Centro Studi GISED

Acne

Acne is a physio-pathological condition typical among adolescents, which manifests itself as blackheads, pustules and at times cysts localised predominantly on the face and back. Different variations exist, which can be implicated also in adulthood or infancy. The principle cause of the classic form (common acne) is hormonal, the rapid augmentation of hormonal levels during pubescence strongly activates the sebaceous glands. The accumulation of sebum in follicles, often blocked by excessive keratinisation at the opening, allowing the formation of blackheads and whiteheads. The proliferation of bacteria present all over the skin contributes to the inflammatory process which forms pustules. Acne can be treated efficiently even over rather prolonged periods. The treatments can act at different stages during the pathogenetic process of acne: on the hormonal cause, on the hyper-keratinisation and on the bacterial flora.

Hello doctor, my name is (…), I’m 25 years old, (49Kg, 1.6m). I have suffered from acne for a couple of years, and now I have been prescribed... I have been taking it for one and a half months, but I don’t see any improvement. There are days in which for a few minutes my skin becomes itchy and tingles and then suddenly new boils swell under my skin, I can’t take any more! It’s since I started taking... that I’ve had these momentary tingles. For one month I took 20mg a day, for the last couple of days I have been taking 2 at 20mg each. I’ve had a month of deterioration and now the situation doesn’t seem to be changing. But what can I do? I’m very down. My topical treatment is a base of: ... detergent/disinfectant, ... I would grately accept your opinion and advice. Thank you.

Dear Sir, the advice is not to give up. Isotretinoin is still the most effective medicine available for the treatment of acne. During the first 2 months of treatment the acne can cease to improve or deteriorate. The length of the overall treatment is, in general, 4-6 months (depending on the dosage daily). During treatment with isotretinoin you test the effects on the skin and mucous membranes to high doses of vitamin A (skin drier, mucose membrane drier etc). At the end of the treatment, however, in most cases, acne has almost disappeared and tends not to return. Best regards, Dr. Luigi Naldi Coordinator of Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

I’m a girl of 23 years affected with juvenile acne that left scars and dark patches on my face and back. I would like to know if any new treatments exist as alternatives to laser or plastic treatments to remove them, and any costs.

Dear Friend, lesions caused by acne, once cured, leave unsightly patches on the skin (different colourations) and scars of various sizes. The patches derive from, most of the time, sun exposure during the period in which the lesions are not yet cured and so tend to hyperpigment. The scars, however, are from pustular lesions or particularly deep cysts, especially if squeezed and grazed. The scars are not easy to remove, the techniques most applied are those that you’ve already mentioned: Laser treatment or dermoabrasion. These treatments are quite expensive and dermoabrasioning is also rather bloody. The treatment of the patches is simpler and less expensive. The patches can be alleviated with the so-called chemical peeling. You attend a few outpatient sessions during which the doctor applies an acidic substance on the skin (in general using alpha-hydro (alfaidrossiacidi)) that is left to act for variable lengths of time until inactivated. A decongestive emulsion is then applied with a light massage. The effect of this treatment is to “rejuvenate” the skin favouring the removal of the superficial layers and the regeneration of those deeper. It’s particularly effective on patches and mildly alleviates scars as well. A side-effect is a transitory reddening. You need to avoid exposure to the sun for several days. Best regards, Dr Lorenzo Peli – GISED

Hello, first of all compliments for the website. I would like to know if it’s true that CETEARYL ALCOHOL can cause acne? Thank you.

Thank you for the compliments. Cetearyl alcohol is a greasy alcohol used in cosmetics like excipients, emulsions, stabilisers and opaque substances. It doesn’t, to the best of our knowledge, come in products that can more frequently induce acne. The substance is, moreover, put into various products used for the treatment of acne. Among the products that can more frequently induce acne, we find: chlorinated hydrocarbides (chloracne), blending oils, tar and it’s derivatives and topical corticostearoids. Best regards, Dr. Luigi Naldi Coordinator of Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Dear Doctor, I write to you on account of my girlfriend. She is 28 years old and for the last 2 years has had continual outbreaks of acne, after repeated visits to the dermatologist without seeing results he prescribed 2 cycles of treatment with... (obviously in the course of the last 2 years), but even this treatment doesn’t seem to give good results. Also, my girlfriend has a small ovarian cyst. Is there anything else that she can do to solve the problem? Good bye and thank you.

