What does acne medication

acne

acne (Acne vulgaris): Skin disease that is associated with enlargement of the sebum glands, increased sebum production and the resulting inflammation. It occurs preferentially during puberty and usually heals on its own by the third decade of life.

Acne is one of the most common skin diseases. Almost everyone has more or less pronounced puberty pimples in their youth, because one of the causes is a temporary excess of male sex hormones (testosterone and other androgens) during puberty. Therefore, acne is usually more severe in boys than in girls. In addition to hormones, drugs, bacteria and cornification disorders can also trigger or promote acne.

For the most part, acne is a temporary phenomenon and can be managed with skin cleansing and care. However, severe forms of acne require drug therapy with external and / or internal acne agents (ointments, lotions or gels or tablets).

Leading complaints

  • Nodules, pus vesicles and blackheads on generally oily skin, preferably on the face, neck and décolleté and on the back
  • As a consequence (which can take on a life of its own) compulsive scratching, nibbling and pressing on affected areas
  • In the process abscesses or scars.

When to the doctor

Coming soon to

  • increased occurrence of blackheads
  • Pustules or papules.

The illness

Acne is one of the most common skin diseases. It affects up to 80% of young people in Germany, boys and young men mostly more than girls. At a later age, however, it mainly affects women: in western industrialized countries around 40–50% of women between the ages of 30 and 40 suffer from late acne (acne tarda) with blackheads, pustules and papules.

Disease emergence

Exactly how and why acne develops is not yet fully understood. The experts assume that various factors interact. The most important are:

seborrhea (Overproduction of skin fats by the sebum glands): If there is an increased production of sebum by the sebum glands located in the dermis, it can no longer drain off the skin surface quickly enough and the sebum accumulates in the sebum glands.

Cornification disorders. In acne patients, the corneal cells in the epidermis die off more quickly, which is commonly referred to as a cornification disorder. The horny cells stick together and, together with the sebum, form a plug in the duct of the sebum gland. The plug, which additionally obstructs the sebum flow, is under the name Blackheads (Comedo) known. When it reaches the surface of the skin, it is tinted dark by the skin pigment melanin; however, this discoloration is by no means an indication of poor hygiene.

Bacterial colonization. Bacteria (propionibacteria) often settle under a blackhead and lead to purulent inflammation; red painful nodules and purulent vesicles are the visible consequences.

Causes and Risk Factors

The processes in the skin described above are triggered or sustained by various causes:

  • Hormonal influences: Male hormones stimulate sebum production, estrogens inhibit it. Acne is therefore typical for puberty, for times when hormones fluctuate (before menstruation, after stopping the pill, during pregnancy) and for diseases in which male hormones are present in excess (e.g. in hirsutism )
  • Genetic predisposition, e.g. B. Elevated levels of the growth factor IGF-1
  • Medication such as B. Cortisone, contraceptives, DHEA-S (steroid acne), anabolic steroids (doping agents, athlete's acne), lithium, vitamin B preparations (acne medicamentosa)
  • Sunscreens and UV radiation (Mallorca acne)
  • Chemicals such as lubricating oil or chlorine (oil acne or chlorine acne)
  • Newborn acne from mother's hormones
  • Psychological factors
  • Smoke
  • Incorrect skin care with so-called comedogenic (blackhead-promoting) products such as cocoa butter, lanolin, coconut oil
  • Whether diet plays a role is controversial.

clinic

Depending on the severity, the doctor differentiates between different forms of acne:

  • The Acne comedonica is characterized by numerous, predominantly closed blackheads (comedones).
  • In the Papulopustular acne Nodules and sometimes purulent vesicles develop from the blackheads through bacterial colonization, and occasionally scars remain.
  • The Acne conglobata is characterized by a very strong seborrhea (sebum production) and occurs predominantly in men. V. a. Large blackheads and purulent melting-in knots develop on the back and neck, which leave significant scars.

Above: Acne comedonica in a 21-year-old patient with numerous closed blackheads. Middle: Acne papulopustulosa in a 19-year-old patient with acne that has existed for 5 years. The blackheads form inflammatory nodules. Below: Acne conglobata in a 24-year-old man. The scar formation marks the entire back area.
Georg Thieme Verlag, Stuttgart

course

In most adolescents, the disease is mild. Only about a third of those affected suffer from forms of acne that require medical treatment.

