“Light up, Light up….” The Answer To Acne?
“What’s new in acne? “….. a question frequently asked of me by patients and journalists alike. Acne-prone patients will do and try anything in order to, well, find a way not to have to think about it so much. And so I was reading an analysis of the systematic reviews (the strongest form of medical evidence) of the latest innovations in acne treatment in the last year and I thought some of the findings were in turn surprising, reassuring and therefore worth sharing.
1) The combined oral contraceptive pill is proven to be useful in reducing acne in women, assuming you choose the correct one ie one with the newer generation of skin-friendly progestogens (such as gestodene, norgestimate and desogestrel). There is not thought to be any major advantage in taking cytoproterone acetate-containing contraceptive pills (Dianette), and these are thought to have an increased risk of clot formation…so stick to the conventional Pill. DO avoid the progesterone depot injection if you’re spot-prone.
2) Benzoyl peroxide (BPO) at higher strengths is probably no better than lower strengths. And it will be more irritating….So give yourself a break and increase the likelihood that you’ll actually use your treament (!) and stick to a kinder prescription preparation like Epiduo that uses a combination formula incorporating BPO at a sensible and tolerable 2.5%, rather than the scorching 5 or 10% single agent formulations.
3) Using topical retinoids doesn’t make acne flare. A common belief among patients….but not proven to be the case and in fact we are becoming increasingly aware of the direct and indirect ways that these powerful topicals have anti-inflammatory actions. So these need to be first-line treatment (unless you’re pregnant or planning to get pregnant- a no-no!)-nothing else will be as effective at preventing those pesky micro-comedones that are literally, the root of all evil, acne-wise. Of course, they will cause driness-which will settle after 10-12 weeks of use. So persist! (Acne treatment brings out the school mistress in me…I get very firm and bossy!)
4) Light sources are as yet of uncertain benefit. And they are expensive when compared to conventional topical therapies. In one study, PDT which causes a fairly unpleasant acne-like eruption after treatment (the so-called PDT effect) was not found to be any better than 0.1% Differin (a new-generation topical retinoid)-so why would you?? Blue and red light are better tolerated and are probably better than placebo, but no decent studies exist clarifying where they sit compared to tried and tested treatments, like topical agents or oral antibiotics.
5) Diet has still not been shown to be causal in acne. That doesn’t mean to say that cutting out dairy or being on a low-GI diet won’t help-its just that it hasn’t been proven yet.
The conclusions I draw from this are simple. Acne remains a big problem for many many people, right into their 20s, 30s and beyond. Acne can be treated, with the right education and the right treatments. New treatments are invariably more expensive and not necessarily better than the ones currently available-so stick with what you know until science proves otherwise. By all means try dietary measures-but do it in a meaningful way by taking a spot count beforehand and sticking with it for at least 3 months.
Dr. Sam Bunting 
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