All posts by doctorhb

Dermatologist and Venereologist in Ajman and Dubai

Very Severe Nodulocystic Acne: FAQ

 

Frequently Asked Questions about Very Severe Acne

Sudden, very severe eruptions of nodules and cysts on the face, chest and back have to be dealt with on an emergency basis as these are potentially deep scar forming conditions.

Very Severe Nodulocystic Acne FAQ
Very Severe Nodulocystic Acne

What is Nodulocystic Acne?

Nodulocystic acne is the very severe grade 4 acne consisting of deep seated fluctuant nodules and cysts and numerous pus filled bumps. Most of the face, front of chest and back is commonly involved in nodulocystic acne.

How is Nodulocystic Acne Formed?

The basic pathogenesis of nodulocystic acne is similar to formation of other types of acne. Increased sebum secretion and inflammation caused by the bacteria P.acnes causes stretching and weakening of the wall of the sebaceous gland and hair follicle. This leads to rupture of the contents in to the dermis. A severe foreign body reaction takes place and the whole inflammatory debris and cells are segregated into fluctuant nodules and cysts deep within the dermis. Thus is formed the nodulocystic acne.

What is the Best Treatment for the Very Severe Nodulocystic Acne?

The best treatment for the very severe type of nodulocystic acne includes drainage of the pus, intralesional steroids, and oral isotretinoin. Isotretinoin gives very good results in this type of very severe acne, but its toxicity reduces its appeal to many patients. It is absolutely contraindicated in pregnancy. The second line of treatment involves use of minocycline in place of isotretinoin.

Other principles of treatment of acne also have to be observed in the case of nodulocystic acne. Avoiding acne triggers is also an important part of the management of nodulocystic acne.

What are the Complications of Very Severe Pimples?

Acne Conglobata
Very Severe Acne: Acne Conglobata result in deep scars

The nodules and cysts in the very severe type of pimples are situated deep within the dermis and when they heal, leave depressed, deep scars. Chances of hypertrophic scars are also high and in those with keloidal tendency, these will form disfiguring keloidal scars. Immediate institution of isotretinoin and other measures help reduce the severity of scarring in nodulocystic acne.

 

What are the Side Effects of Isotretinoin?

The main side effect of isotretinoin is the teratogenic effect on the fetus. Because of the risk of deformities, women should take care that they do not become pregnant during and two months after the course of isotretinoin. Most other side effects of isotretinoin in acne are related to the extreme dryness caused by the medication.

What are the Other Different Types of Very Severe Acne?

In addition to the nodulocystic acne, acne conglobata, pyoderma faciale and acne fulminans are the most severe types of pimples that are seen in patients.

What is Acne Conglobata?

Acne conglobata runs a chronic course with involved areas of the face and trunk filled with communicating cysts, abscesses and draining sinuses. The healing is with hypertrophic and atrophic scars. Recurrent episodes of joint inflammation may also be present in some patients. Treatment is similar to nodulocystic acne.

What is Pyoderma Faciale?

Pyoderma faciale commonly affects females and presents with an explosive eruption of large, tender, red cysts, mainly in the central part of the face. Spontaneous purulent discharge is present from the cysts. Comedones are conspicuous by their absence in this type of acne. Treatment is with drainage, oral isotretinoin and systemic steroids. In fact this is one of the rarer forms of acne where a short course of systemic steroids can bring fast relief to the patient.

What is Acne Fulminans?

Acne fulminans is a rare, ulcerative type of acne that mainly affects young adolescent males. There is an abrupt eruption of inflamed, necrotic acne leaving superficial and deep ulcers on the skin surface. Associated systemic symptoms of fever, weight loss, muscle and joint pains give the patient a toxic and weak appearance. Treatment is similar to pyoderma faciale.

Nodulocystic acne and other types of very severe types of acne are dermatological emergencies which need to be treated aggressively in early stages to avoid permanent deep scars.

Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

How to Treat Severe Acne

The Best Treatment for Severe Acne: Treat Early to Prevent Acne Scars

The best treatment for severe acne is a combination of oral retinoids or antibiotics and topical anti-acne medications.

