Around 80 percent of 11 to 30-year-olds are affected by acne. Treatments, however, can be effective, with 90 percent of those using them showing a 50 percent or better improvement in their symptoms after three months. Maqsood Yasin of Southampton's Adelaide Pharmacy explains which treatments are available and how they work.
Q. What are the main treatments for mild to moderate acne?
A. Mild to moderate acne is generally treated with topical preparations (preparations applied to the skin). Benzoyl peroxide – which comes in gel or cream form – is considered the first- line over-the-counter treatment for acne. A thin layer of benzoyl peroxide cream should be applied once or twice daily over a thoroughly cleansed and dried skin. Regular application can result in improvement of mild acne.
Azelaic acid may be an alternative to benzoyl peroxide or to a topical retinoid for treating mild to moderate acne, particularly of the face. Azelaic acid is usually applied twice a day, in the morning and the evening.
For many patients with mild to moderate acne topical antibacterials may be more effective than topical benzoyl peroxide. Topical preparations of the antibiotics erythromycin and clindamycin are effective for inflamed acne. However these are only available on prescription from your GP.
Q. How does benzoyl peroxide work?
A. Benzoyl peroxide works by reducing the concentration of the bacteria that triggers acne (Propionibacterim acnes, or P. acnes for short). It has a keratolytic action, which means it helps with peeling of the skin, and also has antibacterial properties.
The most common side effects are dryness and flaking. These, however, are generally mild and can be reduced by using an oil-free moisturising lotion daily. Occasionally sensitisation to benzoyl peroxide may occur. When it does, the skin becomes reddened, inflamed and sore, and treatment should be discontinued. Benzoyl peroxide can also bleach clothing and bedding, and contact with the eyes, mouth other mucous membranes should be avoided.
Q. Does azeleic acid work in the same way?
A. Azeleic acid is in a class of medications called dicarboxylic acids. It works by killing the bacteria that infect pores and by decreasing production of keratin, a natural substance that can lead to the development of acne.
Azelaic acid may cause side effects including itching, burning, stinging and tingling. It can also cause a rash, which may be more serious. If you develop a rash while using azelaic acid, call your doctor immediately.
Q How do topical antibiotics work?
A. Topical Antibiotics inhibit the growth of bacteria (P. acnes), which is a chief cause of acne. P. acnes is an ordinary resident of the skin, but if you have acne it grows out of control and irritates the skin's follicles, which leads to spots.
Applying a topical antibiotic reduces the amount of P. acnes, which helps to control acne. Topical antibiotics work best for inflamed acne, rather than non-inflamed blemishes or blackheads. The most common side effects include burning or stinging when medication is applied; dryness, flakiness, or peeling of the skin; mild skin irritation; and, in the case of tetracycline, yellowing of the skin. Very rarely topical antibiotics cause more serious side effects such as stomach pain, vomiting and/or severe diarrhoea, rash and unexplained bleeding or bruising.
Q. What are topical retinoids and how do they work?
A. Retinoids are vitamin A derivatives that cause the skin to exfoliate completely, so that pores don’t clog up and turn into blackheads and whiteheads. Besides easy skin exfoliation, topical retinoids improves your skin in other ways:
Topical retinoids can also make you sensitive to the sun’s rays. So while using them avoid going out in the midday sun, and if you do go out into the sun always wear a wide-brimmed hat and apply sunscreen.
Q. Is the contraceptive pill prescribed for acne?
A. The oestrogen found in the combined oral contraceptive pill may help some women if their acne seems to be partly related to hormone changes. The most common side effects include mild reactions such as headaches, feeling and being sick, stomach upsets, bleeding and spotting between periods, sore breasts, poor tolerance to contact lenses and yellow patches on the skin.
Q When are antibiotic tablets prescribed for acne?
A. Prescribed antibiotic tables are usually prescribed in severe cases of acne. Courses usually last for six to 12 weeks and can be repeated intermittently.
Q. Can GPs prescribe a medicine for severe acne called isotretinoin?
A. Isotretinoin is a strong medicine and is only prescribed by consultant dermatologists for severe forms of acne. That's because it has the potential to cause serious side effects such as depression and major birth defects. So if you're a female of child- bearing age, you must use effective birth control for one month before treatment with isotretinoin, during treatment and for one month after your treatment ends.
