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ACNE

1 - introduction

The Acne is a very frequent illness that reaches millions of people in Brazil. Although the Acne is not an illness that involves risk of death, it causes important psychological and physical alterations. Acne has several causes and presentations. The treatments are diverse and there is a wide range of efficient medicines. These medicines, however, need to be used carefylly. In this section, Naturale Clinic prepared texts that will help you understand what Acne is, and its   treatment options. We must emphasize that the medicines and treatments referred herein are part of a medical procedure for the treatment of acne. Do not use the information for self-medication that can be dangerous for your health; look for a physician that will analise your case and decide on the best treatment for great and safe result.

Navigating in this section you will find detailed information especially prepared by Naturale Clinic's medical staff on the treatment of  acne and its sequels (marks).

The acne is an illness with several causes and presentations that affect the sebaceous follicles of the skin. The sebaceous follicles are very small reentrances of the skin, where the sebum (oiliness) and also  the hair are produced. It is the most common of the illnesses of the skin; in Brazil it reaches about 10,000,000 of people. Little importance was given to its treatment in the past but, in more recently due to the growing concern about  the human aesthetics, the international factories and  researchers have created and developed new and efficient products.

Attention!!!

Attention:  The medicines and procedures referred to herein are part of a medical universe for the treatment of the acne. Do not use the information for self-mediciation  that can be dangerous for your health. look for  a physician that will analise your case and decide on the best treatment for great and safe result.

2 - Causes

The Acne is caused by the alteration of 4 main factors

• The sebum production

• Alteration of the cells of the follicle

• Action of the bacterium Propionibacterium Acnes

• Inflammation of the hair-sebaceous follicle.

In the puberty, there is an increase in the production of hormones called "androgens ".  These androgens cause the increasing of the hair-sebaceous follicles and of the sebum production on the face, shoulders, lap and backs. Besides, there is a larger descamation of the cells of the follicle. The combination of desquamated cells and sebum forms a kind of a plug that closes the exit of the follicle. This cork is the blackhead. This occluded follicle facilitates the action of the bacteria Propionibacterium Acnes that uses the sebum as a source of food. The action of this bacterium liberates products that swells the follicle. The action of these factors (bacteria, sebum, swelling) emerge in several kinds of Acne, as pustulant and closed blackheads, pustules and nodules.

2 - Beginning of the Treatment

The four main factors have to be treated in order to prevent and to treat scars and stains, and to prevent the repetition of the problem. The medicines have to be chosen according to the objetive of reaching the best result and smaller rate of complications. The treatment should be proportional to the extension of the problem. In the lightest cases, medicines in topical creams should solve the problem, while for the most severe cases, there must be a combination of oral medicines. It is  important to point out that the Acne is a chronic problem, and  even after some  improvement, a maintenance treatment  should be performed to offer  preventive and curative measures to enable  lasting  results.

To reach the success in the treatment, a careful evaluation carried out by a medical professional is necessary. This analisis will identify the several factors involved in each patient's specific case and the best treatment may then be chosen. Each patient needs a different treatment, according to the conclusion of the medical consultation. The severity of the acne will determine the treatment. Lighter cases can be controlled by simpler measures and more serious ones will need more complex measures. The age, the skin (dry, oily or mixed type), other existent skin conditions, motivation and the patient's concern with the problem, lifestyle, menstrual alterations, emergence of abnormal pilosity in women are factors that should be considered by the physician in the identification of the causes. The use of cosmetics for the skin and hair, medicines, some specific types of birth-control pills, vitamin B12, habit of traumatizing the follicles should also be considered.

3 - The treatments with medicines

The medicines include topical products (creams) and medicines of systemic use (orally). The agents of the treatment must be, either separately or combined, effective against all the 4 factors responsible for the Acne. A selection of the best medicines available has to be made. The patient  should not take medicine without medical prescription. We will use the scientific names of the products here, because a physician must always be consulted for the correct prescription of these drugs; they can cause problems if they are  not use appropriately .

Products that eliminate oiliness and blackheads.

Topical Tretinoine (trans retinoic acid)

The cream with Tretinoine is effective in the elimination of the existent blackheads . It also normalizes the cells of the internal walls of the follicles. This cream avoids the formation of new blackheads and reduces the possibility of inflammation of the follicles. It acts slowly and some months of treatment may be necessary before important improvements of the skin aspect can be observed. It can be used combined with other agents, with Benzoyl peroxide and topical antibacterials. It has side effects as erythema (redness), skin drought and descamation. It is quite imperative not to be exposed to the sun during the treatment because of the sensibility of the skin caused by the product. In the first weeks of treatment, the aspect of the skin may get worse. However, it gets much better after some time. If the patient is councious about this possibility, he will accept these alterations better and will not abandon the treatment.

