How to Treat Mild, Moderate and Severe Acne

TREATING MILD ACNE

Mild acne consists of small lesions, such as blackheads, whiteheads or pustules, which appear at or near the surface of the skin. As such, mild cases of acne can sometimes be controlled at home by:

• Gently washing the affected area(s) with warm water and a mild soap twice a day to remove dead skin cells and excess oil
• Using a topical (applied to the skin) over-the-counter acne treatment containing benzoyl peroxide or salicylic acid.

Most mild acne can be controlled by gently washing the affected area(s) and using a topical preparation, such as benzoyl peroxide.

At-home treatment requires 4-8 weeks to see improvement. Once acne clears, treatment must be continued to prevent new lesions from forming.
Even mild cases of acne may require the help of a dermatologist. If the acne does not respond to at-home treatment, a dermatologist can assess the situation and determine an appropriate therapy. In these cases, combination therapy (two or more treatments) may be used. Combination therapy may include use of a prescription topical antimicrobial or topical retinoid. These prescription topicals can be very effective in clearing mild acne.

TREATING MODERATE TO SEVERE ACNE

In moderate to moderately severe acne, numerous whiteheads, blackheads, papules and pustules appear that cover from ¼ to ¾ of the face and/or other affected area(s). Moderate to moderately severe acne usually requires the help of a dermatologist and combination therapy (using two or more treatment options).

Treatments used to treat moderate to moderately severe acne are:
• Physical methods, such as comedo extraction or light therapy
• Prescription Medications
o Topical (applied to the skin) antimicrobials
o Topical retinoids
o Oral antibiotics
o Oral contraceptives
• Over-the-counter topical acne medications

Dermatologists recommend early treatment for moderate to moderately severe acne

Dermatologists recommend early treatment for moderate to moderately severe acne because when moderate to severe acne is not treated early, scars can develop. Acne scars take two forms—as raised thickened tissue or as a depression, such as pits or pock marks. The only reliable method of preventing or limiting the extent of these scars is to treat acne early in its course, and for as long as necessary. Additionally, anyone with acne who has a known tendency to scar should be under the care of a dermatologist.

TREATING SEVERE ACNE

Severe acne is characterized by deep cysts, inflammation, extensive damage to the skin and scarring. It requires an aggressive treatment regimen and should be treated by a dermatologist. Severe, disfiguring forms of acne can require years of treatment and may experience one or more treatment failures. However, almost every case of acne can be successfully treated.

Physical methods and prescription medications that dermatologists use to treat severe acne include:
• Drainage and surgical excision
• Interlesional corticosteroid injection
• Isotretinoin
• Oral antibiotics
• Oral contraceptives

Drainage and Surgical Excision:

Some large cysts do not respond to medication and may require drainage and extraction. Drainage and extraction, or “acne surgery” as it is also called, should not be performed by patients. Dermatologists are trained in the proper technique and perform acne surgery under sterile conditions. Patient attempts to drain and extract comedones by squeezing or picking, can lead to infection, worsening of the acne and scarring.

Severe acne requires an aggressive treatment
regimen and should be treated by a dermatologist.

Interlesional Corticosteroid Injection:

When an acne cyst becomes severely inflamed, there is a good chance it will rupture and scarring may result. To treat these severely inflamed cysts and prevent scarring, dermatologists may inject such cysts with a much-diluted corticosteroid. This lessens the inflammation
and promotes healing. An interlesional corticosteroid injection works by “melting” the cyst over a period of 3 to 5 days.

Isotretinoin:

Isotretinoin is a potent drug reserved for treating severe cystic acne and acne that has proven itself resistant to other medications. Isotretinoin is a synthetic (man-made) retinoid (form of vitamin A) that comes in pill form. It is usually taken once or twice a day for 16 to 20 weeks.
Today, it is the most effective acne treatment available because it is the only acne treatment that works on all four factors that predispose a person to acne – excess oil production, clogged skin pores, P. acnes and inflammation. The remissions achieved with isotretinoin usually last for many months to many years. For many patients, only one course of isotretinoin therapy is needed.

While isotretinoin is the most effective acne treatment available, it cannot be prescribed to everyone due to a number of potential side effects—some serious. One of the most serious side effects is the potential to cause severe birth defects in a developing fetus. For this reason, the U.S. Food and Drug Administration (FDA) requires that women not be (or become) pregnant while taking isotretinoin. FDA regulations require women of childbearing age to take 2 pregnancy tests prior to beginning isotretinoin therapy and use 2 forms of birth control for 1 month before therapy begins, while taking the drug and for 1 full month after therapy. It is also important that women not breast feed during this time. Women who wish to become pregnant after taking isotretinoin should talk to their dermatologist and gynecologist about when it is safe to get pregnant after receiving isotretinoin therapy.
Other possible severe side effects that may occur while taking isotretinoin include:
• Severe pain in the chest or abdomen
• Trouble swallowing or painful swallowing
• Severe headache, blurred vision or dizziness
• Bone and joint pain
• Nausea or vomiting
• Diarrhea or rectal bleeding
• Depression
• Dryness of the skin, eyes and nose
• Thinning hair
If any side effect occurs, the patient’s dermatologist or other healthcare practitioner should be contacted immediately because some of these side effects can lead to serious health problems.

While taking isotretinoin, patients are regularly monitored for side effects through follow-up visits. For most people, these side effects are tolerable and not a reason to discontinue therapy before remission is achieved. However, it is important to keep appointments for follow-up visits because monitoring can reveal conditions that a patient might not notice. For example, a patient may not realize a rapid increase in bad cholesterol that is detected through a blood test.

The decision to use isotretinoin should be made jointly by patient and dermatologist. When used with all due caution under close medical supervision, isotretinoin can resolve severe acne that has not responded to other therapy. It has proven especially effective in resolving cystic acne, a severe form of acne that usually does not respond to other therapies.
For a substantial number of patients, one course of isotretinoin therapy is all they will ever need. A small number of patients require more than one course of isotretinoin therapy to control severe acne.

It is important to take isotretinoin as prescribed—even if the skin clears before all of the pills have been taken—to prevent relapse. At the end of an effective course of isotretinoin therapy, all or most of the acne lesion will have cleared. Patients may notice residual erythematous (reddish) macules (flat spots) where acne lesions were present. These macules are not scars, and they will fade in 6 to 8 weeks.

After therapy, patients should continue to follow the 12 Ways to Get Better Results from Acne Treatment.

Oral Antibiotics:

Oral antibiotics have been a mainstay of therapy for severe acne for many years. Like topical antibiotics, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation. Treatment with oral antibiotics usually begins with a high dosage, which is reduced as the acne resolves. Over time, the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When this happens, another antibiotic can be prescribed. Numerous studies support the effectiveness of the following broad-spectrum oral antibiotics that are used to treat acne in the United States: doxycline, erythromycin, minocycline and tetracycline. For information about each of these oral antibiotics, see Prescription Acne Medications.

Oral Contraceptives:

Oral contraceptives have been shown to effectively clear acne in women by suppressing the overactive sebaceous glands. Oral contraceptives can be used as long-term acne therapy; however, this medication should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynecologist.

Severe Acne: 4 types

Severe acne can affect many facets of a person’s life, causing a great deal of embarrassment and stress. Severe acne may significantly limit one’s social life and even interfere with opportunities for employment. Since this condition can be disfiguring and require years of treatment, it is important to see a specialist. Dermatologists have the most experience treating the different types of severe acne.

Four types of severe acne, described in detail below, are:
• Acne conglobata
• Acne fulminans
• Gram negative folliculitis
• Nodulocystic acne

Acne Conglobata:

Acne conglobata is a chronic and severe form of acne vulgaris, characterized by:
• Deep abscesses
• Inflammation
• Severe damage to the skin
• Scarring
• Blackheads (open comedones) are usually conspicuous and widespread—often occurring on the face, neck, trunk, upper arms and/or buttocks.

In acne conglobata, inflammatory nodules form around multiple comedones, gradually increasing in size until they break down and discharge pus. Deep ulcers may form under the nodules, leading to keloid-type scars, and crusts may form over deeply ulcerated nodules
Burrowing abscesses commonly result in deep, irregular scarring.
Acne conglobata may be preceded by acne cysts, papules or pustules that do not heal, but instead rapidly deteriorate.

Occasionally, acne conglobata flares up in acne that had been dormant for many years.

Males are more likely than females to have acne conglobata; the age of onset is usually between 18 and 30 years. The cause of the condition is not well understood.

Treatment. Isotretinoin is the usual treatment of choice for acne conglobata. Antibiotics may also be prescribed. Several courses of treatment may be necessary over a period of years. Even after effective treatment, the patient should have regular checkups by a dermatologist for any signs of recurrence. A dermatologist can also treat the scars.

Acne Fulminans:

Acne fulminans is a sudden onset of highly destructive inflammation. It appears suddenly in a person with inflammatory acne and is characterized by:
• Symptoms of severe and often ulcerating acne
• Fever
• Inflammation and aching of joints, especially hips and knees
A person who develops acne fulminans may have had unsuccessful treatment for another form of severe acne, acne conglobata.
Treatment. Corticosteroids or non-steroidal anti-inflammatory medications may be given to reduce inflammation. Attacks of acne fulminans may recur, and the patient may develop acne that requires long-term treatment with isotretinoin.

Nodulocystic Acne
Cysts are relatively uncommon in acne; however, this form of severe acne is characterized by cysts, which may measure several centimeters in diameter.

Cysts may develop singly or be widespread.

Cysts may occur singly, or be widespread over the face, neck, scalp, back, chest and shoulders. And, they can be painful.

The nodular cyst of acne is not a true cyst—an abnormal dilatation of a normal skin structure. Acne cysts are nodules of inflammation. The cysts may arise from a papular or nodular acne lesion, or occasionally from a type of cyst that develops in the outer layer of the skin—a type of cyst not usually associated with acne. A cyst may appear to be filled with thick, yellow pus-like fluid. This is usually an inflamed and infected cyst. If an attempt is made to drain such a cyst, it should be done in a physician’s office under sterile conditions, not in front of a bathroom mirror.
Cysts occurring close together may coalesce, producing soft areas undermined with tunnels, cell destruction and inflammation, resulting in another form of severe acne, acne conglobata.

Treatment:
Nodulocystic acne usually requires an aggressive treatment regimen that may include isotretinoin and antibiotics, or intralesional corticosteroids that “melt” the cyst over a period of 3 to 5 days. Some very large follicular cysts that do not respond to medications may require drainage and surgical excision.

Gram-negative folliculitis:

Gram negative folliculitis is an inflammation of follicles caused by a bacterial infection that can result from long-term antibiotic treatment. Patients who are being treated with antibiotics for severe acne may develop Gram negative folliculitis.

The word “Gram” refers to a blue stain used in laboratories to detect microscopic organisms. Certain bacteria do not stain blue and are called “Gram negative.”

Treatment:
In Gram negative folliculitis, the bacteria are resistant to many antibiotics. Isotretinoin and antibiotics that are effective against Gram negative bacteria are used to treat this condition.

Anyone with severe acne should be under the care of a dermatologist as dermatologists have the experience needed to control virtually every case of acne.It is important for patients and their families to know that severe, disfiguring forms of acne may require years of treatment and patients can experience one or more treatment failures. During treatment, the support of family and friends can greatly comfort patients.

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Acne flare-ups can be annoying and embarrassing but they can be treated.  There are lots of good acne treatments on the market today, so talk to your dermatologist to find out which ones will work best for you.

Acne skin care products can be classified into three broad categories:  Preventative, Over-the-Counter, and Prescription

Preventive or General Acne Skin Care Products:

Preventative acne skin care products are ones that are used as an acne-prevention measure.  These acne skin care products include cleansers, make-up removers, and similar products that help prevent acne breakouts.  For those individuals prone to acne, these products should be part of your daily routine to head off acne breakouts before they occur.

These acne skin care products work to act against the causes of acne by limiting the production of sebum (oil) and preventing clogging of your skin’s pores.  These products essentially prevent the oil from getting trapped in the pores and hamper the growth of the bacteria that leads to acne.

General acne skin care products also include exfoliation products like skin peels.  These products work by removing dead skin cells, reducing the possibility of pore-clogging and bacteria development.

Over-the-Counter or Specialized Acne Skin Care Products:

These specialized, or over-the-counter, acne skin care products do not require a doctor’s prescription.  Most of these acne skin care products are based on Benzoyl Peroxide and Salicylic Acid, both of which fight against the bacteria that causes acne.  You should start with a product that contains a lower concentration of benzoyl peroxide to see how your skin responds.

