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What is the best treatment for acne?

What is acne?

Acne is a very common problem. It occurs when the hair follicle becomes clogged with plugs of oil and dead skin cells. Bacteria then grow, causing irritation. It usually appears in adolescence, which is when the sebaceous glands produce more oil.

We can find:

a) Comedones or non-inflammatory lesions . They may be:

  • Whiteheads, or “pimples,” form when follicles become clogged
  • and black dots or “smears” when they are open and in contact with the air.

b) Inflamed lesions : when the wall of the follicle is broken the area swells and a red bump forms. If it is close to the surface, a pimple (papule, pustule) forms. If it is in a deep place, nodules and cysts are formed.

c) Residual lesions : Marks and scars.

Dismantling myths

Acne is not contagious despite skin-to-skin contact. It is not due to poor hygiene.

– Foods such as chocolate, fats or milk have not been shown to worsen acne. Nor that it improves with the sun.

How to deal with? General measures

Do not manipulate the lesions (do not squeeze or pop the “pimples”).

Wash with a mild soap or cleanser before applying the creams. It is used to remove excess oil and dirt. The ones that work best are neutral or acid soaps ( Effaclar, Boreade, Bactopur …).

Use water-based, oil-free cosmetics.

It is advisable to wash the face twice a day.

Aggressive washing of the face with abrasive products, detergents or soaps does not improve acne. They can actually aggravate inflammation.

How to deal with? Specific Measures

A.- When pimples or blackheads predominate

There are several treatments in the form of creams, lotions, gels… The results are seen after 4 weeks and should be used for at least 6 to 8 weeks,

1.  Topical retinoids ( tretinoin , isotretinoin , adapalene ).

How do they act? : They dry the fat and make the skin flake.

Disadvantages: They can cause redness, peeling, itching and burning. For this reason, it is usual to start with low concentrations or every other day. They increase sensitivity to the sun. Excessive exposure to it should be avoided. It is applied at night and washed off in the morning.

They should not be applied near the eyes, mouth, or area under the nose.

2. Benzoyl peroxide .  

How does it work?: It dries the fat. It makes the skin peel. Eliminate bacteria. And it decreases inflammation.

Disadvantages: Often causes local irritation. To make it less, start with lower concentration preparations or with a single daily application.

May discolor hair and clothing. Combined use with other topical products such as retinoids is preferred.

3. Azelaic Acid

How it works: Similar to benzoyl peroxide . It is used when this is not tolerated, since it is rare that it irritates the skin.

Disadvantages : There is less evidence of its effectiveness.

It can lighten the color of the skin, so it can be useful when there are blemishes on the skin.

4.  Alpha hydroxy acids. The most widely used is glycolic acid .

How does it work?: Produces superficial desquamation

Disadvantages : At first they can cause slight irritation. It disappears as the treatment continues.

When there is no good result with one of these products, two can be associated. For example, a good option might be to put the topical retinoid at night and benzoyl peroxide in the morning. But keep in mind that it increases irritation.

B.- When inflammation predominates over pimples and blackheads

It is possible to add Topical Antibiotics : Erythromycin or Clindamycin .

They should not be used alone to prevent bacteria from becoming more resistant. They must be associated with the previous treatment. A good option is the association with benzoyl peroxide  (it improves its tolerance).

They should be applied not only on the lesions but on the entire affected area.

How do they work?: They kill bacteria and reduce inflammation.

Disadvantages : They can take 4-6 weeks to begin to take effect and 3-4 months to reach their maximum effectiveness. Do not use more than 3 months.

C.- If there is no improvement with previous treatments

Substitute antibiotic cream for oral antibiotics (by mouth) .

Tetracyclines or Erythromycin can be used . And they take 3-6 months.

It is recommended to maintain topical treatments, except antibiotic creams.

1. Tetracyclines : Doxycycline and Minocycline

How do they work?: Like topical antibiotics but more powerful .

Disadvantages: They can cause gastrointestinal disorders. They are usually mild and transient. They are contraindicated in pregnancy, lactation and in children under 8 years of age.

Increases sensitivity to the sun

2. Erythromycin: used when tetracyclines are not tolerated.

How do they work?: Similar to tetracyclines

Disadvantages : it produces more antibiotic resistance than these.

D.- When there is no improvement with oral antibiotics after 6 months of treatment, or there are scars, or serious psychological effects

They can always be used under medical prescription: Oral retinoids ( Isotretinoin )

Disadvantages:  It has many side effects. They cause chapped lips, nose bleeds, dry skin, impaired liver function, or increased triglycerides. There is also a risk of malformations in the first trimester of pregnancy. For this reason, effective contraceptive measures must be taken when necessary, not only during its use, but at least one month before and one month after it. It is not indicated in children under 12 years of age. It can only be prescribed by dermatologists.

Other treatments

– Phototherapy with mixed blue-red light. Combines antibacterial and anti-inflammatory action. It is an effective measure to treat acne vulgaris of mild to moderate severity. It has no significant short-term side effects.

– Hormonal therapy. It can be used in adult women with hyperandrogenism who do not respond to conventional topical treatment. It works by decreasing the production of sebum due to the action of androgens on the hair follicle.

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