Diagnostic assurance

Typical acne is a visual diagnosis for the dermatologist. In order to be able to better assess the course and the success of the therapy, he determines and documents the severity of the acne, e.g. B. based on the number of pustules in a defined skin area. To classify the causal factors, he asks the person concerned about the time of occurrence, their diet, cosmetic products and the use of medication. In women, the doctor also pays attention to the hair type and other masculinizing signs (menstrual disorders, deep voice).

If the course is unclear or difficult, the doctor will also use laboratory tests. Then z. B. cortisone, blood count, inflammation levels, blood sugar and insulin. In women with irregularities (menstrual cycle disorders) or other indications of hormonal disorders, the doctor determines the blood concentration of hormones such as free and total testosterone, FSH and LH as well as DHEA and DHEA-S.

In some cases, the doctor will also take a smear of blackheads or pustules to have bacteria detected in the laboratory.

Differential diagnoses. Folliculitis and sweat gland abscesses can cause similar skin conditions.

treatment

overview

For mild forms, the doctor recommends careful skin cleansing and care, preferably with special acne preparations that are available in every drugstore. More severe acne should be treated with medication, not only for cosmetic reasons, but also to avoid scars.

Drug therapy is divided into one external Treatment with creams, solutions and gels and one internal Therapy with the intake of antibiotics, hormones and / or isotretinoin. Often different acne drugs are combined.

External therapeutics

Retinoids. Locally applied retinoids (also known as vitamin A acid) such as isotretinoin, tretinoin and adapalene are among the first choice for treating acne. The preparations available as creams, solutions or gels are initially applied once a day (avoid the corners of the mouth and eyelids!), If well tolerated also twice. However, it takes a few weeks before these preparations show the desired effect. After starting the treatment, the acne initially seems to "bloom" - the skin reddens, becomes tight and burns. Pus vesicles also appear in increased numbers temporarily. This initial aggravation is normal and not a sign of intolerance. After about 3 months it can be assessed whether the therapy is successful. A reduction in papules and pustules by 50% is rated as a good response, and by> 75% as a very good response. Topically applied retinoids must not be used during pregnancy and breastfeeding and in children under 12 years of age (see note below).

Benzoyl peroxide. The doctor often prescribes benzoyl peroxide (BPO) in the form of gels or creams (e.g. Cordes® BPO cream). Treatment with BPO should improve symptoms within eight weeks. BPO is also suitable for long-term use because there is no resistance. Avoid eyes, nostrils and lips when applying, as BPO irritates the mucous membranes. Eyebrows, scalp hair, whiskers and textiles can fade on contact with BPO.

Azelaic acid. This preparation is available as a cream or gel (e.g. Skinoren®). Although it temporarily causes irritation and flaking of the skin in the first few weeks of treatment, it is often better tolerated than other local acne remedies on sensitive skin. Azelaic acid can be given during pregnancy.

Local antibiotics. If BPO or azelaic acid are not enough, the doctor often combines them with local antibiotics in cream or ointment form for inflammatory acne. Typical preparations for this are tetracyclines, erythromycin (e.g. Aknemycin® ointment), clindamycin (e.g. Basocin® acne solution) and nadifloxacin (e.g. Nadixa® cream). However, local antibiotics are only used for a short time due to the risk of developing resistance.

Fruit acids. They are incorporated into washing gels and peelings and cleanse the skin intensively by loosening the dead skin cells and reducing the number of blackheads. If the skin reacts irritated to the fruit acid, it is advisable to initially only use the preparation every other day. Preparations for personal use have an acid content of up to 10%, the dermatologist works with up to 70% fruit acid preparations.

Internal therapy

In severe cases, the doctor recommends internal therapy with antibiotics, hormones or retinoids.

Antibiotics. If local therapy is insufficient for inflammatory acne or if the skin is affected over a large area, antibiotics in tablet or capsule form are used (systemic antibiotic therapy). The active ingredients reach the acne-affected skin via the bloodstream, where they effectively fight the bacteria that cause it. Frequently prescribed preparations are minocycline (e.g. Skid®), doxycycline, tetracycline or erythromycin. Due to the possible development of resistance, the doctor prescribes the preparations only temporarily.

