Acne Extinguishers

We deem most products to be inappropriate for acne and we have classified those supposedly acne extinguishers in the following categories:

Type A: harsh chemicals like benzoyl peroxide, synthetic salicylic acid, sulfur preparations, azelaic acid

Type B: topical retinoids - should be used under Doctor's supervision

Type C: topical and/or systemic antibiotics - systemic therapy is required in people who have deep acne with nodules and cysts and should be done only under the supervision of a Doctor.

Type D: Combination Therapy: employed by Doctors when people have a mixture of comedonal and inflammatory acne lesions. Because adequate clinical studies are lacking, it is difficult to compare various combination therapies.

Type X: Accutane and other isotretinoin drugs. These types of acne extinguishers are very dangerous and should only be handled by a trained fire-fighter = a Doctor.

Hold on while we take a closer look at all these.

Type A Acne Extinguishers
These are loaded with harsh chemicals like benzoyl peroxide, synthetic salicylic acid, sulfur preparations, azelaic acid.

These extinguishers when used on cystic acne breakouts that are out of control and as a first line of defence before arriving to a Doctors office are okey but can be dangerous to use on ordinary blackheads or whiteheads or on mild acne lesions, for they create lots of free radicals and their persistent use destroys cells and tissues causing premature aging in the long run.

Benzoyl Peroxide

Benzoyl peroxide is available over the counter and by prescription and has been a mainstay of acne treatment since the 1950s. This chemical has bactericidal and comedolytic properties. It has bacteriostatic activity superior to that of topical antibiotics so it used to be the topical agent most effective against P. acnes, until licorice root extract was discovered to be more effective by researchers in Japan.

Problem with benzoyl peroxide is it destroys bacteria living on the skin but it does not work to prevent their return. Benzoyl peroxide basically just wipes the face clean but the bacteria are right back in a couple hours while in the meantime your skin becomes dry and prone to more acne, as bacteria infiltrates in micro-lesions inflicted by cracking of dry skin.

Benzoyl peroxide also functions as a mild comedolytic agent by increasing epithelial cell turnover with desquamation.

Benzoyl peroxide can be obtained in various concentrations (2.5 to 10 percent), although little evidence exists that efficacy is dependent on the dose. This chemical comes in water-based or alcohol-based gels. The water-based formulations are less drying than the alcohol-based preparations. Benzoyl peroxide gels are applied once or twice daily.

Skin irritation is the most common side effect of benzoyl peroxide. This effect occurs more often at higher concentrations and tends to decrease with continued use. Contact allergy occurs in 1 to 2 percent of people treated. Those using benzoyl peroxide formulations for the first time should be instructed to test for allergic dermatitis by applying a small amount of the agent in the antecubital area before using it on the face.

Because benzoyl peroxide is an oxidizing agent, people should be warned of potential bleaching of clothing and bed linens. This problem can be avoided by applying benzoyl peroxide to a clean, dry face in the morning and putting it on the face again at dinner time, if needed.

Salicylic acid

Salicylic acid also destroys bacteria and helps to unclog pores, which is a desired outcome in any acne care treatment but can be very irritating.

Sulfur Preparations

Sulfur preparations have been used to treat acne since the time of Hippocrates. Sulfur is combined with various other acne medications in many over-the-counter washes and cleansing bars. This agent has been shown to be effective in the treatment of inflammatory acne lesions, most likely as a result of keratolysis. However, efficacy may also be related to an irritative effect.12

Preparations containing sulfur can cause some skin discoloration and can have a displeasing odor. Consequently, sulfur medications are now used less often in patients with acne.

The combination of sulfacetamide and sulfur (Novacet, Sulfacet-R) can be effective in the treatment of inflammatory skin lesions without the unpleasant side effects that occur with sulfur preparations alone. One study of sulfacetamide-sulfur lotion showed an 83 percent reduction in inflammatory lesions after 12 weeks of therapy.13

Azelaic acid

Azelaic acid is available as a 20 percent cream (Azelex), which is applied twice daily to a clean, dry affected area. The agent is fairly well tolerated, with only about 5 percent of patients complaining of transient cutaneous irritation and erythema.16 This rate is lower than the incidence of such complaints reported for benzoyl peroxide and tretinoin. Because azelaic acid decreases pigmentation, it should be used with caution in patients with darker complexions.

Type B acne extinguishers - Topical Retinoids

Retinoids are derivatives of vitamin A, and function by slowing the desquamation process, thereby decreasing the number of comedones and microcomedones. Retinoids are the most effective comedolytic agents in use. They have been a mainstay of acne treatment for the past 25 years.

Topical retinoids such as tretinoin causes skin irritation, photosensitivity, and initially may worsen acne; or adapalene may cause skin dryness and hypopigmentation.

Because of the known teratogenic effects of oral vitamin A products, the use of tretinoin in pregnancy has been an issue of concern. Tretinoin is listed as a pregnancy category C drug and should only be taken by prescription and under supervision of a Doctor.

