Acne management

General principles of treatment
· Acne can be effectively treated, although response may sometimes be slow.
· Where possible, avoid excessively humid conditions such as a sauna, working in an unventilated kitchen or tropical vacations (but ultraviolet light helps).
· Try not to apply irritant oils or cosmetics to the affected skin.
· Abrasive skin treatments can aggravate both comedones and inflammatory lesions.
· Try not to scratch or pick the spots
· No relationship between particular foods and acne has been proven.

Management of mild acne
Most patients with mild acne can be treated with topical agents (gels, solutions and lotions) that can be obtained over-the-counter in Mexico without prescription. Most people just use topical agents for facial skin as they can be difficult to apply to one's back. Vitamins link to Vitamins for acne -Vitamin A and zinc and copper minerals have been proven to help.
· Wash affected areas twice daily with a mild cleanser and water or an antiseptic wash.
· Acne products should be applied to all areas affected by acne, rather than just put on individual spots.
· A thin smear should only be applied to dry clean skin at nighttime.
· Acne products may work better if applied in the morning as well.
· They often cause dryness particularly in the first 2-4 weeks of use. This is partly how they work. The skin usually adjusts to this.
· Apply an oil-free moisturizer only if the affected skin is obviously peeling.
· Avoid applying oily cosmetics such as foundation or sunscreen.
· It may take several weeks or even months to see convincing improvement.
· Discontinue using product if severe irritation results. See your doctor for advice.

Suitable topical agents for mild acne that can be obtained without prescription include:
· Antiseptic washes (Acnederm wash™, Benzac™ AC Wash, Dalacin™ T Prewash, Oxy™ Daily Skin Wash)
· Mild salicylic acid preparations to exfoliate and unplug the follicles (Neutrogena® Oil-free Acne Wash and many others)
· Benzoyl peroxide cream / lotion / gel (PanOxyl™ Acne Gel, Brevoxyl™ Cream, Oxy-10™, Clearasil™ Ultra Acne Cream, Benzac AC Gel)
· Azelaic acid (Skinoren™ cream, Acnederm™ medicated lotion)
· Hydrogen peroxide in stabilised cream (Crystacide®)
Topical agents for mild acne which require prescription include:
· Antibiotics, such as clindamycin solution (Topicil™) or erythromycin solution (Stiemycin™) and gel (Eryacne™) are best used with benzoyl peroxide or azelaic acid to reduce the chance of antibiotic resistance.
· Retinoids i.e. tretinoin (Retin-A™), isotretinoin (Isotrex™), adapalene (Differin™).

Blue light acne treatment is a new procedure recently found to be safe and helpful for mild to moderate acne.
Management of moderately severe acne

Treatment for moderately severe acne usually includes topical agents.I n addition an oral medication maybe used, usually for at least six months.
Suitable oral medications include:
· Antibiotics such as tetracycline, minocycline, doxycycline or erythromycin
· In females, oestrogens and antiandrogens such as Diane 35™/Estelle 35™ or spironolactone
· Some patients are helped by nonsteroidal anti-inflammatory agents such as ibuprofen or naproxen
· For resistant or persistent acne, oral isotretinoin is sometimes used, but it has many dangerous side effects and is not recommended unless under the care of a doctor who will monitor the liver and the kidneys with monthly blood test.

Schedule a consult for advice if your skin problem fails to improve within three months or you have severe acne.
Physical treatments for acne
· Sunlight is anti-inflammatory and can help briefly. However, exposure to ultraviolet radiation results in ageing skin and can eventually lead to skin cancer.
· Laser Genesis-Controls oil gland production and pore size
· Cryotherapy (freezing treatment) may be useful to control new nodules.
· Intra-lesional steroid injections can be used to shrink older nodules.
· Comedones can be expressed or removed by cautery or diathermy.
· Microdermabrasion and/or chemical peels can help mild acne.
· Blue light and sometimes red light phototherapy systems appear helpful. Treatment is often delivered twice weekly for four weeks. The effect may be enhanced by use of a photosensitising agent (photodynamic therapy).
· Note: X-ray treatment is no longer recommended for acne as it may cause skin cancer.

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