Topical Therapy for Acne

Acne is a chronic and relapsing inflammatory condition of the oil glands. Drs. Eugene and Steven Mandrea has treated numerous patients with all types of acne and all grades of severities in Chicago and suburbs, for many years.

Topical therapies have been used in the treatment of acne for a very long time. We shall only mention the ones commonly used at the present time:

• Benzoyl Peroxide, used alone or in combination with an antibiotic such as Erythromycin or Clindamycin, is an important item in the treatment of acne.
• The Propionibacterium Acnes is ananaerobe (It thrives in Oxygen poor areas). Benzoyl Peroxide releases Oxygen and easily kills the P. Acnes. Thus, Even though the P. Acnes can and does become resistant to antibiotics, it can never become resistant to Oxygen.
• Topical Erythromycin and topical Clindamycin (both antibiotics) are often used singly in mild cases of acne or in combination with Benzoyl Peroxide in moderate to severe cases. P.Acnes is largely resistant to both, but their anti-inflammatory action still helps make them useful agents to combat acne.
• Topical Azelaic Acid (Azelex™, Finacea™), has proved to be a very useful topical agent to combat acne, in that it has an anti-inflammatory action and also kills the P.Acnes.
• Topical Sulfur/Sulfacetamide combinations are still popular, after close to 50 years of continuous use. They are anti-inflammatory, suppress P.Acnes and exfoliate the plugs.
• Retinoids (Retin-a™, Differin™, Tazorac™ are very important topical products in that they stimulate a more rapid turnover of cells and thereby help the skin shed the acne producing plugs and also discourage plug formation.

Recently, a combination of Benzoyl Peroxide and Clindamycin topically in A.M. and a Retinoid at bedtime, has been shown to be very beneficial in the treatment of moderate acne. We use this combination extensively and also add an Azelaic Acid product in A.M.

A new, very effective topical cream, containing a Sulfone derivative, Aczone has recently been approved. Sulfones have a strong anti-inflammatory actions in certain conditions, including acne.

Comedone extractor:
There are two types of comedones: Open (Blackheads) and Closed (Whiteheads).
In the 1930's, Dr Jay F Schamberg devised a blackhead extractor: The Schamberg Comedone Extractor, which is still used at the present time. Some other comedone extractors are on the market, but we prefer the Schamberg, as it is less traumatic to use than the others. We have found that in about 10% of cases, comedone extraction may actually cause some papules and pustules to develop. Therefore, the first time we extract comedones, we do it on one side of the face (or back or chest) and compare the two sides on the next visit. If the treated side is better, we continue the procedure, otherwise we don't. We also use the comedone extractor to extract whiteheads (closed comedones) after gently opening them with a No. 11 scalpel. Again, we do it on one side only the first time. Comedone extraction should be performed only by a well trained person.