Tretinoin is now available in a new delivery system (Retin-A Micro) that may minimize its irritative effects. This delivery system works by entrapping the drug in microspheres that bring the medication more directly to the follicle and serve as reservoirs for the medication. The 0.1 percent tretinoin microsphere gel has been shown to be less irritating than 0.1 percent tretinoin cream.

Adapalene
Adapalene (Differin) is a topical retinoid that was labeled by the FDA in 1997. Its mechanism of action is similar to that of tretinoin. Adapalene comes in a 0.1 percent gel or solution for application once daily in the evening.

Studies have shown that 0.1 percent adapalene gel is at least as effective as 0.025 percent tretinoin gel21 and significantly less irritating.22 Adapalene gel has not yet been compared with the newer tretinoin delivery system. Like tretinoin, adapalene may cause skin irritation and initial exacerbation of acne lesions.

Tazarotene
Tazarotene (Tazorac) gel is a retinoid product that the FDA has labeled for use in the treatment of psoriasis and mild to moderate acne. It comes in a 0.05 or 0.1 percent gel for once-daily application. Studies comparing tazarotone with vehicle alone have shown that the medication is effective in treating noninflammatory acne lesions.23

Although comparative drug trials have not been performed, tazarotene and the standard form of tretinoin appear to have similar irritation rates. The use of tazarotene in pregnant women is not recommended.

Type C Extinguishers - Topical and/or Systemic Antibiotics - systemic therapy is required in people who have deep acne with nodules and cysts and should be done only under the supervision of a Doctor.

Topical antibiotics work directly by killing P. acnes. Through their bactericidal activity, they also have a mild indirect effect on comedogenesis. These agents are available in a variety of forms and are applied once or twice daily.

Topical erythromycin and clindamycin (Cleocin T) are the most commonly used agents and have similar efficacy in patients with acne. Clindamycin has been shown to be significantly more effective than topical tetracycline.

Almost all topical antibiotics are associated with some minor skin irritation. This adverse effect may be influenced by the vehicle used.

http://www.aafp.org/afp/20000115/357.html

Type D Combination Therapy:

It is often employed by Doctors when people have a mixture of comedonal and inflammatory acne lesions. Because adequate clinical studies are lacking, it is difficult to compare various combination therapies.

The combination of 5 percent benzoyl peroxide and 3 percent erythromycin (Benzamycin) is a highly effective acne treatment. The agents come unmixed, and the pharmacist or patient must combine the erythromycin powder with the benzoyl peroxide gel. The mixture must be refrigerated. The benzoyl peroxide­erythromycin mixture is then applied to affected areas once or twice daily. This mixture has been shown to be superior to either product alone and to clindamycin monotherapy. Its increased efficacy may be due to the fact that fewer strains of P. acnes develop resistance to benzoyl peroxide­erythromycin than to erythromycin alone.

Other combination therapies may lack convenience but are also effective. In the patient with comedones and inflammatory lesions, a comedolytic agent such as tretinoin, adapalene or azelaic acid may be combined with benzoyl peroxide or a topical antibiotic. The combination of clindamycin and tretinoin causes less irritation than tretinoin alone.

In using tretinoin and the benzoyl peroxide­erythromycin combination together, the patient should alternate the products daily for two weeks to minimize irritation.

Type X Extinguishers - Isotretinoin Drugs
These types of acne extinguishers are very dangerous and should only be handled by a trained fire-fighter = a Doctor.

Accutane belongs to the family of medicines called isotretinoin retinoids, which are similar to vitamin A. Accutane, like other retinoids, works by altering DNA transcription. This affect decreases the size and output of sebaceous glands. It also makes the cells that are sloughed off into the sebaceous glands less sticky, and therefore less able to form blackheads and whiteheads (comedones). It also reduces the number of bacteria in the sebaceous gland and on the skin surface.

Accutane is generally used for nodular, pustular acne that has not responded to full courses of several oral antibiotics. The trend in Accutane prescribing for acne has been towards using it earlier in the course of the disease, especially if there is significant scarring.

Several dosing regimens are used, but the most common regimen involves starting with a low dose, then increasing the dose after several weeks. The length of the treatment course varies but generally lasts from 16 to 20 weeks. Some people notice that their acne gets worse after starting Accutane therapy. The number of acne lesions usually does not increase; rather the lesions may become redder or more painful.

Birth Defects With Accutane
The side effects of Accutane have been a controversial topic. The most noticeable, serious, side effect is its teratogenicity. This means that Accutane causes birth defects if women take it while they are pregnant. The birth defects Accutane causes include central nervous system, facial, cardiac, and thymus gland abnormalities. After Accutane treatment has been completed for one month, a woman can get pregnant without worry about birth defects. Accutane does not affect fertility, or make it difficult to get pregnant. Women who are taking Accutane should use two forms of birth control starting a month before treatment and continuing one month after treatment.

Accutane therapy also has the following serious side effects

Headaches, if persistent and associated with nausea, vomiting, and blurred vision, may be a sign of a condition called pseudotumor cerebri.

The incidence of depression, psychosis, and suicide attempts is increased, and returns to normal after discontinuing the drug.

The production of tears in the eyes is decreased, which can cause, red eyes, itchy eyes, and possibly ulcerations of the cornea, especially with contact lens wearers.

