Treatment of acne

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In most adolescents acne clears spontaneously with minimal scarring. Reassurance and explanation along the following lines helps greatly:

(1) The lesions can be expected to clear in time.

(2) It is not infectious.

(3) The less patients are self conscious and worry about their appearance the less other people will take any notice of their acne.

It helps to give a simple regimen to follow, enabling patients to take some positive steps to clear their skin and also an alternative to picking their spots.

Patients with acne should be advised to hold a hot wet flannel on the face (a much simpler alternative to the commercial "Facial saunas"), followed by gentle rubbing in of a plain soap. Savlon solution, diluted 10 times with water, is an excellent alternative for controlling greasy skin. There are many proprietary preparations, most of which act as keratolytics, dissolving the keratin plug of the comedone. They can also cause considerable dryness and scaling of the skin.

Benzoyl peroxide in concentrations of 1-10% is available as lotions, creams, gels, and washes. Resorcinol, sulphur, and salicylic acid preparations are also available.

Vitamin A acid as a cream or gel is helpful in some patients. A topical tretinoin gel has recently been introduced.

Ultraviolet light therapy is less effective than natural sunlight but is helpful for extensive acne. It is a helpful additional treatment in the winter months.

Oral treatment. The mainstay of treatment is oxytetracycline, which should be given for a week at 1 g daily then 500 mg (250 mg twice daily) on an empty stomach. Minocycline or doxycycline are alternatives that can be taken with food. Perseverance with treatment is important, and it may take some months to produce an appreciable improvement. Erythromycin is an alternative to tetracycline, and co-trimoxazole can be used for Gram negative folliculitis. Tetracycline might theoretically interfere with the absorption of progesterone types of birth control pill and should not be given in pregnancy.

Topical antibiotics. Erythromycin, the tetracyclines, and clindamycin have been used topically. There is the risk of producing colonies of resistant organisms.

Antiandrogens. Cyproterone acetate combined with ethinyloestradiol is effective in some women; it is also a contraceptive.

Synthetic retinoids. For severe cases resistant to other treatments these drugs, which can be prescribed only in hospital, are very effective and clear most cases in a few months. 13-cis-Retinoic acid (isotretinoin) is usually used for acne. They are teratogenic, so there must be no question of pregnancy, and can cause liver changes with raised serum lipid values. Regular blood tests are therefore essential. A three month course of treatment usually gives a long remission. Recently topical isotretinoin gel has been introduced.

Residual lesions, keloid scars, cysts, and persistent nodules can be treated by injection with triamcinolone or freezing with

Treatment of acne

First line

Second line

Third line

Encourage positive attitudes

Topical vitamin A acid

Oral retinoids for 3-4 months (hospitals only)

Avoid environmental and occupational factors

Topical antibiotics

Topical treatment Benzoyl peroxide Salicylic acid

Ultraviolet light

A tetracycline by mouth for several months


Acne after treatment

Acne before treatment

Acne after treatment

Acne before treatment pkf

Severe cystic acne before (left) and after (right) treatment with tetracycline

Keloid scars
Keloid scars on dark skin

liquid nitrogen. For severe scarring dermabrasion can produce good cosmetic results. This is usually carried out in a plastic surgery unit.

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