Acne is a common skin condition caused by various factors, including excess oil production, clogged pores, bacteria, hormonal fluctuations, and inflammation. Effective treatment often involves a combination of topical and oral medications tailored to acne’s severity and underlying causes.

Written by Dr Patrick Treacy, Owner and founder of the Ailesbury Clinics in Dublin and Cork

Topical Treatments

Benzoyl Peroxide (BPO): This topical agent reduces bacteria and unclogs pores. It’s often used as a first-line treatment for mild to moderate acne. However, it may cause dryness and irritation. Recently, Benzoyl peroxide has been subject to scrutiny regarding its potential association with cancer risk. While regulatory agencies like the FDA generally recognize benzoyl peroxide as safe and effective for acne treatment, recent concerns have surfaced regarding the formation of benzene, a known carcinogen, under certain conditions. In a nutshell, the research suggests that benzene, a substance known to cause cancer, can form as a byproduct when benzoyl peroxide interacts with other ingredients or environmental factors such as heat and light. Benzene is a concerning compound due to its carcinogenic properties and potential health risks.

Retinoids: These derivatives of vitamin A help prevent hair follicles from becoming plugged, promote cell turnover, and reduce inflammation. Common retinoids include tretinoin, adapalene, and tazarotene.

Topical Antibiotics: Antibiotics like clindamycin and erythromycin are used to kill acne-causing bacteria on the skin’s surface. They are typically used in combination with other acne treatments to prevent bacterial resistance.

Oral Medications

Oral Antibiotics: Tetracyclines (e.g., doxycycline, minocycline) are often prescribed for moderate to severe acne to reduce inflammation and control bacterial growth. Longterm use may lead to antibiotic resistance. The dose of Doxycycline is usually 100mgs daily.

Steroids: In severe cases, corticosteroid injections can quickly reduce inflammation and promote the healing of large, painful acne lesions.

Oral Contraceptives: For women with hormonal acne, oral contraceptives containing oestrogen and progestin can help regulate hormone levels and reduce acne flare-ups. Dianette contains two active ingredients: ethinylestradiol (an oestrogen) and cyproterone acetate (an antiandrogen). Cyproterone acetate works by blocking the effects of androgens, thereby reducing sebum production and preventing acne breakouts. By inhibiting the action of androgens, Dianette helps regulate hormonal fluctuations associated with acne, particularly in conditions such as polycystic ovary syndrome (PCOS), where excess androgens contribute to acne formation. Excessive sebum production is a key factor in the development of acne. Dianette helps decrease sebum production, leading to clearer skin and reduced acne lesions.

Spironolactone: This medication, originally used as a diuretic, can effectively treat hormonal acne by blocking androgens (male hormones), contributing to oil production. It’s commonly prescribed for women with hormonal imbalances. The typical starting dose of spironolactone for acne treatment is usually 25 to 50 milligrams (mg) per day, taken orally. However, the dosage may vary depending on factors such as the severity of the acne, the individual’s medical history, and their response to the medication. In some cases, healthcare providers may gradually increase the dosage to 100 to 200 mg per day if the initial dose is ineffective in managing acne symptoms.

Isotretinoin (Roaccutane):

Reserved for severe, persistent acne that has not responded to other treatments, isotretinoin is a potent oral medication derived from vitamin A. It works by shrinking the sebaceous glands, reducing oil production, and preventing acne recurrence. However, it carries significant potential side effects. It requires careful monitoring, including regular blood tests to check liver function, lipid levels, and pregnancy tests for females due to its teratogenic effects.

Regular monitoring of blood tests, including sex hormone levels (testosterone), liver function tests, and lipid profiles, is crucial during isotretinoin treatment to manage potential side effects and ensure patient safety. Additionally, healthcare providers must determine appropriate medication doses and treatment durations based on individual patient factors, severity of acne, and response to therapy. The dosage of Roaccutane (isotretinoin) for acne treatment varies depending on factors such as the severity of the acne, the individual’s weight, and their response to the medication. However, a typical starting dose for Roaccutane is typically around 0.5 to 1 milligram per kilogram of body weight per day, taken orally in divided doses. For example, a person weighing 70 kilograms might start with a daily dose of 35 to 70 milligrams. This dosage may be adjusted over time based on the individual’s response to the medication and any side effects experienced.

Treatment with Roaccutane usually lasts 16 to 20 weeks, although it may be shorter or longer depending on the individual’s needs and response to treatment. It is important for individuals to take Roaccutane exactly as prescribed by their healthcare provider and to follow up regularly during treatment to monitor progress and manage any potential side effects.

Since Roaccutane can cause serious side effects and is associated with risks such as congenital disabilities if taken during pregnancy, it is only available by prescription and should be used under the supervision of a qualified healthcare professional.

Laser Treatments for Acne: Cutera AviClear

In acne treatment, laser technology has emerged as an innovative approach to combat this condition. One laser treatment is the Cutera AviClear, which has gained recognition for its efficacy in targeting acne at its source. The Cutera AviClear is an FDA-cleared energy device that addresses mild to severe acne concerns. It operates at a wavelength of 1726 nm, which is optimized to penetrate deep into the skin and target the root causes of acne. The AviClear laser precisely targets acne lesions, delivering energy to the affected areas without causing damage to surrounding skin tissue. By effectively reducing skin sebum, AviClear helps prevent the formation of acne lesions, addressing both existing acne and preventing future breakouts. Unlike traditional acne treatments that may involve harsh chemicals or invasive procedures, AviClear offers a non-invasive solution for acne sufferers, minimizing discomfort and downtime. The laser treatment typically carries minimal side effects, making it suitable for many patients.

In conclusion, acne management involves a tailored approach that may include a combination of topical and oral medications, lifestyle modifications, and regular follow-ups to achieve optimal results while minimizing side effects and risks.