Acne Vulgaris Treatment

 

Acne Vulgaris Treatment

 

 

ACNE VULGARIS TREATMENT

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Abstract

Acne vulgaris is a skin disorders that affect the face, chest and back. Although it mainly affects adolescents, it may present in children and adults. The medical community and general population usually dismiss this disorder as a superficial affliction, which is associated with age. Currently, various permutation and modalities have been designed to control the disorder because of the better understanding of its pathogenesis. Retinodes, benzoyl peroxide and antibiotics are administered in combination with tropical agents. Hormonal therapy, isotretinoin and oral antibiotics can be used for systematic therapy depending on patient requirement. Finally, physical treatment such as lesion removal and phototherapy can also be helpful in some cases.

Introduction 

By definition, acne is a chronic inflammatory disease of pilocebaceous units. Non-inflammatory comedones and inflammatory papules, nodules and pustules characterize the disease. The disorder has four pathogenic mechanisms that include increase in sebum production, follicular hyperkeratinization, P.acne colonization and the inflammation. Researchers and physicians have a better understanding of the pathogenesis of acne and they have designed new therapeutic modalities for new treatment options help in achieving successful therapy of more numbers of acne patients and fulfil patient expectations. Acne patients can have significant psychological and physical effects and a third of those affected require medical intervention to prevent irreversible scarring. This paper discusses the effect of acne and the treatment options available (Webster, 2002).

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Topical therapy

Topical treatment should be applied to existing lesions and all affected areas. Some topical kill the bacteria while others reduce excess oil in the skin. The topical medicine may contain: Benzoyl peroxide, Topical retinoids, Topical antibiotic.

Benzoyl peroxide is an effective topical agent, which is available in different formulations such as lotions, creams, gels and washes. It is a bacterial agent, which is effective due to its oxidizing activity. Benzoyl peroxide reduces comedones and sebum production and inhibits the growth of P. Acnes. It has a concentration of 2.5 to 10 percent. In addition, gels are more stable that creams and lotions, which are irritating and less active. The drug is used in mild to moderate acne because it has an anti-infammatory, comedolytic and keratolytic activities. Benzoyl peroxide can cause mild irritation with a burning sensation, peeling and dryness that occurs within the first days of therapy (Webster, 2002). 

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Topical retinoids the drug targets the microcomedo-precursor lesion of acne and has an anti-inflammatory effect. It acts by modifying the abnormal follicular keratinisation by reducing follicular plugging, inflammatory and non-inflammatory acne. Examples of tropical retinoids include tazarotene, isotretinoin, tretinoin and metretinide. Their effect is mediated through nuclear hormone recepotrs and cytosolic binding proteins. Topical retinoid has the following effects; scaling, erythema, burning sensation and contra-indication in pregnancy. The effects vary depending on skin formulations, sensitivity and type (Webster, 2002).

 

To reduce the resistance of topical antibiotic and increase its effectiveness it is better to use it in combination with benzoyl peroxide or zinc. Tropical antibiotics inhibit the growth of P. acne and reduce inflammation. The most popular topical antibiotics include erythromycin, clindamycin and tetracycline. They are effective against inflammatory acne in

 

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combination of 1 to 4 percent. Topical antibiotics have minor side effects, which include burning, peeling erythema and itching. It also develops resistance and cross-resistance.

Combinational therapy/ Other topical

Benzoyl peroxide is more preferred as a combinational therapy due to its advantage of preventing and eliminating the development of P.acne resistance. When it is combined with clindamycin or erythromycin, its tolerability and efficacy are enhanced. When combined with tretinoin it is more superior to mono-therapy. Additionally, a combination of topical retinoid and topical antimicrobial can effectively reduce both inflammatory and non-inflammatory acne lesions.

Salicylic acid has been used as a comedolytic agent in treating acne, but it is used in less potent than topical retinoid. It has a 10 percent similarity in action to retinoid. Azelaic acid is effective in treating antibacterial activities, inflammatory and comedonal acne. It is also known to normalize keratinization hence its ability to treat comedonal acne. Picolinic acid gel has antibacterial and antiviral properties. Finally, there is lactic acid that is useful in prevention and reduction of acne lesion counts.

Systemic Therapy 

Systemic therapy takes several months for noticeable improvement to be seen; therefore, it should continue for about 3 to 4 months for effectiveness to be assessed. Systemic therapy may be combined with topical treatment. Systemic treatment is used for moderate to severe acne, which include oral antibiotics and nicotinamide. Oral antibiotics for treating acne include doxycycline, minocycline, erythromycin, tetracycline and sulfamethoxazole. Antibiotics effectively reduce P.acne levels because they reduce sebum free fatty acid levels to achieve their anti-inflammatory effect. Use of erythromycin can lead

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to resistance of P. acnes and doxycycline and minicycline are more effective that tetracycline in treating acne (Webster, 2002).

In addition, doxycycline has most frequent adverse reactions such as photosensitivity and oesophagitis than other acne antibiotics. Minocycline rarely cause hypersensitivity and hepatic like dysfunction. Oral antibiotics should be administered if the lesions are widespread. Others side effects associated with oral antibiotics include gastrointestinal upset incidence of upper respiratory tract infection and vaginal candidiasis. Minocycline may also produce pigment deposition in mucous membrane, teeth and skin, but rare cases of reactions such as autoimmune hepatitis, serum sickness-like syndrome and systemic lupus erthematosus-like syndrome are reported with minocycline. Research has shown that long-term treatment with oral antibiotic increase resistance to P. acne, especially with erythromycin. This makes it necessary to follow antibiotic prescribing policies and to make use of non-antibiotic preparations wherever possible. Antibiotic monotherapy should be avoided by combining with benzoyl peroxide or topical retinoid (Webster, 2002).

Hormonal therapy

Hormonal therapy is needed in treating severe seborrhoea, androgenetic alopecia and late-onset acne in female patients. Hormonal therapy helps in preventing the effects of androgens on the sebaceous gland and follicular keratinocytes. Oral contraceptive such as norgestimateethinli estrodiol may be used in treating moderate acne in women unresponsive to oral antibiotics and/or topical therapy. Oral contraceptive decrease levels of circulatory androgens by inhibiting follicle stimulating hormone and luteinizing hormones. Others include Spironolactone, cyproterone acetate and flutamide (Webster, 2002).

 

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Oral isotretinoin

It is administered in severe and moderate acne producing psychological scarring that is unresponsive to conventional therapy. Oral isotretionoin is the only acne drug that has the ability to affect all the four pathogenic mechanisms implicated in acne. Some of its common side effects include effect on the central nervous system, musculoskeletal, cheilitis and flaring of acne these side effects are temporary and resolve after discontinuing the drug.

Physical treatment

Comedones extractors and a fine needle can be used to remove both open and closed comedones with the help of prepeocedure topical retinoid that makes the procedure easier. The risk of tissue damage limits comedo extraction. Few cases may require active deep inflammatory lesions, which is followed by IL steroid injection in cysts. Photo therapy may be done by using visible light or photodynamic. Visible light is used to treat mild to moderate inflammatory acne. Exposure of acne bacteria to ultraviolet free blue light helps in destruction of P. acne (Webster, 2002).

Conclusion

Diet restriction has not been beneficial in the treatment of acne as shown by the previous studies. It is also evident that cases of acne are lower in non-industrialized societies than in modernized society. While treating acne there is need for timely intervention and adherence to the treatment are key to avoiding long-term physical scarring. Finally, acne patients should be referred to a dermatologist if they do not show any response to treatment or in case of physiological effect.

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