Acne

Spots and blackheads are not only a cosmetic problem. They frequently have an impact on the psyche and well-being. The dermatologist is the right contact person to initiate appropriate treatment starting at an early stage. In particular, with strongly inflamed skin and severe acne, a dermatologist should be consulted promptly, as inflammations can result in the formation of scars.

The dermatologist can select from a large number of different, modern treatment methods and tailor these to the individual requirements. It is important for the success of the treatment that suggestions are complied with and that doctor-patient trust is established. Above all, every acne treatment takes time.

The type and intensity of the acne determine the treatment approach. The degree of severity determines whether it is sufficient to use drugs that are used externally, or whether tablets/capsules must be taken.

1. External treatments

Cosmetic options

The professional removal of comedones and the emptying of pus blisters (pustules) can considerably improve the clinical pattern. In this case, it is decisive that the blackheads are removed gently without injuring the surrounding skin. This is frequently possible in dermatological practices or with experienced cosmeticians. Unprofessional 'squeezing out' of the skin impurities normally results in new inflammations and infections. Even scars can develop. Consequently, people should not carry out 'therapy attempts' themselves.

Peeling therapy

The peeling therapy dissolves the plug of horny cells in the sebaceous excretory duct. In doing so, the comedones are removed and new ones are prevented from forming. The following active ingredients are suitable for peeling treatment.

• Vitamin A acid (tretinoin) generates a loosening of the horny cells and makes them less liable to stick together. Closed comedones open up and push out their plug of horny cells. The formation of comedones, papules, knots, and pustules is reduced. Drugs with the active ingredient tretinoin are available on prescription and must therefore be prescribed by a doctor.
• When benzoyl peroxide is applied, this results in a loosening of the plug of horny cells and makes the sebaceous glands smaller. In addition to this peeling effect, it predominantly has a germ-killing (anti-microbial) and sebum-reducing (anti-seborrhoic) effect.
• Azelaic acid has a peeling and anti-seborrhoeic effect. It also has an anti-bacterial effect against propioni bacteria and other germs.
• Isotretinoin (only available on prescription) has a comparable effect as vitamin A acid, but is said to irritate the skin less.
• Adapalen is a substance similar to vitamin A acid with additional anti-inflammatory properties.

Treatment with antibiotics

The active ingredient Erythromycin, for example, is available for external antibiotic treatment. Its effect is based on two mechanisms. Firstly, Erythromycin blocks the growth of germs that play a role in the development of acne, in particular propioni bacteria. Secondly, Erythromycin has an anti-inflammatory impact. It is available in the form of alcoholic solutions, in gels, or ointments. Preparations with Erythromycin or other antibiotics are only available on prescription.

Combinations

Through the combination of two active ingredients, several factors of acne can be treated at the same time. The combination of the peeling agent vitamin A acid with an antibiotic, for example, can considerably shorten the duration of treatment, particularly with inflammatory forms of acne. Cornification disorders in the sebaceous follicle are normalised, pathogenic bacteria reduced, and inflammatory reactions eliminated. Skin irritations that can develop with the sole application of vitamin A acid are prevented by this combination. These preparations are only available on prescription.

2. Internal treatments

Antibiotics

With severe forms of acne papulopustulosa and with acne conglobata, antibiotics sometimes also have to be used internally. For instance, the active ingredient tetracycline, an antibiotic that must be prescribed by the dermatologist, has proven itself. There are, however, other effective antibiotics as well.

Isotretinoin

With severe and very severe forms of acne that do not respond to the usual drugs, a dermatologist can prescribe isotretinoin for internal use. The active ingredient reduces the increased sebum production, prevents the formation of blackheads, reduces the colonisation of bacteria in the sebaceous follicles, and has an anti-inflammatory effect. Isotretinoin is the most effective drug for the treatment of severe forms of acne.

Before, during, and after treatment with isotretinoin, particular precautionary measures must be taken into account. This applies in particular to women. It is imperative that pregnancy must be prevented.

Therapy experiences with isotretinoin

In these film sequences, not only do dermatologists report in a vivid way about the therapeutic options for acne, but patients also talk about their problems with severe acne, and their experiences with the isotretinoin therapy.