Severe acne

Acne Treatment Tips

Acne Vulgaris is a cosmetically problematic skin condition for most people. There are many ideas and tips all over the internet on acne treatment and many are not working. As much as 80% of the population is affected by Acne at some point in life.

This article focuses on the step-by-step treatment of acne, depending on how bad it is. For more information on causes of acne with better explanation, Read the main article below:


Classification of Acne

It is important to know step by step treatment of acne in order to avoid using very strong medications and creams which can be dangerous and damaging to your face while you might be having mild form of acne. Read the Main Article to understand how Acne is classified.

Step 1

Initial treatment for mild Acne is via topical agents such as gels, creams and ointments.

The two most effective agents are Benzoyl peroxide (gel or cream) and Tretinoin ointment.

Benzoyl Peroxide is a Keratolytic agent, which means it destroys facial bumps (pimples) caused by comedones through killing of skin cells on the pimple. It also kills Bacteria Responsible for Acne called Cutibacterium Acnes (Previously called Propionibacterium Acnes). The gel is applied twice a day on the affected areas.

Banzac® gel 5% for acne treatment
Benzoyl peroxide ©

If your Acne is dominated by Pustules, Tretinoin gel or cream is recommended it is applied.  It is applied at night and washed off in the morning. This is because it is very sensitive to light and may cause burns, that’s why you should limit sunlight exposure. Do Not use it if you are pregnant or planning to be pregnant as it is Teratogenic.

Sometimes Tretinoin may worsen Acne in the first few but that is temporal.

Additional Tips: make sure that you check which other medications you are using as they may worsen Acne. Drugs such as Isoniazide (for TB), Corticosteroids and Lithium (used as antipsychotic) are known to worsen acne. You should always consult the Doctor if you notice development of acne after using new medication for consideration of change.


Step 2

If the above mentioned creams and ointments do not works or if you have moderate acne, the next step is oral medication. Here there is use of antibiotics for about 3 months in combination with the above mentioned measures.

The most commonly used and effective antibiotic is Doxycycline 100mg taken once a day for 3 months. Remember not to swallow Doxycycline with iron supplements and antacids.

Other medications that are sometimes used are Tetracycline and Erythromycin.

Step 3

This stage always require a Dermatologist consultation. It is for those who have Persistent acne or with severe cystic acne. Different forms of approach are used in this step by dermatologists depending on the circumstances surrounding the individual. The following list of options for severe acne treatment is not put in order.

  1. Combined Oral Contraceptives (COCs): they contain Cyproterone which is known to help in acne. It is recommended in women who are not planning to be pregnant and who have no family history of Breast cancer.
  2. Oral Isotretinoin ( acnetane®) 1mg/kg : Taken orally once a day for 2 weeks to 3 months is another options. It is almost always effective for stubborn cases of acne but is limited by side effects. The side effects include dryness of the lips, mouth, eyes and vagina, Painful joints and depression. It is also highly Teratogenic.
  3. Cystic acne (Severe acne) can also be treated by injection of Triamcinolone in the cyst lesion for quick improvement. It has anti-inflammatory properties.

Take Home Note

  • Always remember that acne for most people is self-limiting, meaning it subsides on its own after some time.
  • It is important to start with step one (use of topical agents) before jumping to strong stuff and its better to treat acne early to minimise scar formation
  • Never squeeze pimples and lesions in the face, it makes acne worse.

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