There’s never a good time to have acne. The teen years present an intensely vulnerable stage in a person’s psycho-social development. Painful, unsightly cystic acne doesn’t help. Adult onset can also put the brakes on what should be a woman or man’s most confident time.
So little wonder there has been a flurry of research and treatments emerging over the past five years to control acne vulgaris.
Cannabis is being rolled out in labs across the world in all manner of trials. In June, it was announced that Sydney would be one of two sites for a phase 2 clinical trial for a topical treatment of BTC 1503 (with synthetic cannabidiol) after phase 1b results showed reduction in both inflammatory and non-inflammatory acne lesions. The next phase will seek results on patients with moderate to severe acne.
The maker, Botanix, is looking to test the topical drug against the current ‘gold standard’ Accutane or Roaccutane for its capacity to impact on the skin’s oil production.
Another wait and see moment for acne sufferers.
We spoke to Fremantle GP Dr Sarah Boxley, whose primary practice focuses on skin. She said research on the pathogenesis of acne was giving a greater understanding of its hormonal background.
“There seems to be a link with inflammatory markers and insulin-like growth factors in similar ways as metabolic syndrome, which is interesting,” she said.
“Acne is one of the most common things I see. The prevalence worldwide is about 95%, so at some point most people experience acne, but having said that 75% would be classed as mild and only 1% overall would be severe.”
“Most of those with mild to moderate acne don’t seek help for it because there is a mindset that it’s just acne and they’ll grow out of it. But research also is showing how it affects people psychologically and contributes to anxiety and depression.”
“For teens when they are starting to develop their own identity, having acne can affect social integration and their psycho-social-sexual development. Going through something that is visible on the outside while you’re working on who you are on the inside can have a long-term impact so management strategies for acne need to address those issues as well.”
Sarah said her approach was to treat younger people with a range of treatments in order to achieve outcomes quicker.
“Six months is a long time for a person who is 14. So we look at topical treatments to prescription medications from antibiotics to hormonal pills. Spironolactone is coming back as a treatment of acne for its anti-androgen properties. It’s useful for teenagers who don’t want to be on the contraceptive pill, which is usually a parental choice rather than a patient choice.”
“When we are dealing with adolescent acne, we’re also often dealing with parents as well, managing their expectations and their own experiences.”
Sarah said that being in Fremantle, there is a demand for non-chemical treatments and she has explored a range of technology-based treatments such as light therapies.
“We use a photo sensitiser on the skin in similar ways as some skin cancers are treated. It switches off the inflammation response. It is quite painful and when you are doing a full face of a teenager, it is difficult for them to tolerate, but it is a short course and is a way of getting on top of things relatively quickly.”
There is also LED therapy using different light waves – blue wave lengths of 415 nanometres target the Propionibacterium acne while the red wave length at 630 nanometres tackles inflammation and increases vascular flow. For scarring, Sarah looks at 830 nanometres to stimulate collagen growth.
“The most recent development is biophotonics using a chromophore gel on the skin prior to light therapy, which is licensed for moderate to severe acne,” she said.
While treatments continue to develop, a generation of young people is no longer willing to put up with acne. Sarah sees a lot of parents who bring their children to see her because they suffered from acne themselves and they don’t want the same for their children.