Severe acne, with high number of inflammatory pustules and nodules, should be treated promptly to prevent deep ice pick and hypertrophic acne scars.

Severe Acne
Severe Acne: Early Treatment Prevent Scar

In severe acne, there are pus filled lesions, formed fresh or from already existing papules, and a few nodules. Numerous red, painful, pus filled bumps and humps are seen on the face, chest and back.

 How is Severe Acne Treated?

 As with other types of acne, there are specific and general measures to deal with the severe type of acne. In general, the specific treatment of inflammatory acne consists of oral retinoids, oral antibiotics, topical antibiotics, benzoyl peroxide and topical retinoids.

What is the Best Treatment for Severe Acne?

 Oral isotretinoin is the single best treatment for acne. But it is a medication to be used with care and only under the supervision of a dermatologist. It is absolutely contraindicated in pregnancy .

Following is the treatment protocol for severe acne followed by most dermatologists:

  1. Treatment is started with oral isotretinoin at a dose of 1-2 mg per kg body weight per day in males and non pregnant females who are on double contraception during and two months after the medication.
  2. From family history, depth and severity of the inflamed acne bumps, if there is less chance for scar formation, and in those where oral retinoids are not advisable the treatment is initiated with oral antibiotics (minocycline, tetracycline or doxycycline), with a gradual tapering of dosage over a period of 6-8 weeks. In pregnancy, only if severe pustular or nodular bumps are there is systemic treatment advised. The drug of choice for inflammatory acne in pregnancy is erythromycin. All medications are best avoided in the first trimester of pregnancy.
  3. Topical therapy of severe acne is same as in the moderate type of acne. Morning topical clindamycin/erythromycin and evening benzoyl peroxide 5% gel is the preferred combination used in severe acne.
  4. Once the pustules regress, topical benzoyl peroxide is replaced with topical isotretinoin.
  5. Benzoyl peroxide and Topical Tretinoin cause irritation in some patients because of their peeling effect on the epidermis. The following steps will help reduce the irritation in sensitive individuals:
    • Tretinoin and benzoyl peroxide should be applied at night only.
    • A non-comedogenic water based sun screen is used during daytime to avoid sun-sensitization.
    • If redness and scaling occur and skin becomes dried up, wash off the benzoyl peroxide or tretinoin cream/gel after 2 hours in the first week of application. Once the skin starts tolerating the medication, overnight application can be restarted.
    • In these patients, lower strengths of benzoyl peroxide and tretinoin is used in the first two weeks, later shifting to higher strengths, if necessary.
    • At times, after 2-3 weeks of treatment, topical retinoids can cause a flare up. This indicates an inflammatory blowup of the acne bumps and is a good sign. There is no need to discontinue the application.
    • A post inflammatory reddish brown pigmentation is seen after treatment with benzoyl peroxide. This will gradually disappear on continued treatment. A sun protection cream should be used during daytime till the pigmentation subsides.

What are the General Measures in the Treatment of Severe Acne?

 General measures include advices on skin care, washing, diet and life style management. These and the tips on preventing new acne eruptions are the same for all types of acne.

 What are the Complications of Untreated Severe Acne?

Untreated severe acne causes deep ice pick scars and hypertrophic scars in most patients. Post inflammatory pigmentation is common, especially in the dark skinned individuals.

The best treatment for severe acne is a combination of oral retinoids or antibiotics and topical anti-acne medications. The treatment is individualized according to the extent, type of acne and sex and age of the patient.



Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Severe Acne: Frequently Asked Questions

 

Because of the predominance of inflammatory acne lesions, severe grade type 4 acne calls for prompt aggressive systemic and topical therapy.

 What Comprises Severe Acne?

Severe Grade 3 Inflammed Acne
Severe Grade 3 Inflammed Acne
Severe Grade 3 Acne
Severe Acne consists of Inflamed papules and pustules

 Inflammatory pustules and deep acne bumps (nodules) are predominant in severe acne or acne grade 4. More than 100 comedones, or more than 50 papules or pustules and more than 5 nodules with a total count of more than 125 acne bumps comprise severe acne.

