WOMEN’S HEALTH: TREATMENT OF ACNE

All acne can be improved by treatment, and often completely cleared. Mild to moderate acne can usually be remedied by simple, over-the-counter treatments, but beware! – because it is so common: and distressing, big industries have developed their business around its treatment and many measures advertised for contra’ or cure are misleading. If you try something for long enough and it doesn’t work, see your doctor. All severe acne should be assessed by a dermatologist.

The golden rule is that all treatment takes time. We all want a magic potion that will clear our skins overnight, but there’s no such thing. If you don’t see rapid improvement you may abandon many treatments before they’ve had chance to work. You must be patient. Most treatments take at least a couple oil months to produce the maximum benefit and often maintenance treatment must be kept up for a year or more. Here are the medically recommended treatments.

Local hygiene

• Wash the affected area with mild un-j medicated soap once or twice per day! Dry gently. Don’t rough towel, steam or scrub.

• Don’t try to squeeze out blackheads and whiteheads. There are medications (see below) that will get rid of them morel effectively without causing pressure damage to your skin.

Resist the temptation to squeeze pimples. Damaging inflamed skin by pressing on it only makes matters worse; fingers may introduce extra infection.

• If a pimple is painful and has a definite head, prick the skin over the head with a flamed needle. Wipe the pus away gently: don’t squeeze.

Correcting and preventing whiteheads and blackheads

The aim is to unblock the ducts and restore normal sebum drainage.

Applications of sulphur, salicylic acid and resorcinol During my adolescence my friends and I made up someone’s grandmother’s recipe of cold oatmeal gruel mixed to a thick paste with ‘flowers
of sulphur’ (yellow sulphur powder) as a facepack to clear our spotty faces. Today you can buy much less messy creams and lotions containing these treatments, alone or in combination. They work by softening thickened skin and sebum that block ducts. Your doctor or pharmacist will advise about suitable products.

Benzoyl peroxide and retinoic acid These have two important effects in the treatment of acne. They remove the plugs blocking the ducts and also kill some of the bacteria in the sebaceous glands, thus reducing pimples. Both can cause redness and drying of the skin at first, and may lead to peeling. They can be bought without prescription: your doctor or pharmacist will advise about suitable preparations and strengths. Follow the pack instructions carefully.

These treatments often work well in combination: for example, benzoyl peroxide during the day and a sulphur preparation or retinoic acid at night. They have no effect on formed pimples, and must be applied to the whole area affected by blackheads and whiteheads.

Reducing skin bacteria

Local antibiotics Lotions containing erythromycin or clindamycin must be prescribed and made up by a pharmacist. They are more expensive than the above treatments and don’t work any better, but are useful if the others can’t be used because of skin sensitivity or pregnancy.

Antibiotics by mouth Moderately severe acne usually benefits from oral antibiotics. The most useful are low-dose tetracyclines daily for up to six months. You’ll need a prescription from your doctor. Many people are reluctant to take antibiotics long-term, but this treatment has been used for two decades and adverse effects have been extremely rare.

Reducing sebum production

Isotretinoin This recently introduced oral treatment for severe cystic acne has been a great advance. It is a synthetic type of vitamin A and how it works is not yet clear, but it can produce dramatic improvement in the most disfiguring acne. Studies have shown that a course of several months has a long-term curative effect: little or no recurrence has occurred for as long as four years after treatment. Isotretinoin may cause unwanted side-effects and must be prescribed and also monitored by a dermatologist (skin specialist). It is known to cause foetal defects, so pregnancy must be ruled out completely before starting and women shouldn’t consider pregnancy for at least one month after finishing a course.

Counteracting androgens Because increased formation of sebum is stimulated by androgens, it would seem logical to counteract its effects. This can’t be done in males, who need their male hormones for normal development of puberty and general health.

Many young women with acne benefit from certain oral contraceptives – especially those that have become available since 1992, such as Diane-35 ED and Marvelon – that counteract the effect of androgens. These are worth a try if contraception is needed. Other drugs that will counteract the effects of androgens on a woman’s skin include spironolactone and cyproterone. The use of these drugs is generally reserved for the more severe acne, and they are generally prescribed and taken under the supervision of a specialist.

The Australian College of Dermatologists has produced the information leaflet ‘All About Acne’. I recommend this excellent pamphlet to anyone bothered by acne – mild or severe. It is available from dermatologists, your family doctor and pharmacies.

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