Acne consultation

Overview

Acne is one of the most common skin diseases. It begins with a disturbance of keratinisation in the duct of the sebaceous follicle: the duct becomes blocked, sebum builds up, and blackheads (comedones) form. When increased sebum production, usually driven by hormones, and bacteria that belong to the normal skin flora are added, the follicle becomes inflamed; papules, pustules or deep-seated nodules develop from it.

Acne is not the result of poor hygiene. Washing frequently or vigorously does not improve the skin; it irritates it further. Acne can weigh on how you see yourself and on everyday life, and it can leave scars that remain.

Which form and which severity your acne has determines whether topical treatment is enough or whether systemic therapy should be added. [PLATZHALTER: Gibt es für die Aknesprechstunde eine eigene Sprechzeit, oder erfolgt die Behandlung im regulären Sprechstundenbetrieb?]

Areas of application

• Blackheads (comedones) on the face, chest or back
• Inflammatory acne with papules, pustules or deep nodules
• Acne that persists or keeps coming back despite over-the-counter products
• Acne in adulthood, including when it appears for the first time
• Suspected acne kept going by medication, cosmetics or occupational contact with oils and greases
• Marked emotional strain caused by the appearance of the skin
• Scars, once the active acne is sufficiently under control

Procedure

1. Examination and assessment of severity

   We begin by talking about the course: how long the acne has been there, what you have already used, which medication you take, whether pronounced cases are known in your family, and whether cosmetics or occupational contact with oils and greases might play a part. From the findings we establish whether comedones, inflammatory papules and pustules or deep nodules predominate. [PLATZHALTER: Welche weiterführenden Untersuchungen werden bei Akne in der Praxis angeboten, etwa eine hormonelle Abklärung bei Frauen oder ein mikrobiologischer Abstrich?]

2. Topical treatment

   Topical therapy is the basis of almost every acne treatment: vitamin A acid derivatives (topical retinoids) against the disturbance of keratinisation, benzoyl peroxide against bacteria and comedones, azelaic acid, and antibiotics for external use, often two substances in combination. Antibiotics are not used on their own or over long periods, in order to prevent bacteria from becoming resistant. Treatment usually starts at a low concentration, with the frequency of application increased slowly.

3. Systemic treatment

   Where topical therapy is not enough, systemic treatment comes into consideration for pronounced inflammatory or nodular forms: antibiotics from the tetracycline group, given for a limited time and always together with topical therapy, hormonal therapy in women, provided that existing conditions and the risk of thrombosis do not speak against it, and, in severe forms, vitamin A acid derivatives taken by mouth (systemic retinoids). Tetracyclines and systemic retinoids can both raise the pressure inside the skull (pseudotumor cerebri) and are therefore not given at the same time. The retinoids require medical supervision with regular checks including laboratory tests; for women who can become pregnant, the contraception requirements described under the risks apply in addition. [PLATZHALTER: Führt die Praxis systemische Aknetherapien einschließlich der erforderlichen Kontrollen selbst, und werden die Laborkontrollen im Haus abgenommen oder über ein externes Labor veranlasst?]

4. Supporting measures

   Part of the treatment is gentle cleansing and skin care, together with sun protection, because several of the substances used increase sensitivity to light. The specialist literature describes light-based methods as an addition in inflammatory acne; the evidence for them is weaker than for topical and systemic therapy. [PLATZHALTER: Werden bei entzündlicher Akne lichtbasierte Verfahren angeboten (IPL, Excimer-Laser)? Weder die IPL-Behandlungsseite noch die Indikationsliste des Excimer-Lasers führen Akne bisher auf. Falls ja: Verfahren bestätigen, für IPL die Filterbereiche (410 bis 950 nm, bei dunkleren Hauttypen 480 bis 950 nm), und Akne auf der jeweiligen Behandlungsseite ergänzen.] [PLATZHALTER: Wird in der Praxis eine mechanische Komedonenentfernung (Aknetoilette) angeboten, und durch wen erfolgt sie?]

5. Follow-up and maintenance

   Acne treatments are assessed and adjusted after a few weeks, because only then does it become clear how the skin is responding. Once the acne has settled, therapy is as a rule not stopped abruptly but continued at lower intensity as maintenance treatment. [PLATZHALTER: In welchem Abstand erfolgen Verlaufskontrollen, und wird die Erhaltungstherapie in der Praxis geführt?]