Severe Inflammed Acne
Grade 3 Severe Pustular Acne

How is Severe Acne Formed?

The initial pathogenesis behind severe acne is similar to other types of acne, viz, hormone stimulation of the sebaceous glands, thickening of the follicular wall and blockage of the hair pores.

In severe acne, the resident bacteria of the hair follicle, P.acnes, multiplies in the medium of the sebum causing breakdown of its components. This causes a chemical irritation, attracting inflammatory white blood cells known as neutrophils.

Neutrophils release some chemical mediators and enzymes which cause the typical characteristics of an inflammatory reaction within the sebaceous glands and the associated hair follicles: calor, rubor, dolor, tumor and functio-lesa, meaning: heat, redness, pain, swelling and loss of function of the affected area.

The inflammation and the resultant destruction of the follicular walls, sebaceous glands and the debris from the inflammatory reaction results in formation of pus filled bumps known as pustules.

The wall and sheath of the gland and hair follicle expand in the dermis with the pus to form deep seated nodules.

What are the Triggers of Severe Acne?

The acne triggers inducing, aggravating and maintaining severe acne is similar to all other types of acne. Picking at the acne bumps and application of topical steroids worsen the severe acne. Picking at the acne bumps and application of topical steroids worsen the severe acne.

What is the Best Treatment for Severe Acne?

The best treatment for severe acne is systemic retinoids. Because this is a strong medication with local and systemic side effects and chances of fetal abnormalities, it is not usually advised to females of child-bearing age group and during pregnancy. Females and their partners should use a double contraception of barrier plus pills while on retinoids.

How Long Should Severe Acne be Treated?

The duration of treatment varies from individual to individual and the response to anti-acne treatment. The average duration of treatment with oral isotretinoin is 18-20 weeks up to a maximum of 24 weeks. An interval of 3 months is given in between before a fresh course is started.

Those on oral antibiotics and topical applications may have to continue treatment for longer duration, till the active acne bumps stop appearing. Then, the dosage is reduced gradually, and stopped over a period of 1-2 months. The topical antibiotics are also stopped like wise. Topical benzoyl peroxide is continued till no fresh acne bumps appear for a period of 2-3 months.

Maintenance therapy of healed severe acne is with topical tretinoin, usually with the 0.025% concentration. This is important in preventing recurrences. Any recurrence is dealt with the same way as new acne bumps and the best treatment for severe acne re-instituted at the earliest to prevent formation of acne scars.


Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Treatment of Moderate Acne

Grade 3 or Papulopustular Acne
Moderate Acne: Grade 3 or Papulopustular Acne

Moderate acne is a transition state between the non-inflammatory and inflammatory pimples. Skin colored bumps (papules) and comedones predominate in moderate acne, also called grade 2 acne. A moderate amount of pustules (pus filled bumps) is also seen in some patients.

Is it Necessary to Treat Moderate Acne?

The aim of treating acne is to reduce and clear the unsightly bumps thus preventing scarring. Being non-inflammatory acne, expert advice should be sought and treatment started in moderate acne without delay. Remember early, appropriate treatment drastically reduces the chances of acne scar formation.

How is Moderate Acne Treated?

Treatment of moderate acne involves general measures and specific measures. General measures are similar to all other types of acne and involve advice on avoiding the acne triggers, skin care and observing healthy dietary and life styles.

Specific measures in the treatment of moderate acne involve use of topical antiacne medications.

  1. Topical retinoids are the first line of therapy for moderate acne where comedones predominate. Treatment is started with tretinoin or isotretinoin applied sparingly at night. Adapalene or tazarotene are alternative retinoids that may be used.
  2. For papule and pustule predominant moderate acne, a topical antibacterial solution is also added. Clindamycin and erythromycin are the usual topicals used in acne. Azelaic acid is a useful alternative, especially in the healing stages, when mild pigmentary changes are prominent.
  3. If the number of pustules are more, and there is sign of deeper inflammation, an oral antibiotic like doxycycline or azithromycin.
  4. In those with pustule predominant moderate acne, benzoyl peroxide is the second line of treatment, along with either topical retinoids or antibiotics.
  5. Retinoids and benzoyl peroxide are applied at night only, as these can sensitize your skin to sunlight, especially the retinoids.