Hormone therapy. Doctors consider internal hormone therapy for women with severe acne. Are used z. B. estrogens or antiandrogens such as cyproterone acetate (for example also as a pill such as Diane 35®). Treatment often leads to a significant reduction in sebum production in female patients. The acne improves 2-3 months after the start of therapy, and the treatment lasts for at least a year. Hormone therapy is rich in side effects, especially in smokers or overweight patients or patients with arteriosclerosis at risk of thrombosis and embolism. After discontinuing the hormones, there is often a relapse with renewed, excessive formation of pustules and papules.

Isotretinoin. The derivative of vitamin A isotretinoin (e.g. in Isoderm® capsules) is extremely effective, but due to its side effects, it is reserved for severe forms. Isotretinoin is used both externally and internally. The main effect is normalizing the amount and composition of the sebum. The cure rate is high, but relapses occur in over 60%.

Note. The most dreaded side effect of retinoids like Isotretinoin is the Harm to the unborn. For this reason, girls and women must not become pregnant for up to 3 months after the end of therapy. Other side effects include dry skin, especially of the lips, peeling of the skin, inflammation of the mucous membranes, increased nosebleeds and eye conjunctivitis. If isotretinoin is taken as a tablet, liver damage is possible, which is why regular liver tests are required. There is also a risk of headache, muscle and joint pain.

forecast

In about 90% of cases, acne regresses after puberty. For the rest of those affected, the symptoms can persist up to the fifth decade of life.

Your pharmacy recommends

What you can do yourself

  • The earlier and more consistently acne is treated, the better the chances of scar-free healing. You should therefore consult your dermatologist at an early stage in order to initiate the appropriate therapy.
  • Treating acne takes time and patience! Acne is not a sign of poor personal hygiene. Most people are more inclined to wash too much and use soap - which tends to worsen the skin because the protective acid layer suffers. Thorough and careful skin care, which should be specially tailored to oily skin, is important.
  • Under no circumstances should you pinch pimples as they often become inflamed and potentially leave lifelong scars.
  • If you want to put on make-up, use oil-free and antiseptic products from the pharmacy that have been specially developed for acne skin.
  • Well-dosed sunlight can have a positive effect on acne, especially in combination with salt during a vacation by the sea. Avoid long sunbathing, however, as this often leads to an increased formation of blackheads.
  • During the use of some acne ointments (e.g. with the active ingredients vitamin A acid or benzoyl peroxide) or fruit acid peelings, as well as the intake of tetracycline or minocycline, there is a risk of phototoxic reactions in sunlight that are similar to severe sunburns.
  • To what extent the diet has an influence on the course of acne is controversial. So far, no connection has been scientifically proven. However, if you see your acne getting worse after ingesting certain foods, you should take them with caution.
  • Studies have shown that taking lactoferrin, vitamin E, and zinc can improve mild to moderate acne.

Complementary medicine

Hydrotherapy.Chamomile and sage facial steam baths soften the skin so that subsequent therapies such as B. dabbing with calendula extract can work better. Quark compresses and healing earth pads are recommended for large areas of acne (mix healing earth with 1 l of water, apply half a centimeter thick to the affected skin area, remove after about half an hour). Sulfur baths with brine have a healing effect.

Light therapy. Light, air and sun support the healing process, irradiation with blue light or orange light reduces the flow of sebum. Radiation should always be carried out by a dermatologist - the wavelengths used in tanning salons can damage diseased skin.

Herbal medicine. Externally, daily washes with tea made from chamomile, thyme, sage, rosemary or field horsetail - also as a facial steam bath - are recommended, as well as Hametum® or calendula extract for dabbing and compresses with wheat bran extract (e.g. Silvapin®). All teas that stimulate the metabolism are suitable for internal use, e.g. B. Tea made from dandelion, nettle and horsetail.

Acupuncture. In addition to acupuncture, which is used to treat acne with good results in some cases, radiation with a soft laser is also an option.

Psychotherapy. Depending on its severity, acne can be psychologically very stressful, reactive depressive moods and social withdrawal are sometimes the result. In individual cases, talk therapy and social behavior training can help.

Further information

  • www.aknetherapie.de - Private website for those affected with good pro and con discussions about the various therapeutic options for acne.

Authors

Dr. med. Arne Schäffler, Dr. Bernadette Andre-Wallis in: Health Today, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update: Dr. med. Sonja Kempinski | last changed on at 21:58


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.