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Azra Naseem

Taking life, one day at a time.

How acne treatment actually works?

14 December 2021

Almost every doctor across any specialization must have received phone calls from friends and family to know quick tips and tricks to get rid of acne, as the spread is rampant, and also even though it is painful and affects your mental well being, the reluctance to go to a dermatologist for acne still remains high. The number of OTC drugs that people use to get rid of acne as quickly as possible without actually getting a proper diagnosis of the exact stage, makes the treatment process more difficult than it actually is. What also forms a major part of the problem is the scarring , that follows acne and the time it takes to get rid of it.


It is present universally across puberty, but can even start in the prepubertal girls, and can end up spreading to the fourth and fifth decade of life. Research has proven that over 12% of women and 3% of men over the age of 25 have Acne Vulgaris (a broad term to define all the various forms of acne that exist, ranging from open to closed comedones, papules, pustules, and cyst). The severity of acne is more in young boys as compared to young girls.


The pathogenic event leading to acne is the plugging of the infundibulum of sebaceous glands (oil glands) of your skin, which is the part responsible for the discharge of sebum from your skin. The accumulation of sebum and then the overgrowth of acne bacteria (Cutibacterium acnes), followed by the release of and the irritation caused by accumulated fatty acids leads to acne, and the form of acne depends on the stage of this event that you are in. Apart from these the main identified causes are Polycystic ovarian syndrome, use of systemic corticosteroids, or topical fluorinated corticosteroids on your face, and also exacerbation caused by cosmetic oils and creams.


The initial stage is the open or closed comedones (blackheads and whiteheads respectively), which you can recognize as tiny black or white color superficial bumps that give the skin a rough texture. The treatment of this stage involves topical retinoids Tretinoin 0.025% cream (not gel), starting with twice weekly at night, and then increasing the frequency to every night as the skin starts tolerating better. Skin irritation is a major side effect reducing the usefulness of this treatment. To reduce irritation, apply only a lentil-sized amount and wait for 20 minutes after washing your face to apply this cream. The other alternative better tolerated is Adapalene Gel or reformulated tretinoin. Tretinoin is contraindicated during pregnancy. The acne may flare up in the initial 4 weeks of treatment. Benzoyl Peroxide 2.5% gel can also be used in this stage.


The next stage is the progress of the comedones to the stage of Papules which are solid bumps on your skin, and the surrounding skin may appear red because of inflammation. Papules then progress to the stage of Pustules, which are large, tender bumps on the skin with whitish or yellowish pus in them. The next stage is Nodules, which happens when the bumps grow under your skin and are large, hard, and tender. When Nodules get filled with pus due to the underlying infection, it enters into the Cyst stage, which grows under the skin and is soft to touch.


Mild acne in a papular stage can be treated by using Topical clindamycin or erythromycin with benzoyl peroxide topical gel or wash. Topical retinoids can be given based on the patient’s tolerance to them for long-term maintenance treatment.

Once acne progresses to the pustular stage or is not responding to the topical treatment, we shift to oral antibiotics. Most commonly used is Oral Doxycycline 100 mg twice daily for 21 days. Other antibiotics that can be given are Oral Minocycline or Cephalosporin. Benzoyl peroxide gel or wash has to be used along with topical retinoids at night. Doxycycline and Minocycline are contraindicated during pregnancy, but certain Cephalosporins can be used after due consultation from the doctors.

Severe stages of cystic acne not responding to conventional treatment should be given Isotretinoin. It is teratogenic so is absolutely contraindicated during pregnancy. Apart from this, there are numerous other side effects. Further, liver enzymes, triglycerides, and cholesterol levels need to be monitored before treatment. Strict monitoring by a dermatologist is required when a patient is taking this treatment.


Newer forms of treatment include intralesional injection of dilute preparation of triamcinolone acetonide which hastens treatment of nodular or cystic stage of acne.

Nowadays even scares post-acne can be treated by physical or chemical abrasion techniques, and also excision and punch-grafting of deep scars.


A very important factor that affects the success rate of these treatments is patients’ compliance to continue this for a long duration. The average time for the medicine to be taken ranges from 3 weeks to 3 months, and the patient continues to improve for the first 3-6 months of therapy. Relapse can occur, but it cannot be predicted when it will happen. Leaving it untreated will lead to severe scarring. Adhering to the treatment for an adequate duration and strictly avoiding OTC lotions and ointments which promise quick recovery but actually are more harmful in the long run is all that is required to effectively treat a lingering bothering problem that acne is.

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