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ACNE TREATEMENT

INTRODUCTION

Acne is a common skin disease that affects 85-90% of people at some time during their lives. It affects the area of the skin with densest population of sebaceous follicles i.e. face, upper chest, upper back, arms. Acne is characterized by comedones, papules, pustules and nodules.

A comedone is a white head (closed comedone ) or a black head (open Comedone) without clinical sign of inflammation.

Papules and pustules are raised bumps with inflammation.

Nodulocystic acne is characterized by comedones, inflammatory lesions, large nodules greater than 5 mm in diameter. Scaring may be present.
Cosmetic concerns of Acne are because of disfigurement they cause in active form and scars they leave behind particularly on the face.

CAUSES

Genetic factors
Drugs like lithium, anti-epileptics, steroids, iodides etc.
Certain cosmetic agents e.g. Hair pomades can worsen acne.
Endocrine disorders such as CAH (cong. adrenal hyperplasia), PCOD leading to increased androgen secretion.
Hormones – androgen
Premenstrual exaggeration in female
Stress
Dandruff

COMPLICATIONS

Hyperpigmentation, acne scars or pitts, keloid scars are seen in some patients.

ACNE TREATMENT

Self care at home-

• Wash the face twice to thrice a day with soap or a mild cleanser to remove dust and excess oil from the skin.

• Avoid picking at the acne /scrubbing hard which causes more inflammation & damage.

• Some cosmetics & skin care products increase acne so use make up, cosmetics labeled with the word ‘non-comedogenic” which means it does not cause or increase in acne.

Care of dandruff with proper shampoo

MEDICAL TREATMENT

Many treatment options are available to treat all acne forms. Depending on the severity (or grade of acne) Rx varies.

In milder (Grade I, II - comedones, papules-non-inflammatory acne) - topical gels & lotions give good results. Wherein moderate to severe acne (Grade III, IV) oral antibiotics with topical therapy may be necessary.

1	Over the counter medicines are plenty & effective to treat milder acne. Many contain “Benzoyl peroxide which helps in Getting rid of the acne causing bacteria, Causing dryness & flaking of the skin which can help prevent the skin pores from becoming plugged.
2	ANTIBIOTICS
	These may be applied to the skin in the form of gels / lotions/ creams or taken orally by means of pills. They work by killing bacteria & decreasing swelling & redness e.g. erythromycin, clindamycin.
3	TOPICAL RETINOIDS
	These are medicines made from vit.A. Topical retinoids are useful in comedogenic acne. They help open clogged pores by creating a mild peeling effect .Often causes mild dryness of the face.
4	ORAL RETINOIDS
	These are reserved for severe forms of acne. They have a peeling effect as well as decreased sebum / oil production. They are associated with a no. of side effects such as dryness, increased blood fats (hypertriglyceridemia), depression, increased liver enzymes etc.
5	OTHERS
	Birth control pills in women. They counter act the acne causing effect of male hormones.
	PROCEDURES
6	PEELS
	Chemical peeling is a procedure in which upper dead layers of skin are removed by applying a chemical on the skin. It also regenerates new skin cells from underneath. These chemicals are obtained from various fruits & food products e. g. glycolic acid from sugarcane, lactic acid from sour milk, malic acid from apples etc. Effects - Helps decrease the intensity & no. of pimples & decrease chances of post acne scarring. About 4-6 sessions are needed as recurrent peeling will decrease the build up of upper dead skin & underlying cells keep regenerating. This is done at an interval of 2-3 weeks. Post Peel - After a peel, patient is advised to apply a sunscreen. There might be slight dryness/ flaking/mild redness which subsides eventually, leaving behind a glowing skin.
7	MICRODERMABRASION (MDA) / SKIN POLISHING -
	It is a procedure used for epidermal resurfacing i.e. it actually abrades the skin without pain & removes upper dead, damaged layer of the skin. We use 2 techniques:-
	CRYSTAL - Microcrystals of aluminium oxide are propelled forcefully on the skin & sucked away simultaneously which take off the upper dead skin layers. It happens very fast within fraction of seconds. DIAMOND – Wherein a diamond probe with suction is moved on your face to abrade the outer layer. It is very effective for any type of skin as well as ageing.
	This technique is very effective in mild acne scars & pigmentation and for a glowing skin & general skin rejuvenation Post MDA – patient is advised to apply a good sunscreen. Procedure can be repeated in 2-3 weeks time. Most of the superficial scars are removed by this but deeper scars required additional treatment.
8	LASER PHOTOREJUVENATION
	Laser is an intense form of light energy which can be used to treat active acne or acne scars. We use IPL wavelength 590 or NdYAG laser wavelength 1064 or 1320 with fractional lens to resurface facial skin.