Today, doctors have a wide range of solutions available to treat acne during puberty, however severe. If acne spots have become a problem in your daily life, you’re sure to find an adapted treatment by consulting your GP or dermatologist. But the prescription isn’t a magic wand; you’ll also need to follow the recommendations closely and be patient in order to get the results you want. ​

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    Dr Sandra Ly, Dermatologist - Hôpital Saint-André, Bordeaux University Hospital, and Dermatology Clinic in Gradignan.

    Usually it’s most effective to combine a topical treatment for blackheads and microcysts with, when appropriate, an oral treatment (tablets) for inflamed red spots.

    Dr Sandra Ly, Dermatologist - Hôpital Saint-André, Bordeaux University Hospital, and Dermatology Clinic in Gradignan.

The European Academy of Dermatology and Venereology has defined specific stages according to symptoms and acne’s severity, the Global Evaluation Acne (GEA). Before continuing to read this article, we highly recommend that you have a look at those five stages described in the article « Where does acne come from ? ».

 

Dr Sandra Ly, Dermatologist, explains the different strategies to improve acne.​

With any dermatological acne treatment, I have a dual objective as the acne is often a mixture of comedonal and inflammatory lesions.

You therefore need to prescribe a topical cream with a keratolytic action, that is to say, it will refine the skin to fight against the microcysts and comedones that characterise comedonal acne. This is combined with antibiotics to reduce inflammation, chosen based on the acne’s severity. ​

The dermatologist adapts the prescription to each individual case through dialogue with the patient.​

An adolescent with few lesions but who is extremely sensitive about the problem won’t be treated in the same way as an adolescent who accepts their acne more easily. The impact of the acne on quality of life is a major factor to take into account when choosing a treatment. If I think the patient will find it difficult to comply with a topical treatment or has very sensitive skin, I also adapt the prescription accordingly.

How do you treat acne-prone skin? What should you expect? Dr Sandra Ly explains the different steps.

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The inflammation that appears with acne improves relatively quickly .​

​For a “classic” patient with inflammatory spots, blackheads and a few microcysts, I start with a 3-month treatment. At the end of this period, we re-evaluate the results together.​

Usually, there is a relatively quick improvement in the inflammation, but it can take longer for the comedonal acne. After applying a keratolytic cream for 4-6 weeks, I suggest a dermatological cleansing that involves extracting microcysts using micro-incisions. Several sessions are sometimes needed.

Acne treatments often have side effects on the skin. You need to be ready for this, identify them and react quickly when they occur.

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Irritation and intolerance often occur during the first month, but improve over time.

This is the paradox of acne-prone skin! Lesions are caused by hyperseborrhea (hypersecretion of sebum), but the treatments often dry skin out. And yet, trying to dry or strip down acne-prone skin is counterproductive. Topical treatments can generate redness, dryness and irritation. It is therefore best to avoid the most sensitive areas, like around the eyes. Real allergies are rare. If this is the case, it is important to stop the treatment immediately and consult your dermatologist as soon as possible. ​

If the skin is very irritated, I recommended applying the topical treatment less frequently to start with, such as twice a week to start. To compensate for the drying effect, it’s a good idea to alternate with a moisturiser or cosmetic treatment. The aim is to enable the medical treatment to have an effect.

With isotretinoin, acne can flare up at the beginning, something that is rare with other treatments. ​

Generally, the side effects are a normal reaction to the treatment and shouldn’t worry the patient. This just requires a little extra patience – don’t ask too much from your skin, too fast. ​

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When treated correctly, acne usually clears up in 3-4 months .​

For severe cases of inflammatory acne, we prescribe antibiotics for 3 months, the recommended period. We observe fewer and fewer flare ups and lesions, and the acne sometimes also “lightens”. I can’t overstate the importance of continuing to apply the topical treatment to maintain the results. You can still follow a topical treatment in summer provided that you rinse well in the morning and apply adapted sun protection and moisturiser. We know that the epidermis (the outer layer of the skin) tends to get thicker in the summer, which can lead to more acne in the autumn. So, you need to continue applying the treatment in the evening and protect your skin from the sun in the morning. Acne flare-ups are common when a patient stops the antibiotics. This is why it is so important to have a check-up appointment and adapt the treatment if necessary. ​

For comedonal acne with comedones (blackheads) and microcysts, the treatment is usually longer, 3-6 months, and improvement slower. At the end of the period, the patient is again re-evaluated to decide if it is necessary to continue, stop or modify the treatment. ​

With isotretinoin, the improvement often doesn’t occur until the 3rd month.  ​

Generally, when you stop a treatment (especially antibiotics), you need to be cautious and continue applying a topical cream until the lesion clusters are fully under control, especially if there are still some minor flare-ups.

What should you do if your treatment doesn't work?

If there is no improvement after 3 months, the question of compliance arises.

The dermatologist talks to the patient and finds out what happened.

  • Maybe the treatment wasn’t applied well (too constraining or not enough motivation).
  • Maybe other skincare gestures were ill-adapted e.g. using essential oils or thick foundation.

If compliance was good and the treatment applied correctly:

  • The acne may be difficult to treat and could require a different approach, for example, using isotretinoin.
  • External factors - like hormonal imbalances, another medication or food supplements – might be aggravating the condition.

If compliance is good and the treatment applied correctly but the improvement is only partial:

Acne can fluctuate, and small flare-ups may occur. This doesn’t undermine the treatment’s efficacy, especially if there is an overall improvement at the end of the 3 months. The skin should be evaluated over time, and not just on the day of the consultation. If overall the treatment is considered to have been effective, it might be necessary to adapt the way it is applied or taken to optimise and maintain the results.

It is best to be consistent, over the long term.

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Start your topical treatment gently: don’t apply it all over your face or too often – otherwise you’ll have to stop after couple of weeks as your skin will become very irritated. 

Did you remember to apply moisturiser in the morning? This can limit the irritation caused by the treatment, especially during the first month. If your skin is slightly irritated, you could also space out the topical treatment. If your acne is more serious, stop using the treatment for a couple of days and then start again (less frequently).  

If, by the 2nd month, your skin is used to the treatment, try applying it more frequently until you are using it every evening. It doesn’t matter if this isn’t possible, 3 times a week is often sufficient.

During the 3rd month, remember to apply sunscreen when you are outside in sunny conditions, particularly if you still have marks.

If you feel self-conscious, don’t hesitate to conceal your spots using a corrector, or powder if your skin secretes lots of sebum (hyperseborrhea).

How can you prepare your medical visit? 

When you see your dermatologist, tell them what’s going well and what’s not. To prepare for the visit ask yourself the following questions:

  • Have you followed the treatment correctly?
  • If you haven’t, why not? Did you forget? Was your skin too irritated? Were the results not quick enough? Your doctor won’t judge you. But if you haven’t applied the treatment properly, they need to know this.

 

Last but not least, remember to make your next appointment in advance, as doctors get booked up quickly and you don’t want to have to interrupt the treatment.

 

Dr Sandra Ly, Dermatologist