Treatments

General guidance on using treatment
When deciding on the type of topical treatment to use, assessment of the type of acne the patient is presenting with is important, e.g. is it inflammatory or non-inflammatory or a mixture of the two. It is also important to bear in mind the patient’s lifestyle and what sort of treatments they are willing and able to tolerate.

Before discussing with the patient the possible treatment options, it is important that the health care professional ensures that the patient is clear about a number of general issues around acne and its treatment. To start with, patients need to be advised that acne is not caused by any of the mythical causes such as poor hygiene, too much sex, eating chocolate or dietary habits in general. As has been described earlier in the section, acne is a complex condition caused by the interplay of a number of different physiological factors. It may be helpful to explain this to patients. Some patients may believe that their acne is contagious and this falsehood must be dispelled. Regardless of which treatments are eventually used, there are some general guidelines about acne management that are worth discussing. These are listed in Box 10.1.

Box 10.1 General advice on skin care for acne prone skin Avoid harsh washing and specifically do not scrub acne affected skin. It is best for the skin not to squeeze spots. Certainly, if the lesion is red and not pustular it should be left alone. However, for many patients this is difficult to adhere to, so the following guidance is aimed at causing as little permanent damage as possible to the skin: When trying to express the contents of a pustule, stretch the skin on either side of the lesion using a tissue rather than digging in with the nails and squeezing. Gentle pressure and squeezing on either side of blackhead is probably the only way to express those lesions. Whiteheads should not be squeezed. Stop squeezing if blood is seen (Mitchell and Dudley, 2002). Avoid using oily products on the skin. Moisturisers may be needed as the skin between lesions can become dry and tight (especially if drying topical agents are being used). All products should be labelled oil free and non-comodogenic. Foundation and cover-up makeup can make acne worse, although lighter non-comodogenic products are likely to be less troublesome.

It is important that patients are aware that there is really no quick treatment option for acne and that results from treatment will only be seen over a prolonged period of time (weeks to months). In addition, due to the number of different processes that are occurring in the development of acne (i.e. increased sebum production, follicular plugging, colonisation by P. acnes and the resulting inflammation), it is often necessary to have a combination of treatments which tackle different elements of the disease process. In order to optimise the care of patients with acne (and therefore the results they experience), intervention at an early stage is vital. Often it will be a nurse who has the time and skills to undertake this early care. This will ensure that people with acne understand about the process of the disease, how and why to use treatments and importantly how to recognise if the condition is worsening and more intensive interventions are needed, particularly with the aim of preventing scarring.