Topical Treatments
These are suitable for most acne patients except perhaps in
cases wherevast expanses of the body are covered with deep lesions.
The available treatments are designed either to increase the
rate of desquamation of surface scale from the skin and so get
rid of blackheads, or to reduce the numbers of skin bacteria.
A few topical agents used in acne may act via an anti-inflammatory
effect. A detailed description of all available lotions, gels
and creams would require a book in itself; a few general comments
will suffice here.
Antiseptic washes (e.g. pHiso-MED) do little harm and may do
some good. There is some argument as to the usefulness of applications
that contain sulphur. I think that 3--5 per cent sulphur in
calamine lotion or some other vehicle can deal with mild superficial
acne. Benzoyl peroxide-containing applications in 5 or 10 per
cent concentrations (e.g. Panoxyl) are probably the most effective
topical agents. They are available as lotions, creams or gels.
Some preparations of benzoyl peroxide include other agents (e.g.
an antimicrobial as in Benzamycin and Quinoderm).
Tretinoin as 0.01 or 0.025 per cent lotion, gel or cream (Retin-A)
is quite helpful to some patients. Topical isotretinoin (Isotrex)
is also useful. Both these topical retinoids are especially
helpful for patients with superficial acne characterized by
many comedones and pustules. New topical retinoids are likely
to be available in the next few years. Azelaic acid (Skinoren)
has antimicrobial effects and probably helps remove comedones
too. It is nonirritating and helps patients with milder types
of acne.
Extensive warts affecting the back of the
hand.Treatment of this number of warts is always a problem.
Unfortunately all these applications can irritate the skin
if used too frequently, and some sufferers, particularly those
with fair skin, seem quite unable to tolerate certain preparations.
Topical antibiotics are quite popular, clean and nonirritating
acne treatments: tetracy cline (e.g. Topicycline), clindamycin
(Oalacin T) and erythromycin (e.g. Stiemycin and Zineryt). These
agents are among the most effective topical anti-acne treatments.
Systemic Treatments
Orally administered antibiotics are the mainstay of treatment
for moderately severe or severe acne. Tetracycline (or another
member of the tetracycline group) and erythromycin are the ones
that are generally used and appear most helpful. Treatment should
start with 250 mg given three times or twice per day and continued
at that dose until improvement begins. This usually happens after
some six to ten weeks but in some cases may take four or five
months. Treatment with antibiotics may need to be continued for
one or two years.
Treatment with the retinoid drug isotretinoin (Roaccutane)
has proved dramatically successful for many patients with severe
and cystic acne. Isotretinoin is the most effec tive of systemic
treatments for severe acne. It is usually given for a 4 month
course in the first instance, at a dose of 1 mg/kg/ day; this
regimen clears some 70-80 per cent of patients. It seems to
work mainly by cutting down sebum secretion. As with the other
retinoid drugs given systemically - etretinate and acitretin
- isotretinoin is only available from hospital pharmacies. Side-effects
are similar to those caused by etretinate and include dry lips,
drying of other mucosae, transient increase in loss of scalp
hair, increase in blood lipids, hepatic damage and bony problems.
Teratogenicity is also a serious risk and all women in the reproductive
age group must take effective contraceptive measures while taking
the drug and for two months after stopping.
The combination of an anti-androgen - cyproterone acetate -
and an oestrogen ethinyloestradiol, known as Dianette - is an
effective hormonal anti-acne treatment for young women. It suppresses
ovulation and acts as an oral contraceptive.
