Although many people relate eating particular foods to worsening acne, in most cases, diet has little effect on the course of the problem. If certain people feel a particular food may trigger attacks, they can test it by having several attempts at adding and excluding it to their diet over a period of days or weeks to ensure the apparent association is not just by chance.
Stress seems to produce outbreaks (exam time being a common trigger).
Simple daily washing of the skin with water only is all that is needed. Other medicated washes can be used if people feel they help. Sometimes, though, soap type washes can induce a paradoxical increase in skin oiliness and local inflammation.
Depending on the severity and underlying cause most can be effectively treated medically on milder medications. A lot of over-the-counter topical preparations do not have much success in any but the very mildest forms. The better topical applications that are of help are noted below.
Peroxide based gels, creams and lotions (Panoxyl, Benzac AC, Brevoxyl and Benoxyl) and Glycolic Acid (such as Face First & Novopro) useful in inflamed acne skin for their antibacterial and keratin breakdown properties.
Antibiotic Topical Preparations based on Clindamycin (Clinac, Dalacin T and Topicil), Erythromycin (Eryacne Gel and Stiemycin Solution, both available on prescription only in New Zealand) and Azelaic Acid (Skinoren).
Retinoid and Retinoid-Type Preparations (based on Vitamin A) such as Isotrex Gel, Retin-A Cream and Differin Gel. All these require a prescription in New Zealand to be obtained.
In association with these, or if these are not helpful, some oral treatments are available (although all the following are available only on prescription in New Zealand). They can be broken down into three categories:
Antibiotics such as Tetracycline (Doxycycline, Minocycline), Erythromycin and lesser-used ones such as Cotrimoxazole can be started at a full strength antibiotic dose and then lowered or else started at the lower dose. They work on a number of levels including changing some of the biochemistry of the skin.
Hormonal modulators, mainly Diane 35 (now Estelle through another supply company of a similar product), which can be used in women only and is packaged like an oral contraceptive preparation. There are concerns with this product giving a slightly higher risk of provoking deep vein clots. The small increased risk of this should be weighted against the benefits.
Oral retinoids initially only Roaccutane but now also available as a generic Oratane available only on a Dermatologist's prescription. This agent works by reducing the number of sebaceous glands while it is being taken, reducing skin oiliness.
Medical microdermabrasion has been shown to be helpful in both controlling and improving the course of active acne. Usually we would use this in combination with one or more of the above treatments, except Roaccutane (and Oratane). As Roaccutane reduces the number of sebaceous glands which act as a main supply for the growth of new skin cells, regeneration of the skin after treatment is not as vigorous and the end result not as predictable. When used with other treatments, medical microdermabrasion will halve the time to skin improvement.
There may be a breakout of lesions after the first or second treatment.
Thereafter each session should produce progressive improvement. Any associated scarring or pigmentation changes from acne will also be improved. Sessions are best done weekly until control is achieved.
Once controlled, as with other treatments, we would recommend continuing the supplemental treatment for at least six months to achieve some long-term clearance. Microdermabrasion sessions can be gradually reduced in frequency through this time to fortnightly, three weekly and monthly according to response. See more>
Light and Laser Therapy
This has become popular in more recent years mainly through some studies being reported in the daily newspapers. These studies had shown that a small percentage of people would get acne improvement when exposed to a number of light sources including blue light.
The vast majority of people will not respond. However because of the way the results were reported many believe it is a much more successful treatment than it really is.
We have experimented with this approach but did not find it widely effective enough to continue using it at Springdale
This is a variation on the light treatment above and is actually very effective. It has a significant cost attached because the agents utilised in it are quite expensive. By its name photodynamic therapy (PDT) utilises light of various types to produce a change in a medication that will selectively cause a desired tissue effect. It has been used for many years in treating some people with psoriasis. Some lung and other cancers have also been treated this way.
In acne, methyl aminolevulinic acid (Metvix, which we prefer to straight aminolevulinic acid as it is more rapidly and predictably absorbed by the skin) in a cream form is applied to the skin about twenty minutes before it is activated by our scanning Helium Neon (633nm) laser.
The Metvix absorbs selectively into the sebaceous glands. The light activates it into its next form which releases oxygen radicals which damage the cells it has absorbed into. Sebaceous gland activity diminishes and therefore acne activity. The effect is similar to that of Roaccutane without all the systemic effects this medication.
A few sessions (usually three or four) a few weeks apart induce dramatic acne reduction. The treatment is very comfortable usually at the most being felt as a slight tingle. If the 904nm beam of the PR777 laser we use is activated at the same time as the Helium Neon, some improvement in the scarring can be achieved as well. See more>