Some may experience a flare up in the first 2-3 weeks of starting the topical treatment. This is a good sign and there is no need to stop medication, though concentration and frequency may be reduced till the inflammatory blowout is controlled.

 How Long Should Moderate Acne be Treated?

Duration of treatment of acne varies from individual to individual and the type, severity and extent of the zits. In general, treatment should be continued till 6-8 weeks after the acne bumps subside completely and there is no fresh outbreak. A maintenance application with topical retinoids should continue weekly twice or thrice for a few months to years, depending upon previous history of recurrences and the life style of the acne sufferer. Regular treatment will have to be re-instituted, should there be any recurrence.

Treatment of moderate acne involves avoidance of acne triggers , a combination treatment with topical anti-acne medications and following tips on how to prevent acne recurrences.


Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Moderate Acne: Frequently Asked Questions

 

Moderate eruption of acne, being the minimally inflammatory type of pimples, could cause scarring in some affected individuals. This calls for early consultation with a dermatologist to get rid of the acne at the earliest stage itself.

 What is Moderate Acne?

 Acne is divided into different types. Moderate acne comprises of skin colored bumps (papules) predominant acne eruption.

Moderate Acne
Moderate Acne: Minimally Inflammatory Papular Acne

Some comedones and pustules (pus filled bumps) are also present. When the number of comedones are higher than 20, even without the presence of papules or pustules, it may be considered as moderate grade 2 acne. In a nutshell, 20-100 comedones and/or 15-50 inflamed papules or pustules with a total count of 30-125 acne bumps comprise moderate acne.

 How Does Moderate Acne Develop?

The events of acne formation start with the increased production of androgen hormones. These stimulate the sebaceous glands to produce more sebum and also produce changes in the lining of the hair and sebaceous ducts. Keratinous plugs are formed in the opening of the hair follicle, the open and closed comedones. When the normal resident bacteria of the hair follicle, known as Propionibacterium acne, start multiplying within the oily sebum and produce irritant side products, this triggers an inflammatory response within the hair follicle and sebaceous glands.

Mild, Moderate and Severe Acne
Mild, Moderate and Severe Acne

When the inflammation is minimal and contained within, the sebum and the products of the inflammation accumulate within the hair duct, raising the surface of the skin, forming skin colored or slightly reddish bumps.

What is Grade 2 Moderate Acne?
Grade 2 Moderate Acne

When the inflammation is significant, these results in formation of pus, which is actually the debris formed from the inflammatory cells, dead and damaged cells and living and dead bacteria. Thus are formed pustules, the other type of lesions seen in moderate acne, albeit in a limited number.

 

What are the Triggers for Moderate Acne?

The acne triggers inducing, exacerbating and maintaining moderate acne is similar to all other types of acne.

What are the Complications of Moderate Acne?

As with other inflammatory acne, there are chances of scar formation in untreated moderate acne patients. Though it is not possible to predict who will get scarring, a family history of scarring and predominance of papules and pustules should alert the acne sufferer to seek early treatment.

While healing, post inflammatory pigmentation (dark spots) may occur in some patients, especially those with dark skin.

Anxiety and depression may affect the individual from fear of disfigurement from the pimples.

What is the Best Treatment for Moderate Acne?

The best treatment of moderate acne is a combination of topical retinoids (isotretinoin, tretinoin, adapalene) and antibacterials, along with oral antibiotics when inflamed bumps are present.

Being the transition state between non-inflammatory and inflammatory types of acne, it is imperative for moderate acne be treated early so as to avoid the complications of scarring and progression to severe type of acne.

 

Published by Dr Hanish Babu, MD on 28th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Treatment of Mild Acne

 

How to Get Rid of Comedones

Treatment of mild acne involves limiting or controlling triggering factors, life style management and getting rid of the comedones with topical medications.

Mild acne refers to non-inflammatory type of acne presenting with open or closed comedones, the blackheads and whiteheads respectively.

