Hello, Dr Sharon Crichlow and welcome to my third blog. Is clear skin on your Christmas list this year?
Having shared my own experience with persistent acne last month, let me now answer a frequently asked question: How do you decide on treatment for a particular acne patient??
Do forgive me for the length of this particular newsletter, but there is simply no short answer to this question. It is a bit like “How long is a piece of string?” The truth is that every single patient is different, and multiple factors have to be taken into account. My approach depends on - among other issues - the age and sex of the patient, what type of acne they have, its severity, the presence/ absence of scarring and pigmentary changes, whether it is influenced by their menstrual cycle (in women) what they’ve tried in the past, their goals re child-bearing (women), hobbies and activities, mental health, co-morbidities, medication, personal preferences and budget.
This is why a thorough medical history and examination is needed before any effective treatment can be initiated. Each patient is unique and so my treatment plans are unique to that particular patient. A few patients may require blood testing and other investigations if I suspect underlying endocrine abnormalities driving their acne, but this is not the norm.
Having taken note of the above, as a general rule of thumb and not withstanding last month’s article regarding the chronicity of acne, I would say that the first factor I consider is the age of the patient - a teenager has a higher chance of outgrowing his/her acne compared to a 36 year old! I therefore would be more inclined to start treatment with a bespoke regime which combines oral antibiotics (for no more than 3 months) with topicals. The topicals go beyond those routinely available and my experience is that even in situations where patients have failed conventional acne treatments as outlined by NICE and delivered by NHS GPs, they still almost always show good improvement.
Their acne goes into remission and stays there for the next 2-3 years until they gradually grow out of it. Problem solved. I would of course, treat more aggressively if required in this age group, for example if there was scarring, severe psychological impact, or simply severe and/or resistant acne.
However, we know that for some patients, acne becomes a chronic disease and if I am faced with a 36-year-old, (usually women but occasionally men) my approach is entirely different. I would still offer the first option as above (usually with oral and/or topical anti-hormonal treatments added on), but with the caveat that while it may work while the patient is on it, it is almost guaranteed that the acne will relapse with any attempt to withdraw treatment eg trying for a future child. Therefore, my preference would be a more definitive solution such as Isotretinoin or Aviclear laser, which are currently the only two options to offer a long-term solution to chronic acne. Please note that neither of these two solutions will be started at the first consultation but we can certainly treat at follow up once the patient is adequately consented, and all is in place.
Isotretinoin has been around since the 1980s and we know that it works - there is no question of this. It also is less expensive than Aviclear laser treatment.
So why Aviclear? There are many reasons:
Some patients simply do not wish to have chemical/drug treatment if they can avoid it.
Isotretinoin has a list of potential side effects ‘as long as your arm’, some of which persist even after stopping the drug- some people simply don’t fancy risking it! The drug has become more highly regulated since October 2023 with many clinic visits and lots of form filling required.
Some patients do not wish to have blood tests, which are required with Isotretinoin.
Isotretinoin is not recommended if patients have high risk mental health conditions.
Effective contraception is required for women on Isotretinoin - some women cannot have or do not wish to use hormonal contraception and having the copper IUD is an invasive procedure.
Some patients would like to continue to try for a baby even as they treat their acne. This is NOT possible with isotretinoin. We still do NOT treat with lasers once pregnancy is known, but laser treatment can be done as long as the patient is not pregnant at the time. [Note that the Aviclear laser light interacts with the skin only, but treatments are not done in pregnancy as no testing is done- this is a standard precaution with all lasers.]
Some patients are athletes and do not wish the muscle and joint aches that often accompany Isotretinoin treatment.
Some patients have had Isotretinoin once, twice or even three times prior and now wish an alternative.
The above list is NOT exhaustive.
If you suffer with acne, there is no reason to wait any longer for treatment that works. I invite you to book to see me at Aventus Clinic, Hitchin to discuss your specific acne needs. Whatever choice we agree on, please be reassured that YOU CAN BE ACNE FREE!!
You will not find a wider choice of effective acne solutions on offer anywhere else in the UK today!
Have a lovely festive break and a Happy New Year.