Acne treatment information

Modern and historic treatment of acne

A lot of treatment modalities have been tried to treat this condition. Most of these have an effect, but some af them have been abandoned because they were impractical or dangerous in some way. Acne consists of 4 main components: 1. Increased sebum production caused by hormonal factors. 2. Clogging of the outlet of pores by a micture of sebum and dead skin cells - comedones, whiteheads, blackheads 3. Aggregation of sebum in the logged pores. 4. Infection and inflammation caused by bacteria living off the sebum. the treatment methods are directed against 1 or more of these factors.

To read more about the acne process, please go here.

Modern topical treatment methods, products and ingredients

Cosmetic anti-acne-products can contain agents to dissolve comedones, agents to kill bacteria, anti-inflammatory agents or all these types of anti-acne agents. They can be made solely for the purpose of treating acne, or they can be cosmetics with the usual purposes of such products with added anti-acne effectors. Cosmetic products with anti-bacterial effects are often called "medicated".

Anti-acne wash or milk: The purpose of these is to dissolve the fatty deposits that clogg the pores so that the content trapped inside the pores are emptied out, and may also contain agents to kill bacteria causing inflammation by acne.

Rinsing lotions and creams with anti-bacterial additives: The purpose of these is to dissolve the fatty deposits that clogg the pores so that the content trapped inside the pores are emptied out and also to kill bacteria that cause the  inflammation by acne.

Exfoliating creams or acne scrubs: These creams contain factors that dissolve dead skin cells and comedones much harder than the rinsing products. They must be washed away after use.

Day-cream with anti-acne-effect: These day-creams have added ingredients that help to dissolve the clogging of the pores or may contain anti-bacterial agents also. The dissolved elements are washed away when the cream is removed in the night.

Night-cream with anti-acne-effect: These night-cream have added ingredients that help to dissolve the clogging of the pores or may contain anti-bacterial agents also. The dissolved elements are washed away when the cream is removed in the morning.

Anti-acne soap: This is soap with  ingredients to help dissolve the clogging in the pores, and can also contain anti-bacterial agents.

Topical tretinoine therapy (Retin A, Renova): This therapy makes the cells in the epidermis divide faster and thereby the comedones are pushed away by the growing tissue. It also makes the tissue regain faster after damage from the acne process. However, it may also irritate the skin.

Azelaic acid (brand names Azelex, Finevin, Skinoren):This is an ingredient in many rinsing products, polishing products and anti-bacterial products for acne treatment. It is suitable for mild, comedonal acne.

Sulfur: This has recently gained credibility as an alternative topical treatment andmistered as soap, creams, shampoos etc, due to sulphur's antibacterial and antifungal properties.

Tea Tree Oil (Melaleuca Oil): This oil has been used with some success, and has been shown to be an effective anti-inflammatory in skin infections.

Heat therapy: Zeno product uses heat at a specific temperature to kill bacteria and to treat mild to moderate acne.

Nicotinamide, (Vitamin B3):  Nicotinamide is used topically in the form of a gel, has been shown in a 1995 study to be more effective than a topical antibiotic used for comparison, as well as having fewer side effects. Topical nicotinamide is available both on prescription and over-the-counter. Some users choose to make their own at home, mixing together crushed nicotinamide pills with aloe vera gel. The cause of topical nicotinamide's benefit in treating acne seems to be its anti-inflammatory nature. It is also assumed to stimulate synthesis of collagen, keratin, involucrin and flaggrin.

Salt water bath: In some cases, people bathing in salt water (pure from the ocean) noticed lessened redness and decreased size in their acne.[citation needed]
Rofecoxib was shown to improve premenstrual acne vulgaris in a placebo controlled study

Modern oral treatment products, methods and ingredients

Herbal anti-acne pills:  These pills helps to normalize the hormonal chemistry of the body and help to make the cleaning mechanisms of the body more effective.

Antibiotic pills:  These pills help to kill bacteria that cause inflammation by acne. Some antibiotics, like tetracycline also have antiinflammatory effects, and this effect may also be beneficial.

Oral accutane therapy or Isotretinoine therapy: By this therapy one used a drug over 5 months to normalize the hormonal and internal body chemistry, so that the exagerated sebum production and cell proliferation leading to acne stops. The drug also decreases inflammation. The therapy imply some danger, and can therefore only be used under close medical supervision.

Contraseptive pills:  Some variants pf these pills can also help against acne, and are sometimes prescribed to women for this purpose.

Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of inflammatory acne, although less so than tetracyclines.

Modern physical and surgical treatment of acne

Surgical emptying of pimples:  By this methods the clogged pores are opened by an instrument and the content gently pressed out.

Intralessional corticoid therapy:  If severe inflammation develops around a pimple, one can inject cortisone or other steroid drugs to bring down the inflammation.

Laser therapy to burn away acne components:  Laser can be used as treatment aginst acne. Laser will heat the targeted skin, but several components or manifestations of the acne process will be heated in different degrees depending on the color of the laser light. By varying the intensity of the laser light one can also vary the intensity of the heating and the burning effects, and by using thin rays smaller spots can be treated selectively with a higher intensity.

Varying the laser waves these ways, several effects can be achieved selectively. Bacteria in a wider area can be killed without affecting the skin very much. Miscolorings can be burned away. Pimples can be destroyd or they can be punctuated in the middle so that they more easily empty. Scares can be smoothened out.

