How do you treat comedonal acne

About acne

treatment

There is currently no treatment that can be applied equally to all types of acne, so a combination of different treatments is sometimes recommended. Since acne lesions do not fully develop until eight weeks or more, treatment must be continued for at least two or three months before a decision can be made whether it has really been successful.

Assessment before treatment:

In order to determine which is the best treatment for each individual patient, the following information from the medical history and physical examination must be assessed:

  • Clinical type and severity of acne, to determine the types of treatment required.
  • Skin type, dry or greasy to determine the appropriate base of topical medication. This is important as it determines the effectiveness of the treatment in terms of intake and duration. The drug is administered via topical (externally applied) bases, such as ointment, cream, gel, lotion, spray, or powder.
  • Presence of acne scars, to possibly Consider a stronger form of therapy to treat acne.
  • Presence of post-inflammatory erythema or hyperpigmentation, to consider special types of treatment.
  • Regularity of the menstrual cycle and anamnestic signs of hyperandrogenism in women, to the Identify the need for additional laboratory testing and the prescription of hormonal treatments.
  • Skin care and previous acne treatments,to identify potential problems and evaluate previous treatments that have worked or not.
  • cosmetic products and other medicines, around Identify products that may promote acne development.
  • Psychological effects of acne on the patient, to identify the need for a stronger treatment approach or psychological support.

Treatment principles

Treatment for acne is mainly focused on key factors that promote the development of acne lesions: follicular hyperproliferation and abnormal desquamation of epithelial cells (keratinocytes), increase in sebum production, excessive increase in Cutibacterium acnes bacteria, and the presence of inflammation.

They are the first choice for most acne cases. Topically applied retinoids sometimes cause reddening of the skin. It is therefore strongly recommended to apply sun protection with a sun protection factor of at least 30.

Treatment approach

An example of a general approach to initial acne treatment based on the 2016 American Academy of Dermatology depends on the type of acne patients have and their medical history (table).

General approach to treatment based on the type of acne the patient has.

A. Comedonal (non-inflammatory) acne:
  • Topical retinoids (azelaic acid) or salicylic acid
B. Mild and mixed (comedonal) papulopustular acne:
  • Topical antimicrobial treatment (benzoyl peroxide only or benzoyl peroxide + topical antibiotic) + topical retinoid
    or
  • Benzoyl peroxide + topical antibiotic (for patients who cannot tolerate retinoids or for whom a simplified treatment regimen is indicated)
C. Moderate and Mixed Papulopustular Acne:
  • Topical retinoid + oral antibiotic + topical benzoyl peroxide
D. Severe acne (e.g. lump acne):
  • Topical retinoid + oral antibiotic + topical benzoyl peroxide
    or
  • Individual therapy with oral isotretinoin
 

Treatment plan (maintenance therapy)

In general, acne keeps coming back over the years, so maintenance therapy is an important component. Patients must keep in mind that it will take at least two to three months for constant treatment to work. Sometimes it is necessary to adjust the medication.

Main care for acne

Skin care plays an important role in the treatment of acne. For the treatment to be more effective, a specific skin care routine should be followed.

  • Skin care: The face should not be cleaned more than twice a day with warm (not hot) water and a mild, soap-free facial cleanser. The use of cloths and sponges of vegetable origin is not recommended. The skin of the face should also not be rubbed as it can worsen acne and irritate the skin. Under no circumstances should pimples be squeezed out as this worsens acne, causes swelling, and can lead to scarring. In addition, the lesions are more likely to become inflamed.
  • Moisturizer: Using a moisturizing cream will reduce the dryness and therefore flaking of the skin. Use creams that are non-comedogenic (causing blackheads) to prevent the skin pores from clogging.
  • Sun protection: Some of the drugs that are used for acne treatment, such as retinoids or doxycycline, make the skin more sensitive to sunlight. It is therefore advisable to avoid direct sunlight and always apply a sun protection factor of at least 30, which protects against UVA and UVB light.

Bibliography

  1. Zaenglein, A.L., Pathy, A.L., Schlosser, B.J., Alikhan, A., Baldwin, H.E., Berson, D.S., et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol [Internet]. 2016 May 1; 74 (5): 945-973.e33. Source: https://www.ncbi.nlm.nih.gov/pubmed/26897386. doi: 10.1016 / j.jaad.2015.12.037.
  2. Nast, A., Dréno, B., Bettoli, V., et al. European evidence-based (S3) guidelines for the treatment of acne. J Eur Acad Dermacol Venereol [Internet]. 2012; 26 Suppl 1: 1-29. Source: https://www.ncbi.nlm.nih.gov/pubmed/22356611. doi: 10.1111 / j.1468-3083.2011.04374.x
  3. European Academy of Dermatology and Venereology (EADV). Acne: how to treat it [Internet]. 2020. Source: https://www.eadv.org/cms-admin/showfile/9635-EADV%20Acne_2%20How%20to%20treat%20it.pdf