Acne treatments; what you need to know
Hi there. This quick read will prepare you for your consultation with me.
During the consultation, my aim is to provide you with factual information to assist you in;
- Finding an effective solution for your acne.
- To provide safe treatments.
- To mitigate & treat acne scarring.
Here are your options that I will give you during your consultation. It may involve one or more combinations, based on your clinical findings, expectations & preferences.
Treatment solutions are based upon science.
Acne treatment options:
Topical (cream based)
Creams include vitamin A/retinoids as well as topical antibiotics.
Pros: Little side effects limited to skin only.
Cons: Takes 8-10 weeks to work. Success in 60-70% of cases. Won’t solve hormonal or cystic acne.
Pros: Mostly side effect free. No screening test required. Can be combined with all other forms of acne medication for faster & more effective results, eg. lasers, peels & topical prescriptions.
Cons: Success in 70% of cases. Limited efficacy in hormonal acne. Acne may recur. Treatment course may be 4-16 months.
Anti-hormone medications (applies to females)
Pros: Relatively side effect free. No concerns with pregnancy (unlike Accutane). Very effective in hormonal acne cases. Can be combined with creams & anti-inflammatory meds for better and faster results.
Cons: Takes 2-3 months to kick in. Failure rate of 10-15%. Acne may recur after stopping.
Vitamin A/ isotretinoin
Pros: The most effective treatment for acne. It is by far the most cost effective way of addressing acne of all types, including hormonal, cystic, blackhead & picking acne. Accutane has the highest cure rate of over 65%.
Cons: Purging common. Side effects are common, but under your control. Monitoring (blood tests) with follow ups are mandatory whilst on this medication. Major side effects are rare. 30-40% of patients require a second course of this drug.
Lasers & LED/phototherapy
Pros: Treats acne, addresses scars. Little if no side effects. Fast way to clear red marks & post acne pigmentation.
Cons: Success in 70% of cases. Limited efficacy in hormonal acne. Will require 2-6 sessions over several weeks. Best as adjunctive therapy; namely combined with Accutane, topical medications & anti-hormonal tablets.
Pros: The fastest way to treat blackheads & mild to moderate acne. Little if no side effects.
Cons: Limited efficacy in hormonal acne. Best as adjunctive therapy; namely combined with Accutane, topical medications & anti-hormonal tablets.
Skin care & acne
Pros: Mostly side effect free with a small probability it will be effective for moderate to severe acne. Worth a try if you have very mild to mild non-scarring acne.
Cons: Most fluffy over the counter skin care products will not work. If you are inclined to try, you can start with a BHA wash & azelaic acid. You don’t need to see a dermatologist for this.
Diet can help reduce all forms of acne, including hormonal acne, cystic acne & other subtypes. It’s simple. Don’t eat processed foods, no sugar, no dairy products. You can not have cheat days. Ever. Unlike a caloric restricted diet, you can not make up for cheat days. I encourage all patients to be on a diet for better control & accelerated acne clearance.
If you are into supplements, take zinc sulfate. You can buy this in most pharmacies. Dosage as per directions. Zinc can be marginally helpful for some, but given how harmless it is, you can start on zinc supplements if you are inclined to lean towards natural supplements.
Simple, cheap, effective for picking acne. If you pick, I will suggest these patches. They cost approximately 20 to 30 cents each & can be purchased in most pharmacies. Do not get expensive ones, simple hydrocolloid patches will be fine. If your picking is significant, I will also refer you to a psychologist who will provide you with strategies to reduce picking. My counselling skills are limited.
The no BS guide to acne management
During the consultation I will present you with options for treating your acne. The combination depends on clinical findings.
The most useful topical solution?
Prescription retinoids, acknowledging they may take 10+ weeks for maximal effect. Dab on antibiotic lotions can be good for pimples.
The most reliable method of treating acne?
Accutane. It is effective in over 98% of cases. Side effects are common. This tablet is for those patients who are committed to effectively & efficiently addressing their acne.
The highest cure rate?Accutane. Provided you complete a course of treatment (6 to 10 months+), your cure rate is in the order of 65%. This means 35% of patients may require a second course. 10-20% may require a third course.
The fastest way to clear acne?
Chemical peels, manual blackhead extractions & laser phototherapy. Up to 70% reduction of acne spots can be achieved in 5 days. Best combined with medical therapy.
The most side effect free?Taken contextual, anti-hormones & topicals in females. Anti-inflammatories & topicals in males.
The best skin care to use?
BHA washes or simple cleansers depending on your skin sensitivity & combination of prescribed acne treatments.
The most effective non-prescription fairy/natural remedy for acne?
A combination of light (phototherapy), BHA peels, diet, zinc supplements & manual extractions.
The best solution for picking acne?
See a psychologist for habit breaking exercises, pimple patches to reduce picking, & Accutane to place your acne in remission.
The best solution?
A tailored plan to address your specific acne pattern. This gives the highest efficacy rate & highest cure rate. Scar treatment & mitigation includes the use of vascular & picosecond lasers.
The cheapest solution?
See our nurses at Cutis Dermatology for a non-prescription plan consisting of topicals, chemical peels & phototherapy. This will save you a consult with a dermatologist.
How to optimize your acne treatments.
As an adjunct to treatments outlined above, most acne patients can benefit from adjunctive therapy to speed up clearance and or to reduce/mitigate acne scarring. The combination depends on your skin type, clinical findings, skin sensitivity & how fast you would like acne to improve.
