In general, theacne juvenile is treated very well. Unfortunately, theacne adult may be more difficult to treat. However, all treatments require persistence, as several weeks or even months can pass before you see results. Part of the reason why acne lesions are so slow to heal is that they also take a long time to form: at least 8 weeks.

In France, the management of acne was the subject of a recommendation from the High Authority of Health in 2015

Very mild acne (rare comedones and / or papules)

Treatments applied to the skin

They come in different forms: gels, lotions, creams, soaps, etc. Creams are moisturizing and are a good choice when you have dry or sensitive skin. Alcohol-based solutions or gels are best for people with very oily skin or people who live in a warm, humid place.

• Benzoyl peroxide. It fights the multiplication of bacteria Propionibacterium acnes and dries up the skin, which decreases inflammation in the follicles. In France, mention may be made of Cutacnyl ® Eclaran ® Effacne ® Pannogel ® Panoxyl ®…;
• Retinoids (derivatives of vitamin A). 0,025% or 0,05% tretinoin (Effederm ® Ketrel ® Locacid ® Retacnyl ®…), or adapalene (Differine ®) act more on the retention component of acne (blackheads, microcysts) and promote renewal skin cells. They unclog the hair follicles, allowing topical antibiotic treatment to enter them and fight the bacteria that have accumulated there;

Notes. To ensure the effectiveness of the treatment, these products should be used regularly for several weeks. At first, skin irritation may appear; it can lead to limiting the number of applications per week.

Mild acne (comedones and / or papules on less than half of the surface of the face)

Treatments applied to the skin

• Benzoyl peroxide.

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• Retinoids (derivatives of vitamin A).

In case of failure after 3 months of well-conducted treatment:

• Either an intensification of the previous treatment (change of molecule and / or increase in dosage and / or more frequent applications)
• Either an association
  • local retinoids (0,025% or 0,05% tretinoin or 0,1% adapalene) or azelaic acid (Skinoren ® 20% cream)

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• topical antibiotics: they stop or slow down the proliferation of bacteria, especiallyPropionibacterium acne and decrease inflammation. They are in the form of lotion, cream or gel. The most common are based on clindamycin (Dalacin T Topic ®, Zindacline ®…) or erythromycin (Eryacne ® Eryfluid ® Erythrogel ®…). Your doctor may prescribe a product that contains both benzoyl peroxide and an antibiotic, such as erythromycin.

• Either an association
  • local retinoids (0,025% or 0,05% tretinoin or 0,1% adapalene) or azelaic acid (Skinoren ® 20% cream)

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• oral antibiotics: the most commonly used are lymecycline and doxycycline (Doxy ® Granudoxy ® Spanor ® Tolexine ® Tetralysal ® Vibramycin ®…);

Medium acne (more than half of the facial surface has comedones and / or papules)

First-line treatment:

Treatments applied to the skin: Benzoyl peroxide and Retinoids.

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Oral antibiotic treatment

In case of failure after 3 months of well-conducted treatment 

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in the event of failure of the first-line treatment before 3 months in the event of significant scar risk

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in the event of a rapid recurrence:

Isotretinoin

Very severe acne (very inflammatory acne, affecting the whole face, with nodules)

• Isotretinoin (Contracne ®, Curacne ®, Procuta ®…) in first intention. This derivative of vitamin A is prescribed only in the most rebellious cases of inflammatory acne with nodules. It works by markedly reducing the size of the sebaceous glands, which decreases the production of sebum. It should be taken under close medical supervision because of its numerous and dangerous side effects.
• Skin cleansing (removal of retentional lesions by microsurgery consisting of incising comedones and lesions to empty them) may be proposed before the initiation of isotretinoin in order to reduce the risk of severe inflammatory outbreaks sometimes occurring at the start of treatment.
• For forms with a high retention component, isotretinoin should be started at a lower dose (0,2 to 0,3 mg / kg / day) in order to reduce the risks of acute and severe exacerbation (acne fulminans).

Contraception

Contraceptive treatment is often needed to treat acne in women. 1st and 2nd generation pills are recommended as a first-line treatment, especially those based on levonorgestrel.

Scars

The treatment of scars is a medical monitoring. Different techniques are used: dermabrasion, microdermabrasion, laser rays, pulsed light rays and local surgery.