Handling zits
Pimples can be unsightly, especially for teenagers dealing with their raging hormones.
ACNE, also known as pimples, is an inflammatory disorder whereby hair follicles become plugged with excessive oil produced from the sebaceous glands. There is also proliferation of bacteria called Propionibacterium acnes on the skin.
The main physical complication of acne is scarring. It is much easier to treat acne than to treat acne scars.
Other complications include psychological problems such as anxiety and depression. There is also strong evidence that the quality of life of someone with acne is significantly affected. Therefore, seek treatment early to avoid complications.
In Malaysia, the common age to get acne is between 13 and 18 years old, although a person can get it at any age. It is not a disease specific to youth.
Those with a family history of acne are at higher risk of getting acne. Obesity in children and certain hormonal diseases are also known to increase the risk of getting acne.
Certain medications such as steroids, medications to treat tuberculosis (TB) and anti-cancer treatment can cause acne.
Products or environments that block hair follicles can also cause acne.
We know that acne gets worse during periods of stress. Smoking, a diet high in sugar and dairy products may also aggravate acne.
There is also a study that showed that patients who had facial therapy or salon facial massage aggravated their acne.
Is acne confined only to the face? Although acne commonly occurs on the face, it can also be found on the chest and the upper back.
Treatment of acne should be individualised and it depends on the severity, type of acne and how it affects the quality of life of the person.
If it is a mild case, we treat it topically with topical benzoyl peroxide, topical retinoids, topical azelaic acid, topical salicylic acid or topical antibiotics.
For moderate acne, we can treat with a combination of two topical agents. If it is inflamed, we may also add on oral antibiotics.
If the acne is severe, the person needs to be referred to a dermatologist for oral isotretinoin. Systemic isotretinoin only can be prescribed by a qualified dermatologist. The names and places of practice of qualified dermatologists in Malaysia can be found on the Malaysian Association of Dermatologists (Persatuan Dermatology Malaysia) website, www.dermatology.org.my
The medical treatment of acne is generally sufficient to meet the expectations of acne patients.
However, in a number of situations, additional therapeutic approaches may be advisable.
There are a wide variety of useful physical methods. They range from lasers and other light systems using visible light wavelength, to peeling and manual therapy.
Lights (especially blue light) and lasers have been found to be safe and helpful for mild to moderate acne, especially when oral medications are unhelpful, or there’s intolerance for those medications. Treatment is often delivered twice weekly for four weeks.
The effects of treatment may be enhanced by the use of a photo-sensitising agent (photodynamic therapy).
Comedones can be expressed or removed by comedone extractors, chemical peeling or cautery.
Intralesional steroid injections can be used to shrink older nodules, keloid scar and pseudocysts. (Note: X-ray treatment is no longer recommended for acne as it may cause skin cancer.)
Acne may recur if the person stops treatment completely. That’s why we recommend maintenance therapy with topical treatment after stopping oral treatment.
General measures and skin care are also important in the management of acne. These include the following:
l The person is advised to clean with a gentle cleanser and avoid abrasives and scrubbing. Antibacterial or antiseptic washes have no proven benefit in the treatment of acne. l Try not to scratch or pick the spots. l Avoid excessively humid conditions such as a sauna, working in an unventilated kitchen or tropical vacations.
l If you smoke, stop. Nicotine increases sebum retention and increased scale within the follicles, forming blackheads and whiteheads (comedones).
l The person should avoid comedogenic cosmetics, facial products and squeezing pimples.
l Some would advocate a low sugar, low protein, low dairy and high fibre diet, although the evidence is not very strong.
Acne can be effectively treated, but the response may sometimes be slow, and may take up to four weeks.
See your dermatologist for advice if your pimples fail to clear up within six weeks or you have severe acne.