A. Mild to moderate acne is generally treated with topical preparations (preparations applied to the skin). Benzoyl peroxide – which comes in gel or cream form – is considered the first- line over-the-counter treatment for acne. A thin layer of benzoyl peroxide cream should be applied once or twice daily over a thoroughly cleansed and dried skin. Regular application can result in improvement of mild acne.
Azelaic acid may be an alternative to benzoyl peroxide or to a topical retinoid for treating mild to moderate acne, particularly of the face. Azelaic acid is usually applied twice a day, in the morning and the evening.
For many patients with mild to moderate acne topical antibacterials may be more effective than topical benzoyl peroxide. Topical preparations of the antibiotics erythromycin and clindamycin are effective for inflamed acne. However these are only available on prescription from your GP.
Q. How does benzoyl peroxide work?
A. Benzoyl peroxide works by reducing the concentration of the bacteria that triggers acne (Propionibacterim acnes, or P. acnes for short). It has a keratolytic action, which means it helps with peeling of the skin, and also has antibacterial properties.
The most common side effects are dryness and flaking. These, however, are generally mild and can be reduced by using an oil-free moisturising lotion daily. Occasionally sensitisation to benzoyl peroxide may occur. When it does, the skin becomes reddened, inflamed and sore, and treatment should be discontinued. Benzoyl peroxide can also bleach clothing and bedding, and contact with the eyes, mouth other mucous membranes should be avoided.
Q. Does azeleic acid work in the same way?
A. Azeleic acid is in a class of medications called dicarboxylic acids. It works by killing the bacteria that infect pores and by decreasing production of keratin, a natural substance that can lead to the development of acne.
Azelaic acid may cause side effects including itching, burning, stinging and tingling. It can also cause a rash, which may be more serious. If you develop a rash while using azelaic acid, call your doctor immediately.
Q How do topical antibiotics work?
A. Topical Antibiotics inhibit the growth of bacteria (P. acnes), which is a chief cause of acne. P. acnes is an ordinary resident of the skin, but if you have acne it grows out of control and irritates the skin's follicles, which leads to spots.
Applying a topical antibiotic reduces the amount of P. acnes, which helps to control acne. Topical antibiotics work best for inflamed acne, rather than non-inflamed blemishes or blackheads. The most common side effects include burning or stinging when medication is applied; dryness, flakiness, or peeling of the skin; mild skin irritation; and, in the case of tetracycline, yellowing of the skin. Very rarely topical antibiotics cause more serious side effects such as stomach pain, vomiting and/or severe diarrhoea, rash and unexplained bleeding or bruising.
Q. What are topical retinoids and how do they work?
A. Retinoids are vitamin A derivatives that cause the skin to exfoliate completely, so that pores don’t clog up and turn into blackheads and whiteheads. Besides easy skin exfoliation, topical retinoids improves your skin in other ways:
- They check the appearance of future inflamed lesions by blocking early blackhead formation (no blackheads, no inflamed spots).
- They prevent the breeding of p. acnes.
- They speed up peeling, which gives anti-acne solutions a better chance to penetrate the skin.
Topical retinoids can also make you sensitive to the sun’s rays. So while using them avoid going out in the midday sun, and if you do go out into the sun always wear a wide-brimmed hat and apply sunscreen.
Q. Is the contraceptive pill prescribed for acne?
A. The oestrogen found in the combined oral contraceptive pill may help some women if their acne seems to be partly related to hormone changes. The most common side effects include mild reactions such as headaches, feeling and being sick, stomach upsets, bleeding and spotting between periods, sore breasts, poor tolerance to contact lenses and yellow patches on the skin.
Q When are antibiotic tablets prescribed for acne?
A. Prescribed antibiotic tables are usually prescribed in severe cases of acne. Courses usually last for six to 12 weeks and can be repeated intermittently.
Q. Can GPs prescribe a medicine for severe acne called isotretinoin?
A. Isotretinoin is a strong medicine and is only prescribed by consultant dermatologists for severe forms of acne. That's because it has the potential to cause serious side effects such as depression and major birth defects. So if you're a female of child- bearing age, you must use effective birth control for one month before treatment with isotretinoin, during treatment and for one month after your treatment ends.
