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Managing acne
Acne can affect your quality of life. Depending on its severity, it can have effects on your daily activities, leisure, work, personal relationships, and even lead to depression.1 Knowing how to manage acne will help you avoid these effects. Treating inflamed acne early also helps prevent scarring.2

How can acne be managed?

First of all, avoid picking or squeezing acne because this can cause permanent scarring.2,3

Use a gentle cleanser to wash the affected area not more than twice a day. More frequent washing or excessive scrubbing will irritate the skin.2,3

If your skin is dry, use a water-based, non-comedogenic moisturizer. Choose cosmetics that are also non-comedogenic. Non-comedogenic products are tested so that they are less likely to block skin pores and cause spots.2,3

You can also use treatments to help control acne and clear it more quickly. The treatment options are listed below.

What are the treatments for acne?

The choice of treatment depends on the severity of acne, and other factors, such as whether you are pregnant.
Talk to your doctor or pharmacist to select the right one, and to get advice on how long you need to use it for.
They may also refer you to a skin specialist if1,3:

  • Your treatments are not working;
  • You have a lot of papules and pustules on your chest, back, and face; or
  • You develop nodules or cysts.
Topical treatments include creams, gels or lotions that usually contain one or a combination of the following ingredients3:

Benzoyl peroxide2,3
  • Has antiseptic and anti-inflammatory actions
  • Treats blackheads, whiteheads and inflamed spots
  • Apply a thin layer to avoid skin irritation
  • If it irritates your skin, stop using until the irritation clears. Then try the lower 2.5% preparation first, and slowly increase the strength if needed. Or apply it once daily initially and wash it off after a few hours, before slowly increasing the length of time it is left on your skin. Target for twice daily application once your skin gets used to it
  • Bleaches cloth and hair, so avoid getting it on items such as your pillowcase, clothes or hair
Topical retinoids2,3
  • Remove dead skin cells from the skin surface, unplug blocked pores
  • Treat blackheads, whiteheads and spots
  • Apply at bedtime and wash off in the morning
  • Avoid excessive exposure to sunlight
  • Do not use if you are pregnant
Topical antibiotics2,3
  • Kill skin bacteria
  • Treat inflamed acne
  • Your doctor or pharmacist might recommend using topical antibiotics together with another topical treatment to prevent antibiotic resistance
  • Treatment is usually stopped after a 6- to 8-week course
Azelaic acid2,3
  • Removes dead skin cells from the skin surface, unplugs blocked pores and kills bacteria
  • An alternative to benzoyl peroxide or topical retinoids
Your doctor might also recommend a course of oral antibiotics together with topical treatment if you have acne that is more severe.3 Normally, oral antibiotics need to be taken for 4 to 6 months in the treatment of acne.1

For females with moderate acne with mainly papules or pustules, if there is no improvement after using topical treatments and oral antibiotics, the combined oral contraceptive pill can be considered as a treatment option.1

For severe acne that does not respond to other treatments, a skin specialist might prescribe an oral retinoid called isotretinoin. It works very well but has a wide range of side effects.2,3 This medication cannot be taken by those who are pregnant because it will harm the unborn child.3

You need to prevent pregnancy while using isotretinoin. Use one, or ideally two, methods of effective contraception at least 1 month before starting treatment, during treatment, and for at least 1 month after stopping treatment.3

Some acne treatments do not have an immediate effect. You need to be patient and continue with treatment, because some may take 2 to 3 months before you see improvements.3

Why does the combined oral contraceptive pill (COCP) affect acne?

The COCP can often help with acne in females, especially if acne seems to be associated with hormonal changes.2,3 It contains synthetic versions of the female hormones oestrogen and progesterone.4 Increased testosterone levels lead to excess sebum production, which leads to acne formation. The COCP lowers free testosterone levels.1 In contrast, acne can sometimes be worsened by hormonal contraceptive methods that do not contain oestrogen, such as the progestogen-only pill or contraceptive implant.2
The COCP is useful especially if1,3:

  • You also need contraception;
  • Your acne seems to flare up around the time of your period; or
  • You have excess hair growth on the face, chest or back.
Your doctor or pharmacist might recommend the COCP to help with your acne, even if you are not sexually active.

Read more about the COCP here.

Which COCP is suitable for acne control?

Not all COCPs have an indication to treat acne. Speak to your doctor or pharmacist to find out more.

When can’t I take the COCP?

If there are no medical reasons for you not to take the COCP, and you do not smoke or breastfeed, it can be taken until menopause. It should be avoided in women above 50 years of age.4-6

The COCP may not be suitable for you if you have certain conditions, or if you have risk factors for venous thromboembolism or arterial disease.6 Speak to your doctor or pharmacist if you4,5:

  • Have a body mass index (BMI) of over 35 kg/m2
  • Are over 35 years of age and smoke, or stopped smoking under a year ago
  • Have high blood pressure.
  • Have or have had a blood clot, or have a parent, child, brother or sister who has had a blood clot before they were 45 years of age. Venous thromboembolism is the medical term for this
  • Are unable to walk around or move much due to an operation, accident or disability
  • Have had a heart attack, stroke or angina
  • Have or have had migraines. Especially migraines with aura (you have warning signs before the pain begins, such as:
    • Eyesight changes;
    • Pins and needles; or
    • Numbness)
  • Have or have had breast or liver cancer
  • Have or have had diabetes with complications of the kidneys, nerves or eyes

  • Important: Inform your doctor or pharmacist of any illness or operations you have had, or have

    My acne has improved. Why did my doctor ask me to continue my topical treatment?

    Although the spots may have cleared, some people may need maintenance treatment for a few years to keep the spots away.2 Topical benzoyl peroxide or topical retinoids are normally recommended as maintenance treatment.1 To prevent spots from returning, you might be asked to use a dose lower than the dose you used to treat acne.2

    References

    1. Malaysian Clinical Practice Guidelines on the Management of Acne. 2012. Available at: http://www.moh.gov.my/attachments/7190.pdf. Accessed on 19 August, 2015.
    2. Patient. Acne. Available at: http://patient.info/health/acne-leaflet . Accessed 28th September 2015.
    3. NHS Choices. Acne – Treatment. Available at: http://www.nhs.uk/Conditions/Acne/Pages/Treatment.aspx . Accessed 28 September, 2015.
    4. NHS Choices. Combined pill. Available at: http://www.nhs.uk/conditions/contraception-guide/pages/combined-contraceptive-pill.aspx . Accessed 28 September, 2015.
    5. Patient. Combined oral contraceptive pill. Available at: http://patient.info/health/combined-oral-contraceptive-pill . Accessed 28 September, 2015.
    6. Joint Formulary Committee. British National Formulary 64th Ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2012.