The Secret of Great Health Care

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OTC- Chapter 13

Extra: How to Prevent Acne of the Face

Acne




Acne No More is a holistic system to permanently cure acne.

Acne is a skin disease that predominantly affects the face, but also affects the upper back and chest. Acne is contributed to by:

Acne is an important condition and it is more than just cosmetic. Those with acne are emotionally and psychologically affected. It can reduce quality of life and lead to depression, anxiety, lack of confidence, social isolation and even unemployment.

Acne affects 40-50 million people in the United States. Most of those affected are adolescents. Males and female adolescents are equally affected, but in adults it is more common in females.

Key features of acne include:

  • Whiteheads – bumps on the skin with a whitish plug
  • Blackheads – a black plug
  • Small round, red, raised lesion sometimes with a pocket of pus
  • Tender, mass with poorly defined borders
  • Painful solid bumps - nodules
  • Deep bumps with pus inside - cysts
  • Nodules and cysts are more likely to leave scarring.

 What are the causes of acne

Acne is caused by:

  • Excessive androgens (hormones that occur after puberty)
  • Some diseases: Polycystic ovary syndrome and Cushing's disease
  • Blocking of the hair follicles: face masks, make-up (especially oil-based), etc.
  • Risk factors include: high humidity, occlusive clothing or equipment and friction (rubbing hands on face)
  • The use of oil-based cosmetics or hair products
  • Over-the-counter products for tanning or moisturizers that contain lanolin, cocoa butter or mineral oil
  • Certain medications: steroids, some oral contraceptives (some oral contraceptives are used to treat acne), seizure medications and lithium
  • High carbohydrate diets
  • Stress
  • Hormonal shifts (commonly seen after puberty)
  • Genetics
  • Excessive sweating

 

 Who is at risk

Risk factors are essentially the same as any of the causes above. The most prevalent risk factor is being between the ages of 11 and 18.

 

Who needs to see a doctor

Some individuals will likely need to see a doctor to manage their acne. The following conditions are not safely managed without the input of a health care provider:

  • Infection on the face. This will be evident by significant redness, tenderness and heat coming off an area of the face.
  • Hidradenitis suppurativa. This is known by small-pitted areas of the skin with blackheads, tender small nodules under the skin with foul smelling drainage or red tender pustules. Usually seen in the groin, in the armpit on the buttock or under the breast
  • More severe acne. Moderate to severe acne or evidence of cysts, nodules or scaring.

Some patients need to see a doctor with acne on a less urgent basis. This includes those with a sub-optimal response to over-the-counter medications. When over-the-counter medications fail, there are multiple prescription medications including retinoids, antibiotics and Accutane that may help manage acne.  

 

 How to you prevent acne

The primary step to prevent acne is to reduce risk factors.

  • Do not place pressure on the face (no face masks, resting hands on face or use of head bands)
  • Do not use oil-based cosmetics
  • Minimize exposure to dirt and chemicals
  • Dietary restriction does not prevent or treat acne, but avoiding high carbohydrate diets may be helpful
  • Wash twice a day with a gentle cleanser, avoid pumice, anti-microbial soaps, aluminum oxide or polyethylene
  • Do not scrub the face – this may worsen acne

 How do you treat acne

Implementing the prevention strategies listed above, in combination with topical over-the-counter products treats acne. There are multiple over-the-counter products. Medications should be applied to skin after it as been completely washed and dried.

It often takes 4-8 weeks of treatment until there is improvement. The skin should be washed twice a day. When applying medications the vehicle you use will depend on your skin type.

If you have:

  • Dry skin use creams or lotions
  • Oily skin use gels or solutions
  • Sensitive skin use a cream or lotion

 

 

 Over-the-counter products

Over-the-counter products come in two major forms: cleansers and medications.

To purchase products discussed in this chapter visit The Drug Store.

 

 Medications should be applied to the whole area and not just to the areas of acne. Medications used to treat acne are preventative and it may take 6-8 weeks until they are effective. Do not expect immediate results. Some topical medications cause the skin to look worse initially as they can be quite drying. Many prescription mediations can also lead to initial worsening of the acne.

 Benzoyl peroxide (BP) is a popular products for acne. This comes in concentrations up to 10% over-the-counter, but as high as 20% for prescription. The efficacy of the different strengths is not that different. The gel formulation may be most effective at the equal strengths.

BP is applied once to twice a day. It may take up to 6 weeks until effect is noticed.

Benzoyl peroxide has antibacterial properties as well as anti-inflammatory properties. This works well if there is inflammation. It is likely as effective (if not more) than oral antibiotics. It can be combined with some prescription medications such as topical or oral antibiotics or retinoids. While it has anti-bacterial properties, there is no noted bacterial resistance to BP.

