The goals of acne treatment should include clearance of acne and prevent scarring. Patient education is the first and at times the most important step for effective acne treatment. It is important to dispel myths that consumption of greasy food, potato chips, sugar and chocolate are responsible for the development of acne. The patient needs to clean the skin gently and use a non-comedogenic moisturizer. The patient should also avoid picking and rubbing the skin with fragrant or rough skin products. Other important preventive measures should include the use of proper shaving technique and is in line with the skin care regimen. Drinking more water can also help the skin stay healthy. Evidence that the modification of testosterone dose, dosing regimen or delivery method helps improve the symptoms of acne.
Patients with mild to severe acne can be treated with topical or oral medication. Although systemic therapy is mainly used to treat severe acne, it is sometimes necessary for moderate cases.
A variety of systemic agents used to include acne intercessional corticosteroid injection, isotretinoin, oral antibiotics (tetracycline and erythromycin) and oral contraceptives. Intercessional corticosteroid injection is a much – diluted corticosteroid injection by dermatologists to treat severely inflamed cysts and prevent scar formation. It helps treat acne by "meltdown" of the cyst over a period of 3-5 days. Isotretinoin (a derivative of vitamin A) is a very effective oral medication that can help prevent scarring, but because of their potential for serious side effects is contraindicated in pregnant women and in many other conditions. Isotretinoin acts by reducing the size of the sebaceous glands and thus prevents the excess secretion of oil and thus the growth of bacteria. It was estimated that up to 90% of patients treated with isotretinoin result in complete or almost complete recovery from cystic acne.
Tetracycline and erythromycin are effective broad spectrum antibiotics orally for the treatment of moderate to severe inflammatory acne. Tetracycline reduces inflammatory lesions of acne, but is contraindicated during pregnancy and lactation women, and children of less than 8 years. Doxycycline and minocycline, the synthetic derivative of tetracycline, are also used to treat acne. Appropriate oral contraceptives, the valuable additions to the treatment of acne in women include: ethynodiol, norgestimate, norethindrone and norethindrone acetate. They work by inhibiting the overactivity of the sebaceous glands (oil glands).
Azelaic acid, benzoyl peroxide, clindamycin, erythromycin, and sodium sulfacetamide are the prescription topical antimicrobial for the treatment of acne vulgaris in the United States. Azelaic acid is a naturally occurring acid, the keratolytic and bacteriostatic properties. Benzoyl peroxide is cheap and best at killing P. acnes. When used in combination with antibiotics (erythromycin, clindamycin), benzoyl peroxide increases efficiency and reduces resistance to antibiotics. Clindamycin is a safe and well tolerated semi-synthetic antibiotic that acts by reducing P. acnes and decreasing inflammation. Current erythromycin is an antimicrobial and anti-inflammatory agent, but may cause dryness of the skin irritation and possible. Sodium sulfacetamide products usually contain sulfur and are in patients who do not tolerate other topical antimicrobials.
Several types of prescription topical retinoids for the treatment of acne include adapalene, tazarotene and tretinoin. Adapalene is a synthetic analogue retinoid that unclogs pores and shows anti-inflammatory properties. Tazarotene is a second-line retinoid option that helps treat acne by stopping the development of new comedones. Tretinoin is a natural retinoid that works to gradually unclog pores and keep them unplugged.