Treatment of acne requires consant care. The ultimate goal of acne treatment is to prevent the development of new acne. It takes time for acne to get better. If acne does not improve after 6 to 8 weeks of treatment, it is recommended to change the treatment method.
Occasionally, acne rashes may be caused by cosmetics or medications used before. Rarely, acne can be caused by hormonal imbalance. Therefore, it is important to inform the dermatologist about the cosmetics and medications used before treatment.
Women should also consider exacerbation of lesions along the menstrual cycle. Cosmetic type acne lotions and creams can help treat acne. However, if used too often, it can dry out the skin, so the patient must consult a doctor and read the product documentation carefully prior to use.
Scratching or squeezing acne can make the scars worse, so the patient should be treated professionally in a hospital. Treatment of acne takes time, so it is important to be patient and steadily treated.
Treatment for acne usually depends on the severity of the symptoms. It can be roughly divided into medicines to be applied, medicines to be taken, and surgical treatment.
1) Medicines applied to the skin
Medicines applied to the skin are mainly used for mild or moderate acne. Antibiotics act on P. acnes on the skin’s surface and hair follicles, reducing the number of bacteria and inhibiting inflammation. These antibiotics include clindamycin or erythromycin. Vitamin A derivatives, tretnoin or adapelene, have antibacterial and exfoliating properties and promote sebum discharge. Meanwhile, benzoyl peroxide has a strong antibacterial effect and some anti-inflammatory and comedone dissolving effects. Recently, a combination of two or more ingredients has been widely used.
The use of medications applied to the skin can cause dry skin and dead skin cells. Therefore, frequent washing with soap or rubbing dead skin cells should be avoided, and it is recommended to use a suitable skin moisturizer after washing. Patients should also be advised on the correct use and side effects of medications applied to dermatologists prior to treatment.
2) Oral medication
In moderate to severe acne, oral medications are mainly used, including oral antibiotics and vitamin A derivatives called retinoids.
Antibiotics directly reduce acne bacteria in the hair follicles and reduce inflammatory reactions, especially when there are inflammatory lesions on the chest or back. Tetracycline, minocycline, and erythromycin are commonly used.
The main action of a retinoid preparation known as Roaccutane® is to reduce sebum secretion. In addition, it helps to block acne progression, including acne-related hyperkeratosis, inflammatory reactions, and bacterial growth. The main advantage of retinoids is that they are fundamentally treatable and can remain improved for months to years, even if the patient discontinues administration. Side effects often include lipitis, dryness, and itching. There is a need for periodic blood tests because of the high levels of triglycerides, cholesterol, and liver enzymes. In women of childbearing age, it may cause fetal malformation, so birth control must be done from 1 month before starting medication to 1 month after stopping administration.
(3) Oral contraceptives
For women whose acne worsens before menstruation, taking oral contraceptives can significantly improve acne. So, oral contraceptives are sometimes used to treat acne.
3) Invasive treatment
(1) Steroid injection therapy
Large pimples are not only bad in appearance but also likely to remain scars. When the skin is hardened by severe inflammatory lesions, diluted steroids are injected directly into the lesion area. This prevents acne from disappearing quickly and scars remain.
One of the side effects of injection therapy is skin atrophy. However, it is not a big problem since most of them recover after 6-12 months.
(2) Extrusion treatment
Dermatologists also squeeze open or closed comedones. However, patients should not open or squeeze the inflammatory comedone themselves. When comedone is squeezed, it becomes redder, swollen and irritated, eventually leaving scars. The reason for this is that the oil glands walls weakened by inflammation are squeezed and destroyed, which causes more inflammation. Extrusion treatment performed by dermatologists expands pores with clean, hot water vapor, and removes acne with special equipment. Therefore, there are few side effects.
If the acne is widespread, chemical dermabrasion can be done. As the dead skin cells peel off, the clogged pores open at once and the inflammation subsides. It also increases the skin’s absorption of other medications, increasing the efficacy of the medication.
(4) Photodynamic therapy
When a photosensitizer is applied to the skin, it is selectively absorbed by the sebaceous glands and pores. Subsequently, activating a photosensitizer by emitting light of a specific wavelength can destroy the sebaceous glands and pores of acne and suppress the secretion of sebaceous glands. In addition, acne treatments are performed using lasers such as Polaris®, Synergy®, V-beam®, and Aramis®.
4) Treatment of acne scars
There are several ways to treat acne scars.
(1) Chemical dermabrasion
Treatment of scars using chemical dermabrasion involves partial treatment of scars, treatment of the entire face centered on the scar area, and treatment of scars that remain deep after laser skin regeneration.
Among them, cross therapy (dot peeling) is called ‘chemical skin regeneration’. In other words, unlike the method of chemically peeling the entire face, it is a method of putting special chemicals in each scar or pore area and regenerating the skin topically. Trichloroacetic acid (TCA) is the main chemical peeling agent. Chemodermabrasion may be repeated several times at regular intervals depending on the depth of the scar.
(2) Fractional laser
Fractional lasers are based on the principle that the laser energy in the form of microscopic rays passes through the epidermis to the dermis layer. This method destroys the epidermal blemishes and pigment cells, as well as the melanocytes that cause them. It also contracts and produces collagen in the dermal layer. And it increases skin elasticity to improve fine lines and contracts wide pores to treat acne scars.
This is a procedure that fills the depressions of the skin. These include collagen, hyaluronic acid, Restylene®, autologous fat transplantation, and silicone.
(4) Skin regeneration laser
Skin regeneration lasers such as Polaris, Titan® and Genesis® are non-operative methods. Skin can be regenerated by stimulating collagen production in the dermis to promote skin elasticity. Most of the treatments are done with cross therapy and V-beam vascular laser therapy depending on the shape and distribution of the scar rather than the skin regeneration laser alone.
(5) Scar resection
Scar resection is a method of surgically resecting a scar and then resealing it. One type of scar resection is punch resection. This involves local anesthesia of the scar and then resection of the scar area with a punch slightly larger than the scar. Punch resection has the disadvantages of local anesthesia and bleeding, but is well known for treating large and deep scars.
(6) Steroid injection
It may be effective to apply steroid injections directly to the area for acne-causing keloids (the new flesh produced as the wound heals and becomes hard).
Cryotherapy is a method of freezing and destroying scar tissue using liquid nitrogen.
5) Treatment of adult acne
Adult acne occurs at a time when people actively start social life. Compared to puberty acne, the duration of the disease is longer, the response to treatment is slower, and the scar is more severe. It is important to receive proper treatment, as the quality of life may also decrease. The principle of treatment for adult acne is basically the same as for other acne. It is important for patients to start treatment early, and depending on their condition, they may take medication or apply it to the skin. Among them, acne on the cheek or chin tends to have deep lesions and severe inflammation. Because of the high risk of skin redness, pigmentation changes and scarring after inflammation, patients are advised to seek active treatment early.
6) 10 things to be aware of when treating acne
- Keep your face clean with proper washing.
- Do not touch your face.
- Do not squeeze or scratch acne with dirty hands.
- Do not self-diagnose or self-prescribe.
- Live a regular life and be comfortable.
- Be patient and treat steadily.
- Don’t be tempted by acne drug advertisements.
- Be sure to follow your doctor’s instructions.
- Wash your face after going out.
- Wash your hair often.
Acne is common on oily skin, and this type of skin is essentially long-lasting and does not change easily with any treatment. There is no treatment that can cure acne in a short time. Therefore, steady skin care and treatment are necessary until the acne is completely gone.