THE TREATMENT OF ACNE

Cont.

How does hormonal therapy work?

Research  has proven it to be an effective measure against acne in many female patients. Oral contraceptives are used to block the effects of androgens on the sebaceous glands and the skin cells lining the pores. This kind of treatment is recommended for women who suffer from inflammatory acne and who has seen little or no improvement in their acne even after multiple courses of antibiotics. 

Although many kinds of oral contraceptives are effective in the treatment of acne, there is a kind of contraceptive that contains only Progestins, instead of a mixture of Progestin and Estrogen, which can potentially worsen existing acne. Therefore women with an acne problem should be careful to use a suitable kind of contraceptive. The most common kind of birth-control pill that is used to treat acne is called Diane. It also has a generic version called Ginette – this is cheaper than Diane, but works equally well. 

Oral Isotretinoin (e.g. Accutane or Roaccutane)

Oral Isotretinoin is the preferred treatment for severe or cystic acne that does not respond to topical treatment, systemic antibiotics or hormonal therapy.

It works by shrinking the sebum glands, while promoting the shedding of old skin cells and inhibiting the growth of P. acnes bacteria. It also has a strong anti-inflammatory effect. As it addresses all the underlying causes of acne it is an extremely effective way of treating acne.  

However, it remains a controversial treatment because of its potential side effects. 

Common side effects include: very dry and peeling skin, photosensitivity, dry nose, eyes and lips, nosebleeds and headaches. In some cases abnormal liver function has also been reported.  

Isotretinoin is contraindicated in pregnancy and can cause serious birth abnormalities and even the death of the foetus when used during pregnancy. For this reason it has become common practice to do a pregnancy test before commencing treatment as well as prescribing oral birth control for the duration of the treatment for female patients. Sexually active females are also sometimes advised to use more than one form of contraception. 

Some physicians believe  that Isotretinoin can produce significant mood changes, depression and other psychiatric side effects. However, no causal relationship between Isotretinoin therapy and depression has yet been established.  

Finally it is important to remember that Isotretinoin treatment can sometimes cause the acne to get worse or to flare-up  before it gets better. This is normal and patients can expect to see positive results only after a one or two month period, depending on the severity of the acne. An additional benefit of this kind of therapy is that in most cases, the acne stays clear for years after treatment is discontinued and in many cases is permanently erased! 

Treatment procedures done in a doctor’s room

A variety of procedures that can improve acne and reduce scarring are available including: chemical peels, electrocautery, dermabrasion and laser treatment.  

Chemical peeling is useful to address surface scarring and light pigmentation. Peeling agents like fruit acids are used on the skin to penetrate the sebum-heavy follicles.  

Electrocautery is where an electric current is passed through a fine point and applied to the skin as the heat exfoliates the skin and kills the bacteria. This procedure is not often used, as there is a risk of scarring. 

What treatments are available to remove acne scars? 

Tragically, some patients reach a dermatologist’s office too late and as a result have already accumulated extensive facial scarring. Dermabrasion, punch grafting and laser surgery can be used to treat permanent scarring.  

Dermabrasion is the process of removing the upper and middle layers of the skin. It is a painful process that requires local anaesthetic and is unsuitable for very deep-pitted scars.  

Very deep scars are treated by filling them with temporary fillers like collagen or by using punch grafting. This refers to using a cookie cutter type of blade to punch out the scar and then filling the indentation with skin taken from another site. Laser treatments have also proven very effective to remove scars.  

Unfortunately these procedures are very expensive, considered cosmetic and therefore not covered by medical aids.