The medicine that has been prescribed is probably the most potent actually available for the treatment of acne. It’s strange that it hasn’t resolved the problem. Since pointing out the presence of an ovarian cyst, a treatment with a particular pill that contains cyproterone acetate could be considered. Mention it to the doctor treating her, and if he thinks it appropriate, he will prescribe it to her as necessary. It’s a treatment that requires rather a long period of time before it gives significant results though, so it is appropriate to also carry on with the local treatment, at least in the first months. Best regards. Dr Lorenzo Peli – GISED.

I’m a boy of 21 years, and 2 years ago I started using isotretinoin under the advice of my dermatologist. The acne that I had disappeared and sometimes, but very rarely, a few spots appear. I’m not complaining about that, but when the temperature goes down my lips still get dry, is it normal? I read that isotretinoin in one month, two months at most, is eliminated from the body, is it true? The use of this treatment could also have caused problems to do with my erection, I have seen a reduction in my erection more-or-less since that period. But it could also be due to other factors, and I’m speaking to you to find an answer. I hope that you can clear my doubts once and for all, I thank you very much. I ask you, if you can, to respond to this email address when you are able. Best regards.

Dear writer, after 2 years the medicine that you took is certainly totally eliminated from your body and therefore it doesn’t seem possible to me to relate the dryness of your lips to the treatment carried out. The diminishment of your erection isn’t among the undesired effects most common result from the use of cis-13-retinoic acid. Nevertheless it isn’t possible for me to clear all your doubts like you asked because medicine and science rarely permits categorical and definitive answers. Even so, don’t worry. You have completely eliminated the cis-13-retinoic acid taken and there will be no need for it’s use for your whole life. For the problem of your diminished erection, you could seek medical advice if it should persist. Dr Bruno Pansera, dermatologist.

Dear Doctor, I’m a girl of 25 years and I have been suffering from acne. Around a year ago I took... for 4 months with good results. Today little spots are reappearing and so I went back to another dermatologist for his advice and he explained to me that the effects of... (malformations in the case of pregnancy) continue in the successive 5 years after the use of the drug. As when I started the treatment with... my dermatologist had said to me that... could provoke these malformations but only in the period in which it was being taken and the effects continue only for the month after the end of the treatment, I would like to know which really are the consequences that you can have after having taken... I would accept, with pleasure, your advice because I’m very worried. Thank you.

Dear Writer, The information that was given to you isn’t absolutely correct. Within a month of suspending isotretinoin it is already completely eliminated from your body. You are recommended, in general, to start contraception the month before the beginning of treatment and carry it on for one or two months after it’s finished. The other matter regarding tretinoin, derived from vitamin-A taken for diseases like psoriasis, is in circulation even years after suspending treatment and can have teratogenic effects. Best regards Dr Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).

Hello, For the last few months I have been noticing on my face, mostly in the chin area, the formation of “boils” or “spots” that stay under the skin and then I get swollen around that area. They last days and days without evolving into anything. When they finally disappear, like they’re reabsorbed, they leave my skin looking unpleasant – and, to me it appears, irreversible – dark patches. After a few days, where one had already taken shape some time ago, another spot appeared under the skin. The doctor prescribed me... : the swelling has passed, but there is still what looks like a “pimple” that doesn’t go away. What’s going on? What should I do, even regarding the dark patches? Grateful for the kindness available, I await your precious advice soon.

Dear Madam, I believe it’s acne. You don’t indicate your age. In adult women acne is localised usually in the area around the lower face (chin and neck) with scattered lesions that are particularly persistent. The dark patches are pigments that result. Deposits of pigments that follow the inflammatory process. The treatment for acne: antibiotics or local antiseptics, derivatives of vitamin-A (there are a few problems with this in women) for local application. In more persistent cases, tetracycline by mouth or treatment using antiandrogens can be used. In every case, the treatment must be carried out for a few months. Best regards, Dr. Luigi Naldi coordinatore Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED).