Acne can have a genetic, hormonal, bacterial or psychological etiology. The family predisposition heavily influences the appearance of pimples, but also the hormonal alteration (menstrual cycle, pregnancy, adolescence) plays a leading role in its appearance. Stress and psychological disorders can be a co-cause, especially during adolescence; last but certainly not least, the beating Propionibacterium Acneswhich – by blocking the pores of the skin – generates inflammation and acne.
Before embarking on a therapeutic path based on the administration of medicines for the treatment of acne, it is good to keep in mind some rules of hygiene and behaviour, which are useful both for preventing acne and for speeding up its healing when the “disease” is in progress.
- The skin should always be cleaned delicately, with delicate and non-aggressive cleansers
- Avoid excessive cleansing of the skin: an excess of cleansing, in fact, removes the thin natural lipid layer that covers the skin, drying the skin and making it more sensitive
- Always remove make-up after applying make-up
- In case of acne, the hair should be in contact with the face as little as possible
- Do not rub or scratch the pimples, to avoid even permanent scarring
- Do not apply oily creams to your face, especially if you have acne
These simple steps can be effective for mild to moderate acne; if symptoms persist, drug treatment can be undertaken; so much so that in case of seriousness, in the absence of treatments, acne tends to disfigure the face even for 8-10 years. In the light of what has been said, it is understandable how relevant and intelligent it is to consult a specialist (dermatologist) when the condition is alarming; also in this case the importance of dermatological control from the first symptoms should be underlined, to monitor and control the disease.
Below are the classes of drugs mostly used in acne therapy, and some examples of pharmacological specialties; it is up to the doctor to choose the most suitable active ingredient and dosage for the patient, based on the severity of the disease, the patient’s state of health and his response to treatment:
Antibiotics: antibiotic treatment for acne is clearly reserved for severe and complicated cases, as well as those in which the topical application of other specific substances (eg retinoids) is particularly complex or ineffective. However, there are some antibiotic formulations to be applied to the skin, especially indicated for patients who cannot tolerate oral antibiotics.
Antimicrobials: this category of drugs is titrated by benzoyl peroxide and azelaic acid, active ingredients often used in acne therapy to replace antibiotics; in fact, it has been observed that the prolonged administration of antibiotics can develop resistance in the bacterium Propionibacterium acnestherefore it is advisable to take the antimicrobials first and, only later and in case of no resolutive effect, the antibiotics.
- Benzoyl peroxide (e.g. Acnidazil, Benzac Clean, Panoxyl): in general, therapy with this antibacterial should be started in small doses, and then gradually increased during the treatment. If the symptoms do not improve after 2 months of therapy, it is necessary to change the drug and opt for an antibiotic. It is recommended to start the therapy by applying the cream 1-2 times on the damaged skin; continue the treatment with formulations with a higher active concentration. Consult your doctor.
- Azelaic acid (e.g. Skinoren, Finacea): apply a 20% cream to acne-affected skin, twice a day (morning and evening). It is recommended to use mild cleansers and not to scratch the pimples. Indicated for the treatment of mild to moderate facial acne. It creates fewer side effects than the previous drug.
Possible side effects: skin irritation, edema (generally following the very first applications)
Hormones: hormone therapy for acne is reserved for women and girls; most of the time, the patients are treated with a combined therapy: Ethinylestradiol and Cyproterone acetate (e.g. Diane, Dianette). We are talking about oral contraceptives (which must be prescribed by the doctor after a thorough visit), also particularly indicated in the treatment of dermatological conditions such as acne, hirsutism, seborrhea and alopecia. These drugs, although contraceptives, must not be used exclusively for this purpose.
Retinoids: retinoids are drugs widely used for the treatment of acne; however they are quite powerful substances, therefore they must be used with caution, in full compliance with what is prescribed by the doctor. There are also side effects: the intake of retinoids, even if the dosages are respected, can lead to flaking of the skin and erythema; however, it should be remembered that these side effects tend to regress during the period of therapy.
It is also important to warn the patient that the first therapeutic effects of the drug are generally observable after a few months of treatment.
- Isotretinoin (eg Roaccutan, Aisoskin, Isoriac, Isotrex): this drug is used in therapy against acne of psychological aetiology, which cannot be treated with antibiotic drugs, and for cystic acne. Isotretinoin is by far the most powerful anti-acne drug and is also very suitable for the treatment of rosacea. Do not take during pregnancy: the drug has a teratogenic effect, even long after the end of the treatment. The drug is applied to the skin once or twice a day.
- Retinoic acid or tretinoin (e.g. Retin-A, Vesanoid): this drug is widely used in therapy, despite the possible worsening of the acneic condition during the first applications. In fact, by favoring the desquamation of keratinocytes and stimulating cell turnover, the drug tends to accentuate pimples: in any case, this undesirable effect tends to disappear during therapy. Apply a thin layer of cream to acne-affected skin every night before bedtime; subsequently, reduce the number of applications to 3 weekly. Consult your doctor. Do not apply the product during pregnancy and lactation: the drug is a teratogen.
- Adapalene (e.g. Differin 0.1% gel/cream, Epiduo 0.1%+2.5% gel): the administration of this drug is indicated for the treatment of medium-sized acne; it is applied to the injured skin once a day, preferably in the evening, before sleeping. It is less irritating than the retinoids described above, although they belong to the same category.
Natural substances for the treatment of acne
Even nature gives relief to skin affected by pimples: the choice of plants to use is directed towards purifying, anti-inflammatory, purifying and sanitizing drugs. Burdock, birch, calendula, echinacea, fumitory and dandelion are just some of the countless plants that can provide a valid therapeutic alternative to the classic acne treatments.