Acne Acne Therapy

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Acne Acne Therapy
Acne Acne Therapy

Video: Acne Acne Therapy

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Video: Acne: Understanding the Types of Acne and Treatment Options 2023, January

Acne: acute therapy

For acne treatment to be successful, patience and perseverance are important. Even if healing does not take place quickly, you should not prematurely discontinue therapy without consulting your doctor and you should not take any additional measures of your own. Which treatment options are used depends primarily on the form, severity and current stage of the acne. A basic distinction is made between acute and maintenance therapy. Medicinal and physical procedures are used.


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  • more on the subject
  • Advice, downloads & tools
  • The pillars of acute therapy
  • Local drug therapy
  • Systemic drug therapy
  • Physical therapy
  • Whom can I ask?
  • How are the costs going to be covered?

Acne therapy has several goals:

  • Suppression of excessive sebum formation,
  • Combating inflammation and bacterial infections,
  • Disinfection of the skin,
  • Elimination of cornification disorders,
  • Stimulation of the regeneration of the skin,
  • Prevention of severe courses and scarring.

The pillars of acute therapy

In acute therapy, basic therapeutic agents are combined with locally applicable (topical) and / or oral (systemic) drugs and supplemented by physical methods. Which measures are used depends primarily on the severity of the acne.

  • As basic therapeutic agents, (topical) retinoid and / or benzoyl peroxide (BPO) are the first choice.
  • This basic therapy is combined with a topical or oral antibiotic, depending on the severity.
  • Alternatively, depending on the severity, azelaic acid can be used alone or in combination with the therapies mentioned.
  • Oral isotretinoin is often prescribed for severe forms of acne.
  • An oral anti-androgenic contraceptive is also used for women with moderate to severe acne.
  • During pregnancy, azelaic acid is combined with erythromycin and benzoyl peroxide, depending on the severity of the acne. For acne conglobata, an oral glucocorticoid (prednisolone) may be added for a short time.
  • In addition, mechanical removal of blackheads (comedones) is recommended for all degrees of severity with the exception of acne conglobata.

Local drug therapy

For local application, antibiotics, benzoyl peroxide, retinoids and azelaic acid are available, which are supposed to alleviate acne-related skin changes or heal them with different mechanisms of action.

  • Topical antibiotics: Local therapy with antibiotics (erythromycin, clindamycin, nadifloxacin, tetracycline) is intended to reduce inflammation-promoting mechanisms and the colonization of the sebum follicles with Propionibacterium acnes. The treatment should last until the pustular stage has permanently ended. Longer therapy is also not advisable with regard to the development of resistance in P. acnes.
  • Benzoyl peroxide (BPO): Local therapy with BPO causes free radicals to develop in the skin through oxidative breakdown processes. These reduce the number of propionibacteria. This mechanism avoids the development of resistance, which is observed during long-term antibiotic acne therapy. BPO also has an anti-inflammatory effect. For mild forms of acne, a therapy period of eight weeks is often sufficient. BPO can also be used permanently as maintenance therapy.

Note Since benzoyl peroxide is a potent bleaching agent due to its strong oxidizing properties, colored or dark clothing, dark hair and bed linen can be bleached during acne therapy with BPO. Local skin reactions such as redness and burning sensation are also possible.

Topical retinoids: They are essentially represented by three substance classes: tretinoin, isotretinoin and adapalene. The existing comedones are reduced (comedolytic), and the formation of new comedones is inhibited (anticomedogenic). Topical retinoids also have anti-inflammatory and slightly antimicrobial effects on Staphylococcus aureus and P. acnes. The duration of therapy is eight to twelve weeks or, if Adapalen is combined with BPO, twelve months. Local retinoids are available as a gel, cream, lotion or solution

Note The sun should be avoided during therapy with tretinoin and isotretinoin. With Adapalen, however, it is possible to stay in the sun. Topical retinoids should not be used during pregnancy or breastfeeding.

Azelaic acid: Existing comedones are reduced, the formation of new comedones is inhibited. Azelaic acid also has anti-inflammatory and antimicrobial properties. The recommended duration of therapy is more than twelve weeks. Azelaic acid can also be used in sunny seasons and holiday countries

Systemic drug therapy

When basic therapeutic agents and local drug therapies do not achieve a satisfactory effect, drugs for swallowing are used.

  • Antibiotics: On the one hand, systemic antibiotics reduce the colonization of the sebum follicles with Probionibacterium acnes and, on the other hand, various pro-inflammatory mechanisms.
  • Isotretinoin: The formation of blackheads is reduced. The size of the sebum is reduced (by up to 90 percent) and sebum production is significantly reduced. The inflammatory reaction is slowed down and the number of bacteria is indirectly reduced (by changing the follicular microenvironment).
  • Antiandrogens (contraceptives): An antiandrogen therapy can reduce the sebum synthesis rate by up to 65 percent. It is used as needed in women with various forms of acne.
  • Other system therapies : A systemic therapy with glucocorticoids, dapsone or zinc can be considered in special cases.

Physical therapy

In addition or as an alternative, physical therapies can be used for active acne. For most methods of light therapy and chemical peeling there is currently a lack of data on the effectiveness or tolerability. On the other hand, manual acne therapy is recommended for mild to moderate acne to support medical therapy.

How is manual acne therapy performed?

Initially, the skin is cleaned with a mild syndet (soap-free cleaning agent) and then disinfected. An optimal preparation for the removal of comedones can be carried out using a device with warm steam (vapozon). Often, superficial peels are used to loosen the comedones.

Open and closed comedones are removed with sterile instruments under a magnifying glass. Even florid ("blooming" = purulent) acne lesions can be opened carefully. Sensitive patients or large affected areas can be pretreated with a local anesthetic cream. Another disinfection and the application of a soothing mask after cleansing complete the treatment.

The frequency of manual acne therapy can vary, depending on the severity of the disease, between twice a week at the beginning and once a month as maintenance therapy. Years of treatment may be necessary in individual cases.

Whom can I ask?

Drugs specializing in dermatology and venereology are prescribed medical therapies for acne after a diagnosis has been made.

Manual acne therapy is offered by dermatologists and cosmetic institutes. It should be prescribed by a doctor and performed by a well-trained beautician to prevent aggravation or scarring. The patient has to bear the costs for this himself.

Particularly large blackheads (macrocomedones) can be removed by a doctor using an electrocautery (electric branding iron, usually in the form of a small wire loop).

How are the costs going to be covered?

The e-card is your personal key to the benefits of the statutory health insurance. All necessary and appropriate diagnostic and therapeutic measures are taken over by your responsible social insurance agency. A deductible or contribution to costs may apply for certain services. You can obtain detailed information from your social security agency. Further information can also be found at:

  • Right to treatment
  • Visit to the doctor: costs and deductibles
  • What does the hospital stay cost?
  • Prescription fee: This is how drug costs are covered
  • Medical aids & aids
  • Health Professions AZ
  • and via the online guide to reimbursement of social insurance costs.

(*) German Dermatological Society: S2k guidelines for the treatment of acne, AWMF register no. 013/017.

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