Alpha-Hydroxy-Acid based moisturizers are also a popular products.  You may need to try a few to find a brand that works best for you.

Prescription Acne Skin Care Products:

These acne skin care products are prescribed by your dermatologist.  They include ointments that can be applied to the affected area, or oral antibiotics, or just about any topical treatment.  Your doctor may also prescribe a hormone-based treatment (since hormonal changes are also known to cause acne). Such acne skin care products are known to be very effective in some cases.  Finally, your dermatologist’s may suggest a minor surgical procedure to treat your acne.

Always consult your dermatologist before trying any acne skin care products to learn of their benefits and drawbacks for your particular skin type.

Your body is an incredibly efficient healing machine, and when it’s injured, it does all it can to protect itself.  Acne is an infection, and just like getting a cut, your body responds by sending white blood cells and other molecules that help fight the infection to the wounded site.  After the healing process is complete, a scar forms at the site of the repair leaving the skin not as smooth as it was before the acne.

Let’s discuss some various types of scars and some methods that doctors use to help you looking healthy again.

Types of Acne Scars:

The first thing you should know about acne scars is that everyone has a different tendency to scar.  The same type of acne on one person may only result in minimal to no acne scarring, while the other person may experience more severe acne scarring.  Bottom line, everyone is different.

Acne scars come in two types – scars that are caused by the loss of tissue and scars that are caused by increased tissue formation.

Depressed Scars – These acne scars distinguish themselves by their loss of tissue.  Some depressed acne scars result in a rupture that can cause a loss of collagen giving rise to a deep recess or depression.  The skin above the acne scar is left unsupported due to the lack of tissue below it and a saucer shaped or jagged “Ice Pick” acne scar is formed.  Ice Pick scars are more common on the face.

Keloids – In some people, the acne scar forms in a reverse fashion.  With the loss of collagen, the body triggers fibroblasts that produce excessive collagen, producing scar tissues called keloids.  Keloids are more commonly found on male torsos. Another type of increased tissue formation scar is called hypertrophic or overgrowth acne scar.

Acne Scar Treatments:

The good news is that most acne scars can be treated by your dermatologist using various acne treatments.  Consult your dermatologist to discuss costs and the results you’re looking for from the treatment.  You need to be aware of the varying success rates for treating your type of acne scarring.

The most common treatments for acne scarring are – collagen treatment, laser treatment, dermabrasion, microdermabrasion, skin surgery, and skin grafting.  Keloids may be left untreated if it is felt that further acne treatment will only form additional keloids.  Keloids can sometimes be treated with steroid injections.  Speak with your dermatologist to see what may work for you.

This article is only for informative purposes. This article is not intended to be a medical advise and it is not a substitute for professional medical advice. Please consult your dermatologist for your medical concerns.

As a teenager, acne often poses a huge dilemma. Although it is true that acne usually occurs during puberty, it is probably just as true, just that there are a growing number of individuals who suffer from acne well into their adulthood.

Adults in their twenties, and older, still experience acne flare-ups. Adult acne can have just as many negative effects on a person as teenage acne. The effects in adults is often amplified. Living with adult acne can cause undo stress on work and family from trying to cope with an unsightly skin problem.

Mental stress can be one of the main causes of adult acne. It is also no surprise, that women suffer more often from adult acne than men. Women often have a lot more stress in their daily routines, and are prone to hormonal imbalances during their menstrual cycle and pregnancy. Just as teenage hormones play an important role in the development and exacerbation of acne, hormones can play a similar role with adult acne.

The environmental factors that surround a person, coupled with the individual’s lifestyle can also play an important role in the appearance of adult acne. A poor diet or behavior such as smoking and drinking can effect the skin’s condition and resistance to adult acne and other diseases.

Prevention is the only way to deal with adult acne. Sticking to a proper diet, drinking plenty of water, and getting rest, is a good way to start treating adult acne. The attempt to reduce stress and maintain proper care and hygiene can also help to prevent acne.

But what about the pimples you already have?

There are many treatments for people who have adult acne.

Anti-acne medications, skin care products, and even laser surgery are options that are available to treat adult acne. Visit your doctor or dermatologist to learn what treatments will be most affective for your skin type. Adult acne is very treatable, so act now.