Expectations and Realities of Acne Treatment
Introduction
Acne Vulgaris is a common dermatological condition. Although most teenagers will be affected by acne, of varying severity and duration, most cases can be treated effectively and safely. Acne can persists into adulthood for many teenagers. Facial acne scarring occurs in at least 20% of teenagers. Over the past few years, there has been an upward trend in adult onset acne cases. Again, the distribution and severity may differ from adult onset acne compared to adolescent acne.
The duration of acne vulgaris is highly variable. While acne may erupt due to stress, lack of sleep or even a change in lifestyle, this fortunately lasts a couple of days to weeks. Cases like these tend to subside quickly with simple treatments.
Help - My Acne Does Not Seem to Stop!
On the other hand, acne may last months or even several years! In cases where your acne is just not going away, research has shown that acne to be a chronic inflammatory disease of the pilosebaceous unit. What this means is that the constant inflammation underneath the skin can lead to scarring and causes suffering such as low self-esteem for a prolonged period. The chronic inflammation is a result of androgen dependent increase in sebum production, abnormal skin cell maturation (keratinisation), inflammation and bacteria (Propionibacterium acnes.) colonisation within the hair follicles.
As to what exactly triggers acne is currently unclear. Although is may run in families, this is not always the case It is not uncommon to see individuals with acne, finding it puzzling as to why no other siblings are affected.
Can Acne Be Cured?
There is no ideal treatment for acne. In many other chronic medical conditions ( e.g. Atopic eczema, Asthma, Diabetes) where there is no cure, treatments are aimed at bringing comfort, reducing suffering and helping individuals find a suitable regimen to optimise their treatment. After all, the old adage of “Cure sometimes, relieve often, and to comfort always” rings true when doctors treat conditions where a cure is not attainable.
The development of effective acne treatments over the last few decades have undoubtedly benefited a significant number of people. It has helped regain confidence, reduce suffering and minimize permanent scarring. Although there is no permanent antidote for acne, most individuals are able to find a suitable treatment regime to minimise acne. Topical treatments in the form of benzoyl peroxide, retinoids, and antibiotics when used in combination can greatly improve acne control in mild to moderate cases. An oral antibiotic may be prescribed for inflammatory acne vulgaris, often with a topical agent to minimise bacterial resistance. Oral Isotretinoin (e.g. Accutane, Acnotin, Oratane) is often reserved for moderately-severe, cystic acne or acne that is not responding to oral antibiotics. The use of oral isotretinoin although highly effective, is limited by its side effects and teratogenic potential.
Does Everyone Respond Equally To Treatment?
We understand that individuals suffering from acne may feel distressed, and are often anxious to find a solution to quickly address their concerns. Individuals often wonder whether a particular treatment is really working for them or not, and may regrettably abandon treatment when they do not see the results they are expecting within a set amount of time.
Everybody is different. Humans are biological entities with different genetic make up. The response to treatment will invariably differ across individuals. As we differ genetically, our treatment response and even adverse effects will vary from one individual to another. This is known as Pharmacogenetics. Knowing that no two individuals are alike, as doctors, we try our best to come up with a treatment plan that is appropriate for your condition, skin type and medical background. We may not get it right all of the time, but you can rest assured that we will try our best to come up with a most suitable treatment plan for you. For example, in cases where acne is resistant to standard therapies or is rapidly progressing, we may need to step up treatment to control the condition.
6 Things to Know About Your Acne Treatment:
- Be patient. Acne treatment takes time, and responds slowly to treatment. A significant improvement may only be noticeable from 8 weeks onwards. Many clinical studies are based on a 12 week treatment duration. Its quite unrealistic to expect results in a few weeks!
- Flares may occur. This is especially so when many treatments are retinoid based (whether topical or oral). Retinoids are highly effective at reducing comedones, inflammation, but also increasing skin cell turnover. This initial acne flare is common and will settle quickly in most cases.
- Slow and Steady. We normally advise a gradual step wise approach to treatment. Many acne based creams or gels can cause skin dryness, redness and/or irritation. It is important that you begin treatment slowly, allowing the skin to adapt. This can take up to 4-6 weeks.
- Fight Resistance. Antibiotic resistance is a major issue worldwide. In cases where an oral antibiotic may be prescribed for inflammatory acne vulgaris, we may prescribe some topicals. A topical retinoid and/or benzoyl peroxide based treatment in combination reduces bacterial resistance!
- Moisturize. Many acne treatments (especially oral isotretinoin) can cause skin dryness. Regular application of a lip balm, lotion, or even artificial tear eye drops helps greatly. Skin that is too dry increases the risks of skin infections. Moisturise regularly!
- Perseverance. Ok, your acne is more or less under control. However, there are still few annoying outbreaks. As acne may last for many years, we advise treating newly emerging acne (whiteheads/blackheads/small papule or pustules) early.
References:
- Thiboutot D, Gollnick H, Bettoli V, Dréno B, Kang S, Leyden JJ, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009 May. 60(5 Suppl):S1-50.
- Collier CN, Harper JC, Cafardi JA, Cantrell WC, Wang W, Foster KW, et al. The prevalence of acne in adults 20 years and older. J Am Acad Dermatol. 2008 Jan. 58(1):56-9.
- Gollnick H, Cunliffe W, Berson D, Dreno B, Finlay A, Leyden JJ, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2003 Jul. 49(1 Suppl):S1-37.
- Lee JW, Yoo KH, Park KY, Han TY, Li K, Seo SJ, et al. Effectiveness of Conventional, Low-dose and Intermittent Oral Isotretinoin in the Treatment of Acne: A Randomized, Controlled Comparative study. Br J Dermatol. 2010 Nov 29.
