isotetrinoin treatment. 

Following investigation are mandatory before starting isotetrinoin then repeated monthly.

• CBC
  
  
• LFT
  
  
• Lipid profile
  
  
• Urine/pregnancy test (HCG)

Note: Pateints may have abnormal health and wound physiology upto one year from isotetrinoin discontinuation. Some patients may be prescribed with steroids while starting isotetrinoin . 

Surgical management of acne:

Some cases like large inflammatory, cystic and nodular acne may get benefits from injection of steroids in acne site. (intralesional steroids). Some benefits maybe from laser and lught therapy. While surgical extraction, and incision and drainage may also be useful.

Some medications not mentioned above include: Azelaic acid, tazarotene, trifarotene, daptomycin, glycolic acid and salicyalic acid.

Superficial peels that use glycolic or salicylic acid can be used for some cases for treatment of acne. 

What are the treatment of acne in Nepal?

Multiple medications, which includes all of the above are available in Nepa for treatment of acne. 

Acnecare  and some other medicines are common. These drugs are commonly called acne face creams and are available in cosmetic shops over the counter OTC. Many such cosmetic products are sold under names acne soap for face, acne face wash, adapelene gel, clean and clear face wash etc. There are best dermatologists in nepal which can easily handle your condition and get you rid of acne and ppimples to give you gowing white skin.

Thank you very much. If you have acne related questions you can ask us in chat box below. If you have feedbacks you can provide us directly. And if you need treatment, contact your doctor or book an appointment below. 

DERMATOLOGY MCQ are here

Answers to above dermatology MCQs

Information in this website is not substitute for professional medical advice and if any harm done by trying information form here is full liability of that person. This information should be taken for educational purposes only.