What are the considerations in choosing the best treatment method to get rid of acne?
The treatment algorithm for acne is well established internationally. The key considerations are:
1. Severity of your acne. Mild acne should be treated with topicals (e.g. benzoyl peroxide, adapalene, tretinoin). Topical antibiotics are effective but may lead to antibiotic resistance down the road. Combination topicals e.g. clindamycin + benzoyl peroxide (clindoxyl) may offer better results and reduce the occurrence of antibiotic resistance but has a shorter shelf-life and are generally more expensive. Moderately severe acne may require a short course of oral antibiotics (e.g. doxycycline, erythromycin) over a period of 2-4 months to control the acne inflammation adequately. Severe acne with large painful lesions are at risk of significant scarring will often require the most effective medication (isotretinoin) appreciating it has potential side-effects that you must be made aware of.
2. Efficacy of treatment. More effective and alternative medication may be needed to control acne that has failed to respond to the usual medication used initially to treat your acne. Do let your doctor know what you have been treated with previously and what works and what does not.
3. Safety of treatment. As acne tends to run a relapsing course of a period of 6-12 years starting after puberty, it is necessary to adhere to a safe maintenance topical regime over a longer period of time even after the initial flare has been controlled. The use of powerful oral medication (e.g. isotretinoin) to treat mild acne disregarding its potential to cause serious side-effects should be discouraged.
Hence, the best treatment to treat acne is not simply the most effective treatment currently available but should be based on your current acne severity, previous response to treatment, known drug allergies or sensitivity to topicals previously given, underlying medical condition (e.g. liver disease, depression), if pregnant or breastfeeding (this impact safety of medication given) among other factors.
A proper evaluation by your doctor followed by a discussion of the various treatment options will be essential to find the best treatment method for you balancing the various considerations highlighted above.
Hope this helps!
Dr YC Chin
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