How is acne treated?

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Research Analysis by Consensus

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Comprehensive Overview of Acne Treatment Modalities

Topical Treatments for Acne

Topical treatments are often the first line of defense against acne, particularly for mild to moderate cases. These treatments target several of the key pathological factors responsible for acne, including hyperseborrhea, hyperkeratosis, microbial colonization, and inflammation . Common topical agents include:

Retinoids (tretinoin, isotretinoin, adapalene, tazarotene): These are effective in reducing comedones and have anti-inflammatory properties .
Antibiotics (erythromycin, clindamycin): These help reduce bacterial colonization and inflammation, although resistance is a growing concern .
Benzoyl Peroxide: Known for its strong antibacterial properties without inducing resistance, it is often used in combination with other topical agents .
Azelaic Acid: This agent has both antibacterial and anti-inflammatory effects and is effective in treating hyperpigmentation.

Systemic Treatments for Acne

For moderate to severe acne, systemic treatments are often necessary. These treatments include:

Oral Antibiotics (tetracyclines, erythromycin): These are used to reduce bacterial colonization and inflammation but are associated with the risk of bacterial resistance .
Oral Isotretinoin: This is considered the most effective treatment for severe acne, targeting all the etiological factors of the disease. However, it is associated with significant side effects and requires careful monitoring .
Hormonal Treatments (oral contraceptives, anti-androgens): These are particularly effective in female patients by reducing androgen levels, which in turn decreases sebum production .

Physical and Procedural Treatments

Physical therapies are often used as adjunctive treatments and include:

Comedone Extraction: This manual removal of comedones can provide immediate relief .
Chemical Peels: These involve the application of chemical solutions to exfoliate the skin and are effective for mild to moderate acne .
Laser and Light Therapies: These newer treatments, such as blue/red light therapy, 1,450-nm diode laser, and photodynamic therapy, offer alternatives to systemic medications and have shown promising results in reducing both inflammatory and non-inflammatory acne lesions .

Complementary and Alternative Medicines (CAM)

There is growing interest in natural and safer treatment options for acne. However, the efficacy of CAM therapies remains under-researched, and more evidence is needed to validate their use.

Conclusion

Acne treatment requires a multifaceted approach tailored to the severity and type of acne. Topical treatments are effective for mild to moderate cases, while systemic treatments are reserved for more severe forms. Physical therapies and newer laser and light treatments offer additional options, particularly for patients who do not respond well to conventional therapies. Despite the variety of available treatments, the increasing resistance to antibiotics and the need for more evidence on CAM therapies highlight the ongoing need for research in this field.