Side effects include burning or stinging. Other side effects include peeling of the skin, redness or swelling of the skin. If this happens, decrease the strength of the formulation and decrease the frequency of application. It may lead to bleaching of clothing or hair. Some people also have allergic reactions to this product. This usually presents with itching.

Initially the product should be left on for about 15 minutes and than washed off. Starting off with the 2.5% is recommended. If this is tolerated a longer duration of application and/or higher strength can be tried.

BP is also associated with sun sensitivity, so if you go out in the sun use caution. The application of sunscreen is encouraged.

Proactiv

Proactiv is a popular over-the-counter product that has three steps in it. The active ingredient in 2 of the 3 steps is benzoyl peroxide. In addition it combines a product called allylamine. One study showed that the combination of BP with allylamine may be more effective that BP alone. The product is not magic. While it MAY be more effective that other acne products (at least theoretically), it may not be.

Natural Products

 Holistic products are available for the management of acne. Acne No More is a holistic system to permanently cure acne.

Salicylic Acid

Salicylic Acid works by penetrating the skin, thins the skin on the acne lesion and around the lesion causing the skin to shed. Salicylic Acid comes in concentrations of 0.5% to 2%. It is not recommended as a first line agent as it is not as effective as BP.

It comes as washes, cleaners, gels and creams. Utilizing gels and creams are preferred as this medication takes contact time with the skin for it to be effective. Consequently, the use of cleaners and body washes are not as effective. Side effects are similar to BP and include: redness, swelling, stinging and burning of the skin.

 

 Sulfur

 

 Sulfur based drugs are not commonly used as they are not cosmetically pleasant agents due to their ability to discolor (yellowish) the skin and the odor of sulfur. They also can cause the skin to develop dark bronze scales (more common when sulfur is combined with resorcinol).

Sulfur comes in products with concentrations of between 3 and 10%. It is combined with resorcinol 2% in some products. Sulfur based products are most effective when used on a short-term basis for localized treatment.

To purchase products discussed in this chapter visit The Drug Store.

Some alternative products are purported to manage acne. Common products include: tea tree oil, glycolic acid, and alpha hydroxy acids.

Tea tree oil is not as effective as BP, but does show some benefit. It is also associated with fewer side effects.

Glycolic acid in high concentrations is found in facial peels and may reduce acne scars. Lower concentrations are found in acne washes and may be somewhat effective in the management of acne.

Homeopathic products do not have good evidence to support their use. Selected products include Acne by Nature's Sunshine and Acne Formula by HERBALmax.

Many alternative products are available at Vitamin World.

Prescription medications

Prescription medications are used when risk factor avoidance and OTC medications do not manage symptoms. Retinoids (Tretinoin [Retin A] and Adapalene [Differin]) are topical mediations that are often combined with BP or topical antibiotics to manage acne. They can be quite irritating and are usually applied once at night.

Topical antibiotics are often used. The two most common are clindamycin and erythromycin. Topical antibiotics come in a variety of formulations including lotions, gels, solutions and ointments. These products come with a risk of the development of antibacterial resistance (as opposed to BP).

Oral antibiotics are often tried in the treatment of acne. They work best when there is a lot of inflammation. Antibiotics are taken for months and there is a risk of antibacterial resistance.

Isotretinoin (Accutane) is used for severe acne that has not responded to other treatments. It cannot be used in those who are pregnant and is associated with some significant side effects such as: increased triglycerides, liver problems and vision problems. 

 

 

 

 

Name

Medication

Directions

Benzoyl Peroxide

Oxy- Spot Treatment

Benzoyl Peroxide 10%

Clean skin, apply to affected area 1-3 times a day

Stridex - Power Pads

Benzoyl Peroxide 2.5%

Wipe entire area 1-3 times a day

PanOxyl – Cleansing Bar

Benzoyl Peroxide 10%

Wash affected area for 1-2 minutes, use 1-3 times a day

Salicylic Acid

Acne Stress Control – Power Wash Foam

Salicylic Acid 0.5%

Massage gently in wet face, rinse well

Acne Stress Control – Power-Cream Body Wash

Salicylic Acid 2.0%

Use daily, massage over wet skin, rinse well

Stridex – Sensitive

Salicylic Acid 0.5%

Clean skin, wipe affected area 1-3 times a day

Stridex – Max

Salicylic Acid 2.0%

Clean skin, wipe affected area 1-3 times a day

Sulfur

Clearasil – Stayclear – cream

Sulfur 8% and Resorcinol 2%

Apply to affected areas 1-3 times a day

Acne Free Clear Skin Treatments

Step one – Purifying Cleaner

Benzoyl Peroxide 2.5%

Use Am and PM

Step two – renewing Toner

Use Am and PM

Step three – Repair lotion

Benzoyl Peroxide 3.7%

Use Am and PM

To purchase products discussed in this chapter visit The Drug Store.

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