Acne

Acne is a common chronic skin condition characterized by red, inflamed bumps that typically appear on the face, neck, back, chest, and shoulders. Sebaceous glands provide nutrients to Propionibacterium acnes, an anaerobic bacterium that normally resides on the skin. The overgrowth of this bacterium leads to inflammatory acne. Acne can affect individuals of all ages, especially adolescents and young adults.

While acne is not a serious health condition, severe or persistent acne can result in permanent scarring or pitting, leading to psychological distress.

Prevention

• Manage stress and set realistic work goals to allow time for relaxation activities.

• Maintain proper hygiene at all times.

• Avoid oily cosmetics and instead choose water-based or non-comedogenic products.

• Avoid friction or pressure on acne-prone areas, such as from helmets, backpacks, tight collars, or phone contact.

Management

• Consider comedone extraction using appropriate tools.

• Wash the face with warm water twice daily, especially after sweating or vigorous activity.

• Keep hair clean and away from the face, particularly when oily, to prevent clogged pores.

• Avoid using oil-based products, which may trigger acne.

• Acne treatment requires time. Medications can reduce severity and prevent new acne formation.

• Avoid squeezing or picking acne to prevent secondary infections and scarring.

When to See a Doctor

• If symptoms do not improve, worsen, or spread within 8 weeks of starting treatment.

• If acne causes dark spots or scarring.

• If acne leads to emotional distress, lack of confidence, or depression.

• If acne is accompanied by irregular menstruation or hirsutism (excessive hair growth).

Treatment Options

1. Topical Acne Products

Keratolytics such as azelaic acid, benzoyl peroxide and salicylic acid promote skin exfoliation and are used for acne, dermatitis, dandruff, warts, and hyperkeratotic conditions.

• Benzoyl Peroxide is a first-line treatment and helps prevent antibiotic resistance in Propionibacterium acnes when combined with topical antibiotics.

• Dosage and use: Apply once or twice daily after cleansing.

Patient Advice:

• Start with a low-strength formulation and gradually increase as tolerated or use every other day initially.

• Results may take 6–8 weeks to become noticeable.

Topical Retinoids like adapalene, isotretinoin, tazarotene and tretinoin have comedolytic and anti-comedogenic effects.

• Do not use tazarotene during pregnancy.

• Dosage and use: Apply a thin layer once daily at night.

Patient Advice:

• Start with low-strength products and gradually increase usage.

• Combine with keratolytics by alternating products initially (e.g., retinoid at night, keratolytic in the morning).

• Nicotinamide-based products may also be added.

2. Systemic Antibiotics

Oral antibiotics reduce P. acnes growth and inflammation. Suitable for moderate to severe acne that doesn’t respond to topical treatments.

• Tetracyclines (e.g., doxycycline, minocycline, oxytetracycline) are commonly used but should be avoided in pregnant women, children under 8, and those on oral retinoids.

• Minocycline can cause serious adverse reactions (e.g., lupus-like syndrome).
  Other options: azithromycin, erythromycin, clindamycin, cotrimoxazole.
  Oral antibiotics should not be used as monotherapy. Combine with topical agents.

3. Corticosteroids

Triamcinolone injections may be used for severe inflamed acne.
Short-term oral corticosteroids can reduce inflammation, but long-term use can worsen acne.

4. Skincare Products

Cleansers often contain ingredients like glycerin, lactic acid, sodium cocoyl isethionate, or sodium lauryl sulfate to help prevent acne.
Some products include UV-blocking ingredients such as bemotrizinol, bisoctrizole, octinoxate, tianium dioxide, or tridecyl salicylate—suitable for acne-prone skin.

5. Hormonal Therapy

Combined oral contraceptives (e.g., cyproterone, drospirenone, ethinyl estradiol, levonorgestrel) counteract the effects of androgen on acne.
Appropriate for women whose acne is due to high androgen levels. A specialist should assess suitability and screen for contraindications before prescribing.

6. Topical Antibiotics

Topical antimicrobials such as clindamycin, erythromycin, metronidazole, and sodium fusidate are effective for inflammatory acne and are often used with keratolytics to reduce bacterial resistance.