Acne Comedones
Mild Acne: Pathogenesis and Treatment

In most cases of adolescents and teenagers, the comedones on the forehead, cheeks and nose are the first signs of arrival of puberty. In majority of affected cases, the acne eruptions are too mild to necessitate any treatment. But when the eruptions are generalized and appearing in crops, early treatment will effectively control the acne.

 What are the General Measures Advised to Treat Mild Acne

 General advices and tips for dealing with acne are the same for all types of acne. These include advices on washing, skin care and lifestyle adjustments. Teens suffering from comedones, especially the blackheads may try to pick, squeeze and scrub the zits leading to worsening of the condition, and, possibly, inflammatory changes like redness and infection. This should be avoided at all costs. If you want to remove the debris from the blackheads, have it done by an experienced dermatologist or a cosmetologist using a comedone extractor only.

How to Treat the Mild Acne?

Following is a step by step guide to get rid of the comedonal acne:

  1. Wash the skin no more than twice a day with mild soap and water.
  2. In general, the mild acne is treated with a single topical application. Topical retinoids are considered the first line therapy for comedonal acne.
  3. Apply the retinoids only at night.
  4. To begin with, start at the lowest strength of the topical retinoid. Most commonly used retinoids are tretinoin, isotretinoin and adapalene, either in gel or cream forms. Gel has a drying effect and is preferred in those with an oily skin.
  5. Benzoyl peroxide 2.5-5% is the second choice in comedonal acne; but used only if the topical retinoids are not tolerated well. Azelaic acid may be used if the patient cannot tolerate benzoyl peroxide.
  6. During a follow up after 4-6 weeks, the physician will assess the response to treatment. If the response is evident and positive, same regimen is continued till new eruptions cease to appear. A maintenance application of 2-3 times every week is advised till there is no evidence of acne eruptions for at least 2-3 months at a stretch.
  7. A non comedogenic, water based moisturizer is used in the morning if the anti-acne medication is causing excessive skin dryness.
  8. Some patients may experience a flare up of the acne bumps during the first 2-3 weeks of topical retinoid application. This is mistaken as a worsening of the acne and the medication is stopped by the patients. Actually this reaction is an inflammatory blowout of the comedones and indicates the beginning of the recovery period. Hence, the applications should be continued in such cases, albeit at a lower concentration and frequency than before, till the reaction subsides. At times, a course of oral antibiotics may be required to tide over the inflammatory reaction.

In females requiring contraception, a combination pill may be advised, as these also help control the acne eruptions.

It is possible that even minor acne eruptions can cause significant negative psychosocial impacts in the affected teens. The treatment of acne will not be complete unless this issue is also taken care of through relevant supportive therapies.


Published by Dr Hanish Babu, MD on 27th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Mild Acne: Frequently Asked Questions

Mild Acne: Comedones: To Treat or Not to?

Mild acne, being the commonest type of acne affecting majority of adolescents and teenagers need not be actively treated. The following are a few of the most frequently asked questions on mild acne.

What Comprises Mild Acne?

Mild comedonal acne
Comedonal acne
Mild Acne
Mild Acne Black-heads

Acne is divided into different types depending upon the severity of the eruptions. Mild acne denotes a few eruptions of the comedones, both open and closed varieties. This is the most common type of acne that makes its first appearance in adolescence. Most cases of mild pimples do not require any active treatment and they rarely cause any scarring.

Comedonal Acne
Acne Grade 1: Comedone

How is Mild Acne Formed?

The arrival of puberty causes a surge of androgenic hormones in the body.  They have specific action on the sebaceous glands, which start secreting thick, sticky oily sebum into the hair follicle ducts. The hormones also act on the lining cells of the follicular wall, which become thickened and keratinous. This cellular debris and the sticky sebum accumulate in the hair follicle duct and form a plug to close the pore. This plug is known as a microcomedone.

When the keratinous plug pushes out under a thin layer of the skin, it is known as closed comedone or whitehead. When the opening is open, it widens under the pressure from the plug to form a blackhead or open comedone.

