Acne is the overall single most common reason for a visit to the dermatologist.
Acne affects 80% of people at some point in their life.
It afflicts 30% to 85% of adolescents and aggravates 12% of adult women between the ages of 25 to 44, many of whom have never had a blemish before
Traditional acne treatment includes:
- restoring normal behavior in the cells lining the pores, so they won’t plug up, with a retinoid i.e. tretinoin, tazarotene or adapalene
- keeping bacterial population down with benzoyl peroxide and surface and/or internal antibiotics
- loosening pore contents with alpha hydroxy acids
- reducing oil gland size and activity with hormones, such as birth control pills, and/or Accutane.
- acne surgery, comedo extraction, peels, intralesional injections, dermabrasion
New therapeutic approaches
* New topical treatments:
- The combination of a retinoid (tretinoin, tazarotene, adapalene) with a benzoyl peroxide and/or a topical antibiotic is now considered to be the standard of care rather than monotherapy.
- Solubilized benzoyl peroxide (BPO) gels are showing better follicular penetration, better bioavailability and greater reductions in acne lesion counts than traditional BPOs. Both non inflammatory i.e. blackheads and whiteheads, as well as inflammatory lesions i.e. pustules, small and larger cysts, showed improved lesion counts. BPO is a 1 billion dollar a year product and a major player in the treatment of acne.
- Combination products containing a topical antibiotic and a BP have shown to decrease the risk of antibiotic resistance. Some combine a retinoid and an antibiotic.
- Topical retinoids are still considered the gold standard in the treatment of both comedonal and inflammatory acne. Because of their irritation potential, we have always advocated a “step-up” dosing schedule as well as the use of a gentle moisturizer interface. New less irritating formulations have made them easier to tolerate.
* New oral treatments:
- The FDA approval of the low dose contraceptive YAZ for acne has made an enormous difference in patients whose acne is hormone influenced. We have witnessed repeated cases of very diligent treatment-resistant acne patients respond dramatically within a month or two of starting YAZ.
- Accutane has gone generic and remains the most effective and the most rapid way to clear acne. We still advocate sticking to the brand name if possible.
- A subantibiotic dose of doxycycline has been added to our armamentarium, allowing us to gradually taper antibiotic regimens and not worrying about antibiotic side effects. This dosage provides an anti-inflammatory effect only and is thus very helpful in mild to moderate inflammatory acne as seen in rosacea.
* New laser and light treatments:
- PDT or Photodynamic Therapy has been shown to provide results equivalent to oral antibiotics.
- Isolaze works a little like the CoolBreeze laser but with an added device that is supposed to suction out blackheads. This sounds great, but seems to work too inconsistently to justify the extra expense.
- Despite ample documentation of the success of some laser treatments, insurance companies are still vigorously resisting reimbursement to patients.
Additional info can be obtained from the American Academy of Dermatology at http://www.skincarephysicians.com/acnenet/index.html