Peels will accelerate acne clearance. Most patients will benefit from a series of 2-4 peels, in combination with medical therapy outlined above. This especially applies to blackheads & congested skin.
LEDs & lasers are one of the fastest ways to treat blind pimples & red marks from acne. Treatment is painless, fast & effective. 1-5 sessions, depending on the type of acne.
Scar revision procedures
Revision procedures include lasers & deep focal peels. They can be undertaken at any time during your acne treatment program. The most important factor determining success is the control of active acne.
Everyone will benefit from an acne free diet. The catch is that it is hard to maintain, as you cannot have any cheat days.
These patches can be purchased in most pharmacies. They are by far the best treatment for picking acne as they can reduce picking, hence prevent acne scarring.
Facts on Accutane
• This is the most effective medication for acne. Over 98% success rate in treating all forms of acne.
• For the most part you control the treatment, namely if this medication does not suit your lifestyle, or should you have any side effects, you can cease it or reduce the dose. It is up to you.
• Remission or cure is seen in 60-70% after completion of one course (6-12+ months). Hence in 30 to 40% of cases, recurrence can be expected.
• Skin purging (pushing acne out) can be expected in most cases. Acne may get worse for 2-6 weeks after starting Accutane.
• Common side effects; dry skin, sun-sensitivity, purging.
• Uncommon side effects; sore joints, liver enzyme changes, headaches, mood swings.
• For females; you can not take this medication if you are planning conception. Birth defects are almost universal should you fall pregnant whilst on this drug.
• Combining chemical peels & lasers will accelerate your acne clearance whilst on Accutane.
• Most acne scar revision procedures are allowed whilst on this medication.
• Completing a course of Accutane will give you the highest rate of success. Stopping the medication early will increase the chances that acne will not be in remission.
• View your treatment as a statistical number & don’t take it personally. If your acne recurs despite optimal compliance & end points, you fall into the 30-40% of patients requiring further courses. Some may continue on a very low dose for several years.
• Get your blood tests. Accutane is safe, provided you undertake testing as advised. We can not see what your liver is up to, hence liver enzyme tests are important.
• Exert common sense. If you feel depressed or have mood swings on this medication, you have the option of stopping it.
What happens if my acne treatment program is not working?
Specialists view acne treatments as medical. This means in some cases, your program may not produce adequate clinical improvement. Reasons & solutions include-
• Treatment program not aggressive enough. If this is the case, we will review your treatment & execute a more powerful option. In most cases, this means oral isotretinoin.
• Secondary causes such as endocrine & intracrine dysfunction (mostly due to normal hormones with over sensitive oil glands).
• Microcystic acne (deep cysts) may require manual or laser cyst removal.
As a guide, provided you are open to negotiation, my team & I can effectively treat over 99.9% cases of acne. In most cases, this means Accutane.
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Natural treatments: what we offer.
Some patients will want a natural solution, acknowledging this can be effective in some. For the most part, you do not need to see a dermatologist to undertake natural treatments, as we will always prescribe drugs & not fairy dust. Our nursing staff can initiate mainstream non-prescription acne medications outlined below.
You can attempt a combination of;
- Supplements. The best supplement is zinc sulfate.
- Fuzzy feel-good skin care such as retinol, niacinamide & vitamin C. Azelaic acid is another good ingredient for acne.
Our nursing team can add natural solutions including;
- AHA or BHA peels. The former are fruit acids, the latter is a derivative of willow bark.
- Light therapy including blue, green & red light.
- Extractions & cyst removals manually or assistance with a laser.
A sensible way to approach acne is to combine the above with proper medical therapy. My purpose is not to convince you out of natural therapy, but to optimize your treatments to treat acne safely & effectively. This markedly reduces acne scarring.
Knock yourself out with witch hazel & tea tree oil. This combination can be marginally effective in some. Contact allergic reactions are not uncommon. Another effective natural remedy is sulphur, however the odour from this element is pungent.
If you are into natural solutions, a dermatologist may not be the best choice.
Acne & pregnancy / conception plans.
Obviously, safety is a priority. Skin changes are common & fluctuate with your hormones.
You can have-
• Most exfoliating washes.
• Some anti-inflammatories.
• Most topical vitamins, except for vitamin A
You cannot have-
• All forms of retinoids, including oral or topical.
• Some types of anti-inflammatories.
Here is my go-to program.
- Acne diet.
- AHA peels.
- Phototherapy with lasers & light emission.
- Topical anti-inflammatories.
Post pregnancy, I will negotiate other treatments with you that may be more effective.
What is causing my acne?
There are many factors that contribute to the formation of acne. In short-
- Genetics (sensitive oil gland)
- Foods (hence the anti-acne diet)
- Hormones (hence anti-hormonal medicines)
- Stress, wrong skin care & others
I do not need to investigate the cause of acne in most cases. Exceptions include-
- PCOS (but this will not change how I manage acne)
- Hormonal causes (super rare endocrine tumours, genetic causes etc…)
An important concept to understand is that in most cases, hormonal levels are normal. It is your sebaceous glands that are sensitive.
What if I don’t want Accutane?
Your call. Our job is to give you effective options based upon-
- The clinical scenario.
- Your past & present history including previous acne treatment failures.
- The presence of scarring.
We respect your wishes if you choose not to consider this medication. My team & I can present you with other second & third line treatments, acknowledging that they may not be as effective as first line treatments.
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