What to expect

• Acne therapy takes time: as a rule it is several weeks to months before the skin changes noticeably. Switching products too early wastes the effect; speak to us before you stop a treatment.
• At the start the skin can get temporarily worse. Tolerance of the topical substances usually improves over the first weeks, provided the application is increased slowly and the skin is kept well moisturised during that time.
• Once the acne has settled, maintenance treatment over a longer period is usual, because the underlying tendency remains.
• How strongly and how quickly acne responds differs from person to person. A particular result cannot be guaranteed.

Risks & notes

• Topical substances irritate the skin especially in the first weeks: dryness, flaking, redness and burning are possible. Vitamin A acid derivatives increase sensitivity to light, which is why sun protection is part of the treatment. Benzoyl peroxide can bleach fabrics and hair.
• During pregnancy and breastfeeding, vitamin A acid derivatives are not an option even when applied topically. So please tell us before an acne treatment begins if you are pregnant, breastfeeding or planning a pregnancy; other substances are available in that case, azelaic acid among them.
• For acne, antibiotics are used only for a limited time and not as the sole treatment; the reason is given in the treatment steps.
• Tetracyclines taken by mouth can markedly increase sensitivity to light and cause gastrointestinal complaints. They are not an option during pregnancy and breastfeeding or in younger children.
• Hormonal therapy is not suitable for every woman. Existing conditions, smoking and the risk of thrombosis have to be weighed up beforehand; coordinating with your gynaecological care makes sense.
• Vitamin A acid derivatives taken by mouth cause serious harm to an unborn child. Reliable contraception before, during and for a defined period after treatment is mandatory, as are regular pregnancy tests and laboratory checks. Pronounced dryness of the skin, lips and eyes and increased sensitivity to light are common. Changes in mood and behaviour have also been described: depressive mood, anxiety, aggression and suicidal thoughts. If you or those close to you notice such changes, please have the treatment discussed with a doctor without delay.
• Please seek medical attention without delay if severe headache with nausea, vomiting or visual disturbance occurs during systemic acne treatment.
• Even with consistent treatment, pronounced cases can leave scars, lasting redness or dark marks. The earlier treatment starts, the more this can be limited.
• We explain the risks, contraindications and interactions that apply to your therapy to you in person beforehand.

What you can do yourself

These points support any acne treatment:

• Cleanse the affected areas twice a day with a mild product and use skin care, make-up and sun protection products that are labelled as non-comedogenic.
• Leave inflamed spots alone; squeezing encourages scars.
• Stick to the routine you agreed on, even if little happens in the first weeks.
• Tell us which other products and medicines you use; some cosmetics and some medicines can keep acne going or trigger it.
• Say so if the state of your skin is weighing on you. That belongs in the consultation.

Acne scars

Treating scars becomes an option once the active acne is sufficiently under control; on actively inflamed skin it is not appropriate.

• Depressed (atrophic) acne scars can be treated fractionally with the CO2 laser; there is a page of its own for this in the aesthetics section.
• RF microneedling works with radiofrequency delivered through fine needles and largely spares the skin surface.
• If redness remains after the acne has healed, the pulsed dye laser may be an option.
• After systemic treatment with vitamin A acid derivatives, an interval has to be observed before laser treatment.

Frequently asked questions

May I squeeze blackheads and spots myself?

Better not. Squeezing pushes part of the contents deeper, the inflammation becomes stronger, and the risk of dark marks and scars rises.

Does diet play a part?

Links with dairy products and heavily sugared food are being discussed. The evidence is not clear-cut, and there is no general anti-acne diet. If you notice a connection in your own case, we will talk about it.

What has to be observed with systemic treatment using vitamin A acid derivatives?

It is medically supervised and accompanied by regular checks. For women who can become pregnant, strict contraception requirements apply; the details are set out under the risks.

Can my acne scars be treated at the same time?

Once the active acne is sufficiently under control. We then discuss the possibilities; after systemic treatment with vitamin A acid derivatives, an interval also has to be observed.

Does health insurance cover the treatment?

Treating acne means treating a disease. [PLATZHALTER: Bitte angeben, welche Leistungen der Aknesprechstunde über die Krankenkasse abgerechnet werden und welche als Selbstzahlerleistung anfallen.]