Oral IsoTretinoine

Isotretinoine (13 cis retinoic acid ). It is a byproduct of the vitamin A that is effective for all the 4 factors that cause Acne. However, it involves risks, being reserved for the most serious cases and always prescribed with medical criterion. It also requires careful medical attendance. It is a teratogenic substance, what means that if there is pregnancy during  use, it may cause the malformation of the fetus.

b - The products that fight the Bacteria

Benzoyl Peroxide

Benzoyl peroxide has action on P. Acnes, the bacterium associated to the acne. It can be used in creams, in several concentrations and combined with other medicines. P. Acnes do not grow well in the presence of oxygen, and the Benzoyl Peroxide alters the follicle, generating an environment that’s not favorable for this bacterium to grow.

The Antibiotics

The clindamycin , the erithromycin, the sulfacetamide and the salicylic acid are substances that also have action on P. Acnes, reducing  the rate of this bacteria in the skin. However, with the lingering use, it  may cause resistance. The antibiotic should be used during a phase of the treatment, and before developing resistance, a different treatment has to be introduced. The eritromicine, the tetracycline, the doxicilyn  and the mynocicline are systemic antibiotics (orally), that are effective against P. Acnes. They can be used for the treatment, but  always under professional orientation.

New technologies

The treatment of the lesions with Laser may replace the antibiotic.

The application of a laser with specific light spectrum  kills the bacteria in the skin, reaching the same resultas of antibiotics. The Laser helps the treatment a lot, considering that the bacteria associated with the ACNE have resisted more and more  to the conventional treatments.

New phenol peelings help improve the complications as the acne scars.

New anti-acne medicines

Retinoids

Other byproducts and different presentations of the retinoic acid have been developed, such as the adapalene, the tazatorene, Retin A  Micro  and  the  polymerized cream  of Tretinoine. They aim at obtaining less side effects with equal, or better, action

Adapalene

It is a synthetic acid with retinoic activity. It has a chemical structure that is different from the retinoic acid, but with similar results. A better action against blackheads, better anti-inflammatory action and less undesirable effects were observed.

Tazarotene

 It is a synthetic retinoid  that  quickly penetrates in the skin and which is then converted into the active substance. It seems to present less side effects than the retinoic acid,  but with comparable effectiveness.

retin-a micro gel

Retin Micro is the Tretinoine in a new  preparation that uses the technology of microsferes. The intention is to liberate the product more slowly inside the skin, then reducing the side effects.

The Polimeryzed  Cream of Tretinoine is the retinoic acid associated with a polymer, the poliprepolimer i.  2 (PP-2).  The intention is to liberate the product on the area where it is more efficient, increasing its positive effects and reducing the undesirable side effects.

Other topical products

Azelaic Acid

 It was initially used for the treatment of stains of the skin. It is also effective for treating  the rosacea. It has an antibacterial action and it has demonstrated to have a positive action on the treatment of the Acne.

New sulfacetamide formulations

The sodic sulfacetamide has action against the bacteria of the skin. It has already been used for  some time, usually combined with the biosulfur. New preparations without the biosulfur have shown good resultas with small side effects.

Combination of Clindamycin and benzoyl  peroxide

This combination has  shown efficiecy in the treatment of the acne.

New oral hormones

The hormones are used in the treatment of the acne, when ovarian dysfunctions happen, causing the excessive production of androgens, as in the polycystic ovaries. A new hormonal combination of oral contraceptive and hormones (Ortho tri-Cyclen) has specifically been used for the treatment of the acne.

The Treatment Technique in Naturale Clinic

The success of the treatment agianst the acne requests careful evaluation and specific indication of the adequate treatment for each patient, respecting their individualities. The appropriate anti-acne agent is then selected and the constant checing of the results will determine the efficiency and the need strategy changing. It is important to determine the severity of the acne as light, average or serious, and the predominance of lesions. However, the program is a general strategy that can be used to rationalize the procedures. Although other techniques and approaches are equally accepted, Naturale Clinic has developed a method that has brought good results to its patients.

Naturale Clinic - Acne Treatment Program

Treatment of the Acne

We have considered four treatment phases:

Phase 1

Evaluation, cleaning and antibiotic

The case is evaluated by the physician and systemic antibiotics are prescribed;  creams for  cleaning  the skin and the aestheticist 's work is indicated  for mechanical removal of the blackheads.

Phase 2

Inhibition of the sebum production

Creams and medicines that inhibit the sebum production are chosen. The medicines are applied locally or taken orally, depending on the severity of the problem.

Phase 3

Treatment of the complications

Scars and stains are treated using peelings, subcisions and  fillers.

Phase 4

Maintenance

Following the case up, with preventive measures and reintroduction of therapeutics when necessary.

Treatment of the acne sequels - stains and scars

Subcisions  and Fillers

The technique of subcisions and fillers to treat acne scars is based on releasing the scar of the fibroses that are under the skin with very fine needles. The space is filled  with filler substances, improving the aspect of the skin.

The procedure can be carried out at the clinic, not demanding hospital stay.

Lighteners

A treatment with lighteners is performed to reduce stains caused by the acne.

Peelings

Peelings of phenol are used for more superficial stains and scars

Bioplasty

Bioplasty is used for the advanced cases of acne sequels, when the whole sustentation of the skin is condenmed, showing a process of laxity and loss of definition of the jaw. The Bioplasty can improve the aspect of laxity, restructuring the facial outlines.

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