The black color of the blackheads is not due to dirt accumulation, but due the action of oxygen in the atmosphere on the fatty acids of the sebum.

What is the Clinical Appearance of a Comedone? 

Closed comedones or white heads present as skin colored, white or slightly reddish bumps on the facial skin. Open comedones or blackheads have wide rimmed opening with a characteristic black plug covering the opening. This black color is not due to dirt, but caused by oxidization of the sebum when it comes in contact with the atmospheric oxygen. The treatment of mild comedonal acne do not warranty use of oral medications, topical applications will work well in most cases.

Does Mild Comedonal Acne Cause Scarring?

 This is an important question which requires specific clarification, as it may have a bearing in treatment decisions; both by the patient and the physician. Though rare, mild comedonal acne can cause scarring in some affected teens. A family history of acne scars and hard, wide open comedones should prompt the sufferer to seek prompt medical treatment.

When Should Mild Acne be Treated?

Almost everyone, at least once in their life time would have suffered from mild attacks of acne, mostly of the comedonal type, or a few cases of scattered papules (skin colored bumps). Most of these does not warranty any treatment and will go away by themselves. The following are the indications for seeking treatment if you are suffering from mild acne:

A family history of acne scarring.

Widespread comedonal acne.

Large comedones which are hard in consistency are more prone for ice pick scars and should be treated early.

The habit of picking at the comedones and squeezing or picking at the blackheads can cause worsening and inflammation of the acne bumps and warrants early treatment.

 Is it Advisable to Extract the Comedones?

 Actually, it is not the comedones that are extracted, but the mixture of the oily sebum and the cellular debris blocking the hair duct within the comedones that is being extracted.

Clearing the blocked ducts in blackhead will result in faster healing, if done properly.

Never squeeze or scrub the comedones, this will worsen the acne and may precipitate an inflammatory reaction resulting in scarring.

Do not try to extract contents from a white head or a closed comedone. Breaking of the sebum and debris into the dermis may result in inflammatory acne formation.

The procedure should be carried out by an experienced dermatologist or cosmetologist only, with a comedone extractor.

How to Treat Mild Acne?

Mild acne treatment is carried out through topical applications, topical retinoids being the most preferred agents.

Read more about treatment of mild acne.


Published by Dr Hanish Babu, MD on 27th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.
Copyright 2018 © Dr Hanish Babu, MD

Acne Treatment: General Advices from Dermatologist

 

Before discussing how to manage the different types of acne in detail, it will only be proper to dwell upon the general measures to be observed while managing acne.

Here are the general advices from dermatologist to manage your acne:

  1. Boost confidence: Having the first outbreak of acne and severe acne lesions on the face is potentially threatening to a teenager. The resulting anxiety built up and low confidence levels can affect your performance both at home and at your school/ work place. Sympathetic counseling and support are required at this stage. Take time to talk to your acne skin physician or dermatologist about your fears and doubts .
  2. Dietary and food restrictions are important in most cases. Low fat, low calorie diet, avoidance of high iodine containing food, chocolates, fizzy drinks and fried food is advisable. Intake of lots of vegetables and fruits and salads should be encouraged. Avoidance of alcohol and caffeine are mandatory. Remember, cola drinks and tea also contain caffeine. For details on the effect of food on acne, see the links below.
  3. Stress Management: If there are frequent flare ups during stress periods, a stress management program should be charted out. Learn how to manage your stress to reduce acne outbreaks following stressful periods.

    Acne: Avoid Compulsive Face Wash
    Acne: Avoid Compulsive Face Wash
  4. Avoid compulsive washing: Excessive washing will further irritate the skin and interfere with the treatment regimens. Wash the face with mild soap 2-3 times daily, not more than that. Take care to wash off all specks of cosmetics that you have applied before going to bed and applying the acne medication.
  5. Avoid constant picking on the acne lesions. This will irritate the lesions. I always remind my acne patients that they are actually ‘feeding’ the pimples when they touch them too often!
  6. Avoid acne inducing cosmetics: If you have an acne prone face, avoid oil based cleansers and moisturizers on the face. Moderate use of non greasy lubricants and water based make ups are allowed. A gradual decrease in cosmetic usage is encouraged as acne improves.
    Topical Applications causing Acne
    Avoid Topical Applications causing Acne

    This is essential to avoid recurrent flare ups. See this useful tip to find out the grease or oil content of  make up cream.

