TREATING HUGE CASES OF STABLISHED ACNE

TREATING HUGE CASES OF STABLISHED ACNE

Please scroll down to watch the video.👇👇

🔹 1. Medical Treatments (Most Effective for Severe Cases):

✅ Oral Isotretinoin (Accutane)

• Most powerful treatment for severe acne.

• Shrinks oil glands, unclogs pores, and reduces inflammation.

• Usually a 4–6 month course.

• Requires close monitoring due to side effects (e.g., dry skin, mood changes, birth defects if pregnant).

✅ Oral Antibiotics

• Like doxycycline, minocycline, or erythromycin.

• Reduces inflammation and bacteria.

• Often combined with topical treatments.

• Used short-term (3–6 months) to avoid resistance.

✅ Hormonal Therapy (for Women)

• Birth control pills or spironolactone can reduce hormone-driven acne.

• Helps especially if breakouts worsen around menstruation or are lower on the face/jawline.

🔹 2. Topical Treatments (Often Combined with Oral):

✅ Benzoyl Peroxide (BPO)

• Kills acne bacteria.

• Helps prevent antibiotic resistance when used with antibiotics.

✅ Retinoids (adapalene, tretinoin, tazarotene)

• Unclogs pores and boosts skin turnover.

• May initially worsen acne (“purge”) before improvement.

• Used long-term for prevention.

✅ Topical Antibiotics (clindamycin, erythromycin)

• Reduce inflammation.

• Usually combined with BPO.

🔹 3. In-Office Procedures:

✅ Cortisone Injections

• Used for painful cysts.

• Reduces inflammation rapidly (within 24–48 hours).

✅ Chemical Peels or Light Therapy

• Help unclog pores and kill bacteria.

• Often used as add-on treatments.

🔹 4. Lifestyle Tips (Supportive, Not Curative):

• Use non-comedogenic skincare/makeup.

• Avoid picking or squeezing.

• Eat a balanced diet (some find dairy or high-GI foods worsen acne).

• Manage stress—it can trigger flares.

🚨 When to See a Dermatologist:

If your acne is painful, scarring, or not responding to over-the-counter products within 2–3 months, see a dermatologist. Early intervention prevents permanent scarring.

​Treating severe or established acne—particularly nodulocystic acne—requires a comprehensive, evidence-based approach. Below is a detailed overview of current best practices, supported by clinical guidelines and peer-reviewed studies.​

🧪 1. Oral Isotretinoin (Accutane)

Oral isotretinoin is considered the most effective treatment for severe, scarring, or treatment-resistant acne. It works by shrinking sebaceous glands, reducing oil production, and preventing clogged pores.​

• Indications: Severe nodulocystic acne, acne unresponsive to antibiotics, or acne causing significant scarring.​

• Treatment Duration: Typically a 4–6 month course.​

• Monitoring: Regular blood tests are necessary to monitor liver function and lipid levels.​

• Precautions: Due to its teratogenicity, strict pregnancy prevention measures are mandatory for women of childbearing age.​

Delaying isotretinoin in favor of prolonged antibiotic use is discouraged, as extended antibiotic courses can lead to resistance without additional benefit .​

💊 2. Oral Antibiotics

Oral antibiotics are commonly used for moderate to severe inflammatory acne. They help reduce inflammation and bacterial proliferation.​

• First-line Options: Doxycycline and minocycline are preferred due to their efficacy .​

• Duration: Should be limited to the shortest possible time, typically 3–4 months, to minimize resistance .​

• Combination Therapy: Should be combined with topical agents like benzoyl peroxide or retinoids to enhance efficacy and prevent resistance .​

• Alternative Antibiotics: Erythromycin and azithromycin can be considered in specific populations, such as pregnant women or children under eight, where tetracyclines are contraindicated .​

⚖️ 3. Hormonal Therapy (for Women)

Hormonal treatments are effective for women with acne, especially when associated with hormonal fluctuations or conditions like polycystic ovary syndrome (PCOS).​

a. Combined Oral Contraceptives (COCs)

COCs can regulate hormones that contribute to acne.​

• FDA-Approved Options: Yaz, Ortho Tri-Cyclen, and Estrostep FE are approved for acne treatment .​

• Efficacy: COCs have shown significant reductions in acne lesions across various types .​

• Considerations: Not suitable for women over 35 who smoke or those with certain health conditions.​

b. Spironolactone

An androgen receptor blocker that reduces sebum production.​

• Dosage: Typically 50–200 mg daily .​

• Efficacy: Effective in treating hormonal acne, with improvements often seen within a few months .​

• Side Effects: May include menstrual irregularities, breast tenderness, and dizziness .​

• Monitoring: Routine potassium monitoring is generally unnecessary unless specific risk factors are present .​

🧴 4. Topical Retinoids

Topical retinoids are a cornerstone in acne treatment, effective for both inflammatory and non-inflammatory lesions.​

• Common Agents: Adapalene, tretinoin, and tazarotene .​

• Mechanism: They promote cell turnover, prevent pore clogging, and have anti-inflammatory properties .

• Usage: Applied once daily, usually at night.​

• Side Effects: May cause skin irritation, dryness, and increased sensitivity to sunlight; using moisturizers and sunscreen can mitigate these effects .​

💉 5. In-Office Procedures

Dermatological procedures can provide adjunctive benefits in severe acne cases.​

• Corticosteroid Injections: Directly injected into cystic lesions to reduce inflammation rapidly.​

• Chemical Peels: Utilize agents like salicylic acid to exfoliate the skin and unclog pores.​

• Laser and Light Therapies: Target bacteria and reduce oil production; options include blue light therapy and photodynamic therapy.​

🧬 6. Emerging Therapies

New treatments are being explored to provide alternative options for acne management.​

• Clascoterone: A topical androgen receptor inhibitor showing promise in reducing acne lesions with minimal systemic effects .​

📌 Summary

For individuals in Phnom Penh, Cambodia, seeking specialized care, it’s advisable to consult with a dermatologist experienced in managing severe acne cases. They can provide personalized treatment plans, monitor progress, and adjust therapies as needed.​

If you need assistance finding a qualified dermatologist or have further questions about acne treatments, feel free to ask.