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Best Acne Treatments | ellé derm

You may have tried many products to keep your skin clear and blemish free but so far nothing has been successful. This article dives deep into the pathophysiology of acne and the treatment approach one should consider for long term management. 

The cause of acne vulgaris, or commonly known as acne, is multifactorial and therefore the best acne treatment is a routine or combination of products that addresses the underlying cause of acne. The cause of acne can be due to one or a multiple of the following factors: 

 

  • Excess sebum production,
  • Blocked hair follicle trapping oil and dead skin cells, 
  • Excess androgen production driven by hormones, and 
  • An imbalance of Propionibacterium acnes (P. acnes), a bacteria that commonly lives on the skin goes on to digest the sebum, causing blackheads and inflammation to the skin.

 

Acne tends to affect teenagers between 14 years to 24 years old but research has shown acne can persist well into 30s and 40s (this is known as adult acne and is predominantly driven by an excess of androgen). 

Androgen is a hormone and is present in both males and females. Androgen levels increase both in boys and girls during puberty. This is why many teenagers have acne while younger children do not. Also, girls reach puberty earlier than boys and so may develop acne at a younger age than boys.

The cause of adult acne (acne in adults in their 30s and 40s) is mostly driven by excess androgen production. The underlying pathophysiology is more complex and successful treatment requires correcting this imbalance at the hormone level (more on this in another article). 

 

Over the Counter Treatment for Acne Vulgaris

The best acne treatment is a routine or combination of products that addresses the underlying cause to ensure long term success. Ideally, you want products that addresses multiple factors so your routine stays simple and minimises the risk of adverse effects. Most people stop using their treatment because (a) Acne takes time to treat - usually about 2-4 weeks to see improvements and (b) Most people experience adverse effects and stop their treatment prematurely. 

  • Azelaic Acid: Azelaic acid has antimicrobial and anti-inflammatory properties, which make it effective in the treatment of skin conditions like acne and rosacea. The acid can prevent future outbreaks and clean bacteria from your pores that causes acne.
  • Benzyl Peroxide: Benzyl Peroxide has mild antimicrobial activity and take about 4 weeks to work. One common side effect of Benzyl Peroxide is irritation to the skin and dryness. 
  • Salicylic Acid: Salicylic acid works to treat acne by unclogging blocked pores. It does this by breaking down the bonds between dead skin cells and breaking down sebum. Salicylic acid also decreases the skin's sebum production as well as turn over skin cells. This usually come in the form of Salicylic Acid 2% cleanser or Salicylic Acid cream.
  • Non prescription Retinoids: Retinol and Retinaldehyde have also been used for the management of acne. These Vitamin A derivatives aid in increasing skin cell turnover and prevent the blocking of pores.  Retinaldehyde has been shown to be more effective in the management of mild to moderate acne with fewer side effects. The advantage of using Vitamin A derivatives over benzyl peroxide is that it also possess anti-ageing benefits, making it a more attractive option for some women. The disadvantage with Vitamin A derivatives is that they are not recommended during pregnancy. 

 

Prescription Treatment for Acne Vulgaris 

  • Oral Isotretinoin - A prescription retinoid, Isotretinoin is commonly prescribed in severe acne resistant to other treatments. This decreases hyperkeratinsation and shrinks the size of sebaceous glands in the skin. This reduces the amount of oil that is produced by the skin. Oral isotretinoin has no direct antimicrobial action, but by dramatically reducing SER and the size of the pilosebaceous duct it alters the microenvironment within the duct making it much less favorable to colonization with P. acnes.
  • Oral contraceptive pill - this is especially useful in adult acne where there is a hormone imbalance driving excess androgen production
  • Oral or topical antibiotics - a short course of Doxycycline or Minocycline has shown to be successful in the management of cystic acne. Topical antibiotics combined with benzyl peroxide have also shown to be effective in the management of acne vulgaris. 

 

Diet and Acne 

There are numerous studies to suggest that foods with a high glycemic index and dairy can exacerbate acne. Our next article will review the evidence behind this phenomenon. 

 

 

Written by:

Helen Lam (B Pharm) MPS

 

References: 

  1. Benzyl Peroxide (2019). NHS UK. Accessed: https://www.nhs.uk/medicines/benzoyl-peroxide/ 
  2. Assessing Salicylic Acid for Acne (2021). Journal of US Pharmacist. Accessed: https://www.uspharmacist.com/article/assessing-salicylic-acid-for-acne#:~:text=Salicylic%20acid%20exerts%20its%20pharmacologic,to%20gently%20exfoliate%20the%20skin.
  3. Australian Medicines Handbook 2021

 

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