  7. No OTC medication without consulting your dermatologist! Many OTC applications, whether they are herbal or chemical are potentially harmful to the skin on prolonged usage. Take expert advice before you experiment. It is your face. You cannot afford to make it an experimental field for the cosmetic industry!
  8. Avoid any suspicious medication that you may be taking (for other illnesses) that you suspect is worsening your acne. Request for alternate prescriptions from your physician.



Published by Dr Hanish Babu, MD on 26th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

Acne Treatment Guidelines

Guidelines on How to Get Rid of Your Pimples
Acne-Skin Care Tips From Dermatologist
Acne-Treatment Guidelines

Having an understanding of the basic principles of Acne treatment and available guidelines will help the acne sufferers effectively keep their pimple problem under control.

Control of acne becomes easier and more effective if the basic pathogenesis and type and extent of the pimples are understood well. Most teenagers who suffer from acne take it lightly, at least in the early stages, and resort to self treatment with acne home remedies and OTC acne medications.

Several acne treatment aspects have been evolving since the last decade; like the combination therapies, the role of lasers and light based therapies and the various modalities of treatments for acne scars.

Acne Treatment Principles

Most people tend to believe that acne is a natural phenomenon and a minor irritation during adolescence and teenage. The latest updates from the global alliance to improve outcomes in acne recommend early and aggressive treatment of acne to reduce the chances of permanent scar formation in acne sufferers.

Following are some important guidelines regarding the management of acne:

  1. There is no cure for acne. It is impossible to get rid of acne in 3 or 10 days as is being claimed by some commercial websites.
  2. The goal of treating pimples is to control the disease activity and limit inflammatory response within the dermal layer of skin before it damages the skin structures. This will help prevent formation of acne scars and blemishes.
  3. There is no single effective treatment for all types of acne. Treatment of zits varies according to the type, severity and extent of acne eruptions. The age and sex are also deciding factors while planning a treatment schedule for the acne.
  4. It could take anywhere between 2 weeks to 16 weeks for the acne eruption to get under control.
  5. Required duration of treatment for pimples varies from individual to individual.
  6. Normally combinations of systemic and topical anti-acne medications are instituted to initiate the treatment of acne. Once new acne eruptions stop, the oral medications are gradually tapered. The topical medications, usually a combination of tretinoin/ adapalene/ tazarotene or benzoyl peroxide with topical antibiotics clindamycin or erythromycin are continued as maintenance therapy. Later, topical antibiotics are also stopped as new eruption of acne is not evident for a few weeks.
  7. Topical medications, especially the retinoids, may cause flare up of the pimples during the initial stages of treatment. There is no need to stop or change the treatment in such cases. If irritation is continues, the frequency and strength of application may be reduced till the skin tolerance is regained.
  8. Never rely on OTC acne products or acne home remedies if you have inflammatory acne (red, painful eruptions). Any delay in proper treatment of inflammatory acne could lead to permanent scarring.
  9. The topical retinoids and benzoyl peroxide applications should be used only at night; never during daytime. When you are using these creams, it is advisable to avoid prolonged sun exposure. A sun screen with sun protection factor (SPF) 30 or above should be worn while outdoors.
  10. In those with a family history of acne scarring and severe eruption of comedonal or inflammatory acne, initiation of treatment with oral isotretinoin is advised by most dermatologists.
  11. Oral retinoids are absolutely contraindicated in pregnancy. If you are a female of child bearing age group, you should practice double contraception (pills with barrier) throughout the period of treatment and at least two months after the cessation of therapy with oral retinoids.
  12. If you have an acne prone facial skin, avoid using oil based make up and creams on the face.
  13. Constant picking at the pimples is an often ignored cause of scarring and pigmentation in acne. Avoid manipulating the acne bumps at all times.
  14. Do not use topical steroids on the face unless under the supervision of a dermatologist, that too for specific indications only.
  15. Most acne treatments, in addition to their medicinal properties, have a peeling effect on the skin. In those with sensitive skin, the skin may turn red and irritated in the initial stages or during the therapy. If the dryness and irritation is severe, discontinue the treatment for a few days, apply non-comedogenic moisturizers, and then restart the treatment when the skin returns to normal.
  16. Though controversy still exists regarding the role of diet in acne formation, most acne patients do experience flare ups with certain food items. Low fat, low calorie food, avoidance of milk and milk products, high iodine containing food items, chocolates, fizzy drinks and fast foods are best avoided by acne sufferers. Excess alcohol and caffeine intake is also discouraged in acne.