Radio frequency therapy  to burn away acne components:  By this therapy radio waves with short wavelength are directed towards the skin. The skin will then be warmed up, but some components will be heated more than others. What components will be most heated depend on the wavelength used. By this therapy bacteria in the skin can be killed.

Laser therapy to stimulate healing of damages done by acne:  By this therapy one use small intensity laser beam with a wavelength that penetrates deep into the skin. The skin will not be burned in any way. The energy absorbed will stimulete healing processes. This form of laser therapy may help to heal scars. It may help to bring the color-producing calls back to an active level so that skin depigmentated by the acne process get its color back again.

Chemical peel:  By chemical peel, etching chemicals are used that remove skin tissue to some depth, and then the skin have to grow back from beneath. It is used against severe scars and miscoloring after acne.

Electric therapy on acne spots:  Electricity directed at the pimples can dry out the tissue around the comedones, and make them fall off.

Popping pimples:  It is possible to empty ripe pimples oneself by stinging a sterile needle though the comedone and gently squeesing the content out.

Light therapy:  Blue and red light is used against acne, either only blue light or a combonation of blue and red light. The blue light kills the bacteria and lessens inflammation.The mechanism appears to be that a porphyrin (Coproporphyrin III) produced within P. acnes generates free radicals when irradiated by blue light. Particularly when applied over several days, these free radicals ultimately kill the bacteria Red light is supposed to stimulate the skin to heal.

Historical treatments

Surgical abbration:  This mathod has been used to smoothen strongly scarred skin, but are by now mostly abandoned.

X-ray therapy:  This therapy is fairly effective in reducing the processes by acne, but it is dangerous. It can cause long term skin damage and cancer. It is since abandoned.  However, as late as the 1960eths this therapy was propagated as a clean and effective way to treat acne.

Use of ultraviolet light to treat acne:  Until recently ultraviolet light was a recommended method for treatment of acne. It can possibly reduce the bacterial activity. It can reduce the inflammation process. It may possibly smoothen scarring by induce peeling or by stimulating new cell growth. The treatment can however also cause damages and cancer, and the treatment is now abandoned.

However, people need some ultraviolet light on the skin in a regular fashion for the production of vitamin D and other stimulating effects. This recommended amount of ultraviolet light is possibly best achieved by lettig the skin be exposed to sunlight within regular intervals and within reasonable doses, and this may also alleviate acne.

Hot sulfurous mineral water bath: In Ancient Rome bathing in hot, and often sulfurous, mineral water was one of the few available acne treatments. One of the earliest texts to mention skin problems is De Medicina by the Roman writer Celsus.

Bensyl Peroxide: Benzoyl Peroxide was used in the 1920es.

Laxatives: Laxatives were used as a cure for what were known as 'chastity pimples around 1930.

About azelaic acid

The organic compound azelaic acid has the chemical formula (CH2)7(CO2H)2. Azelaic acid is therefore a saturated carboxylic axid with thwo carboxylic groups and 7 carbon atoms between these. In dry condition it is a white powder which is highly solvable in water. It is found naturally as many other related compounds, for example in wheat, rye, and barley. It is further produced by Malassezia furfur (Pityrosporum ovale), a yeast that living on normal skin. It is industrially produced by the ozonolysis of oleic acid

Bacic medical properties of azelaic acid
 

As it has two carboxylic acid groups. it has a mild eching effect. This effect is one of the reasons it is useful as a skin conditioner and rinser.

Azelaic acid reduces the growth of bacteria, for example those in the skin follicles (Propionibacterium acnes and Staphylococcus epidermidis).

It dissloves comedones and horny layer in the skin.

Azelaic acid helps the skin to cells in the epidermis and in the follicles to return to normal growth so that som much horny substance is not produced any more. 

Azelaic acid reduces pigmentation, propery useful for people that have excessive or uneven pigmentation because of skin disorders, for example melasma and actinic lentigines.

It reduces inflammation.

It works as a scavenger of free radicals and is thus an antioxidant.

Azelaic acid is Non-toxic, and is well tolerated by most patients. Azelaic acid does not result in bacterial resistance to antibiotics, reduction in sebum production, photosensitivity (easy sunburn), staining of skin or clothing, or bleaching of normal skin or clothing.

 

Uses of azelaic acid

Treatment of acne: Azelaic acid is used to treat mild to moderate acne. It is useful against both comedonal acne and inflammatory acne. It works in part by stopping the growth of skin bacteria that cause acne, and by keeping skin pores clear.


Rosacea treatment: Azelaic acid is also used as a topical gel treatment for rosacea, due to its ability to reduce inflammation.

Hair loss treatment: Azelaic acid  stimulates heir growth and is therefore used in products against heil loss and heir thinning.

Reduction of hyperpigmentation: Azelaic can be used to reduce inwanted pigmentation due to several conditions.

Cautions

In some cases, females have reported hair growth on face and neck. A concentration of more that 20% can irritate the skin and it should therefore not be used without survaillance by a fyscician in higher concentrations. Azelaic acid can lead to reduced pigmentetion that is not wanted.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. This information is nutritional in nature and should not be construed as medical advice. This notice is required by the Federal Food, Drug and Cosmetic Act.