acne vulgaris

Treatment. The noninflammatory lesions often respond to over-the-counter creams and lotions, but inflammatory lesions may require intensive and individualized medical treatment under the direction of a dermatologist. Acne is treated by both topical and systemic drugs; the one most frequently recommended is benzoyl peroxide in a 5 or 10 per cent concentration. It is applied to the skin daily or as frequently as necessary to produce mild dryness of the skin. A mainstay for treatment of inflammatory acne continues to be oral tetracycline, which is effective for most cases and safe even when taken for years. A relatively new systemic drug for severe, treatment-resistant acne is isotretinoin (13-cis-retinoic acid). It inhibits the secretion of sebum and alters the lipid composition of the skin surface. Isotretinoin is a teratogen; hence it is not given to pregnant women. It can also cause bone changes. Minor side effects include dry mouth and dry eyes. Another agent used against acne is tretinoin (all-trans-retinoic acid), which is applied topically to reduce the number of comedones and to prevent formation of inflammatory lesions.

Acne therapy can continue for months and even years. Patients who conscientiously follow the prescribed regimen greatly increase their chances for improvement and the prevention of permanent scarring and pitting of the skin.

When acne has left permanent, disfiguring scars, there are medical techniques that can remove or improve the blemishes. One method is planing with a rotary, high-speed brush. This removes the outer layer of pitted skin, leaving the growing layer and the layers containing the glands and hair follicles. New epithelium grows from the layers underneath; it is rosy at first and gradually becomes normal in color. The technique has also been used successfully in removing some types of disfigurations resulting from accidents. This so-called “sand-paper surgery” or dermabrasion is recommended only for selected cases of acne and results are not always satisfying.

Patient Care. Because patients with acne often have a lack of knowledge about the nature of their skin disorder, patient education is a major component of care. Additionally, the disorder often affects young people at a time when they are deeply concerned about their appearance and acceptance by their peers. Adolescents need to know that their concerns are taken seriously. Even though the disorder is not life-threatening, it can adversely affect one's self-image and self-esteem.

Laypersons often are misinformed about the cause and effects of acne. It is not a contagious disease, nor is it due to uncleanliness or poor personal hygiene. It is not caused or made worse by lack of sleep, constipation, masturbation, venereal disease, or by anger or hostility. Dietary indiscretion can sometimes contribute to the appearance of lesions, but there are very few people who can find a cause-effect relationship between certain foods they have eaten and the appearance of acne lesions. In general, cola drinks, chocolate, and fried foods need not be restricted or eliminated from the diet in hopes that acne can be avoided or cured. A well-balanced diet is all that is recommended for the management of acne.

Scrubbing the skin and using harsh soaps is not recommended because this only serves to damage the skin and predispose it to breakdown. A mild soap is as effective as special medicated soaps. If the hair is excessively oily, it may help to shampoo regularly and keep the hair off the face.

Pimples and pustules should not be squeezed. This can press the sebum and accumulated debris more firmly into the clogged duct and increase the chance of inflammation and the spread of infection. Blackheads and whiteheads are best removed by applying a prescription medication that causes peeling of the skin.

Since the management of acne can go on for years, requiring periodic evaluation by a dermatologist, patients and their families will need continued support and encouragement. Patients taking prescription medications will need to know the expected results, any adverse reactions that might occur, their symptoms, and to whom they should be reported.