Learning the basic principles on which the treatment of acne is based will be beneficial for those suffering from this most common skin disease with far reaching physical and psychological consequences.

Published by Dr Hanish Babu, MD on 26th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD

 

Best Acne Treatment Practices

 

Why Acne Should be Treated without Delay
Acne:  Education, Goals and Choice of Therapy

Managing the acne patients involve proper education to dispel the acne myths, defining the goals of therapy and instituting evidence based therapeutic measures.

Education of Acne Patients

Most adolescents and teens affected by acne bumps are anxious and worried about the after effects of acne bumps, the acne scars and blemishes. Proper education is necessary to reassure the patients about the natural course of acne. But care should be exercised not to trivialize the condition, so that proper treatment is delayed or ignored.

Education is based on various aspects of acne and its management.

  • The prevalence of acne. Acne is a common disorder of the adolescents and teens, affecting almost everyone at least once during their life time.
  • The natural course of the pimples. There are different types of acne and most cases of mild acne improve without causing scars. Moderate to severe types of acne require therapy for longer duration to avoid the scarring.

    Acne Treatment Best Principles
    Acne Education: Acne Myths have to be expelled
  • The common acne myths. There are many prevailing; should be clarified during the first visit.
  • Treatment options for acne. Treatment differs according to the types of acne.
  • Life style adjustments required to reduce the chances of recurrences.
  • Follow up and maintenance therapy. Regular follow up and maintenance therapy with topical retinoids is necessary to keep the acne eruptions under control.

Goals of Acne Treatment

Treatment will not cure acne. The following are the goals of acne treatment:

  • To get rid of acne bumps.
  • To prevent the inflammation from becoming deep and extensive.
  • To prevent acne scars.
  • To improve the compliance of patients.
  • To reduce anxiety and stress associated with pimples.
  • To improve self esteem in affected teens.

Choice of Acne Medications

Choice of acne medications depends on the type and extent of the acne eruptions.

  • Mild comedonal acne: Topical retinoids alone or in combination with topical clindamycin or benzoyl peroxide. Acne topical medications alone will suffice in this type of acne.
  • Moderate papular and pustular acne: Combination of topical antibiotics and benzoyl peroxide. If inflammation extensive: add systemic antibiotics.
  • Severe pustular and nodular acne: Systemic retinoids alone or a combination of systemic and/or topical antibiotics and/or benzoyl peroxide. Laser and blue light therapy may be useful in this type of acne.
  • Very severe nodulo-cystic acne:  Systemic isotretinoin for the first 12-16 weeks, then shift to combination of systemic antibiotics and topical retinoids if necessary. Surgical intervention and intralesional steroids if necessary.
  • Acne Scars need to be dealt with according to the individual characteristics and types of scarring.

Maintenance of Acne Therapy

Most acne sufferers are free of the disease by the age of 25 years. About 3% males and 12% females may still get periodic acne eruptions beyond 25 years.

Maintenance therapy, usually with topical retinoids, is necessary to prevent acne recurrences.

Adherence to these best acne treatment practices will not only help get rid acne, prevent scarring, but also ensure better patient compliance.

 Published by Dr Hanish Babu, MD on 26th May, 2018

Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or the website will not be responsible for any consequences. The images provided are for illustration purpose only and are copyrighted.

Copyright 2018 © Dr Hanish Babu, MD