Who Has Acne & Where?
Acne is a very common skin problem in adolescents. You and your friends probably have had this trouble in the past or even now. Girls reach their puberty earlier and have the peak around age 14 - 17, while boys around age 16 - 19. Actually, lots of adults are troubled by acne too, and believe it or not, even people around the age of 40 still come to the doctors seeking treatments for acne. Their acne is also more difficult to treat than those in youngsters.
Acne distributes mainly in areas where there are lots of oily secreting glands called sebaceous glands. Apart from the face, it is frequently seen on the chest, back and shoulders. Among the sufferers, 99% have it on their face, 90% on their back, 78% on their chest, and 75% in all 3 areas.
Not uncommonly acne happens only on the shoulder or the chest, and patients are puzzled to learn that it is acne rather than some skin allergy they have in mind.
Some people may think that acne is only a mild skin problem that would burn itself out after a while, and ignore proper treatments. This could lead to long-term deep-seated inflammation and leave permanent scars. This is totally preventable these days with very effective medications, and so early treatment is warranted.
There are numerous of them around, and you can find from very cheap one to very expensive cosmetic brands in the chemists. Even the expensive ones are not necessarily good. All of them are helpful only to the mild acne.
They contain too many different ingredients that cannot be all listed out here. The more effective ones are glycolic acid, salicylic acid, and benzoyl peroxide.
Glycolic and salicylic acid can improve the dead skin layer and reduce blockage. Benzoyl peroxide can inhibit the growth of bacteria and prevent the pimples from becoming inflamed acne.
1. Benzoyl Peroxide
To the first-users, there may be irritation in the initial period, with dryness and flaky skin. This usually subsides after getting adapted to it. This is best avoided during pregnancy because there is uncertainty regarding their absorption into the system and safety to the babies.
4. Azelaic Acid
Therefore azelaic acid is very effective against both non-inflammatory and inflammatory acne. It can soften the deep pustules and make them smaller. Like others, significant improvement takes 3 - 4 months.
The main side effect is irritation and dryness. Because of its effect on melanin, it can also be used in lightening melasma.
5. Fruit Acid
Doctors will, according to individual cases, prescribe higher concentrations like 10 - 15%. Some will also use 20 - 70% solution to perform chemical peeling, which is useful in treating acne as well as the acne scars.
You need to take them for a course of 3 - 6 months. Sometimes people stop taking them after only a short period when they see some improvement. This can cause the bacteria becoming resistant and make future treatments more difficult.
The usual antibiotics prescribed are Tetracycline and Oxytetracycline. They cannot be taken together with milk because of poor absorption. The new generations like Doxycycline and Minocycline do not have this limitation and also have less bacterial resistance. Another choice is Erythromycin.
The problem with antibiotics is the ease of bacteria becoming resistant. Also the treatment effect is short lasting, with high chance of early recurrence. Therefore you may be taking course after course of antibiotics over the years, and each time of recurrence may give you new marks and scars on the face.
Antibiotics may cause gut upset or skin allergy. Tetracycline can stain the developing teeth black, and may make the skin more sensitive to the sun with easier burn. Minocycline can rarely cause some bluish grey discolouration of the skin, and allergedly some skin features similar to those in systemic lupus.
Females can be troubled by the overgrowth of candida in the vagina, because the antibiotics disturb the balance of micro-organisms. The effectiveness of the contraceptive pills may be reduced too.
Like antibiotics, recurrences are common. The main side effects are gut upset and liver damage. If you cannot take the contraceptive pills for some reasons, for example migraine, then you cannot take this too.
3. Vitamin A Derivatives
The usual course of Isotretinoin is 4 - 6 months. On average, the dosage is 0.5mg for every kg of body weight per day. So most people would be taking 20mg - 30mg daily, although sometimes more may be needed.
It has many functions. It can shrink the sebaceous glands and reduce their oily secretion; normalise the cell growth inside the follicles, reduce the blockage and pimples; and also has anti-bacterial and anti-inflammatory effects.
Although it has to be taken for a few months as for antibiotics, it has a major significant difference. Recurrence after antibiotics is quick and common, while the improvement from Isotretinoin can last for a long time, on average 2 - 5 years, although some may be shorter or longer. Even though when the acne does recur, the degree is usually much less, with less inflammation and smaller pimples. Therefore, despite the higher initial cost, it is more economical in the long term when compared to antibiotics.
If you decide to take Isotretinoin, pay attention to the following:
The main side effect is dryness, of the skin, lips, and even insides of your eyes. This usually slowly disappears in weeks. You need to apply plenty of moisturiser.
Other side effects include mild muscle ache, and headache. Sometimes the liver enzymes and triglycerides levels may rise, so may the sugar level in diabetics. If they are too high you need to stop the medication and they will return to normal with no permanent damages.
The most important thing is that female patients should not become pregnant while they are on this medication, otherwise the baby will be abnormal. Therefore during and 4 weeks after the treatment, an effective contraception must be used.
On the whole, Isotretinoin is a very effective treatment. It should be considered before the permanent acne scars are formed, and not after everything else has failed, because it would not be useful for scars.