The ability to distinguish between shades of black and white can be decreased causing night blindness.

Liver enzymes can be elevated causing jaundice, hepatitis, and abdominal pain.

Other Side Effects With Accutane
Accutane therapy can also cause the following less serious, but potentially annoying side effects.

Dry skin requiring the frequent use of moisturizers

Dry and cracking lips

Nosebleeds

Itchy skin

Thinning hair

Excessive peeling, especially of the palms and soles

Muscle aches and pains, even worse with physical activity

Increased sensitivity to the sun causing sunburns more easily

Elevated triglyceride levels

Lab Monitoring of Accutane
Prior to starting Accutane therapy, patients should have blood work to check triglyceride levels, liver functions, and a complete blood count. Women should also have a pregnancy test. Periodically during the course of therapy, but especially one month after starting therapy, these labs are checked again.

Course of Therapy With Accutane
A standard course of therapy is 16 to 20 weeks. At the end of 16 weeks, about 85% of patients are clear. The beneficial effects of Accutane do not stop when the drug is discontinued. A further reduction of acne lesions and improvement of scarring is seen for months after treatment has stopped. Your Doctor might tell you that another beneficial effect of Accutane is that after a course of the drug, the skin usually responds better to conventional acne therapy, so be prepared for more acne on your way...

BIO ACNE CARE
Gentle but effective acne treatment serum for pimples & acne cysts

The product is oil free and contains the following ingredients that act in concert to yield benefits that go beyond the sum of those of their specific parts:

a) our biological Helix Aspersa Müller Glycoconjugates with antioxidant, antimicrobial & skin regeneration properties to heal skin lesions within the follicles, control acne bacteria and prevent and get rid of acne scars;

b) the active extract of the bark of the Black willow ( Salix Nigra) tree to enhance cell renewal on the surface of the skin, unclog pores and reduce acneic skin flora (Propionibacterium acnes and Staphylococcus aureus). The actual content of willow (Salix Nigra) extract expressed as standarized salicylic acid is less than 0.5%. The Salix Nigra extract also provides natural B-hydroxy acid activity, without the skin irritation commonly associated with synthetic salicylic acid;

c) modified glucomannan (carbohydrate) -high molecular weight heterpolysaccharides made up of glucose and mannose derived from the Japanese Konjac tuber (root)- that reduce the surface tension of oil and facilitates its dispersion into droplets. These droplets get distributed evenly along the skin’s surface, minimizing their presence and oily feel;

d) Hyaluronic Acid a glycosaminoglycan (also present in the snail serum) to deeply moisturize the skin and restore the capacity of the skin to hold in moisture; and seaweed extracts that provide moisture and trace minerals necessary for the recovery of damaged skin cells; and sodium salt of pyroglutamic acid (naturally in human skin) moisturizer;

e) Japanese Licochalcone LR-15 from Licorice (Glycyrrhiza inflate) extract which clinicals (*) in Japan have shown that at very low concentration reduces undesired p. acnes and other acneic skin flora, is anti-irritating, anti-inflammatory and reduces sebum output. 

Apply a thin layer twice a day on all the area affected with acne (whole face, chest or back) and then always use sun protection.  If you are allergic to salycilic acid or to aspirin do not use the product and if you experience stinging or irritation (very unlikely) you must stop using the product and consult your physician.

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(*) A New Dermatological Availability of the Flavonoid Fraction from Licorice Roots-Effect on Acne
Journal of Society Cosmetic Chemists Japan, VOL.37; NO.3; PAGE. 179-186(2003) Authors: Kambara Toshimitsu^a, Zhou Y, Kawashima Yoshihito^a, Kishida Naoko^a, Mizutani Kenji^a, Ikeda Takao^a, Kameyama Koichiro^b.

^a Research Center, Maruzen Pharmaceuticals Co., Ltd., 1089-8 Sagata, Shin-ichi, Fukuyama, 729-3102 Hiroshima, Japan. ^bAoyama Dermatological Clinic, dr@aoyamahihuka.com 5-1-3 Aoyama 8F Minato-ku Tokyo 107 Japan.

Abstract: Licochalcone-A, Polyol Soluble Licorice Extract P-U (now in the market as Licochalcone LR-15), prepared from the roots of Glycyrrhiza Inflata Batalin shows several activities such as inhibitory actions of testosterone 5 ALPHA-reductase, lipase and phospholipase A2, as well as androgen receptor antagonist, antimicrobial and SOD-like antioxidant actions, which relate to skin care, especially the suppression of acne formation and development. On basis of this evidence, a trial with acne patients was carried out and the efficacy of the extract was demonstrated clinically.

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A deeply moisturizing natural skin care cream that replenishes the lipid barrier of the skin and triggers the repair of cells damaged by UV radiation and Free Radicals. Also gets rid of brown, sun and age spots, actinic keratosis scales and all types of skin blemishes. The same ingredients in BIOSKINCARE with an added natural substance that reduces melanin hyperpigmentation and a biomimetic peptide that inhibits the accumulation of melanin pigments.

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