Acne Treatment: Recommendations from the Ministry of Health of Malaysia

With tons of low quality self-help e-books out there on acne treatment, many people with acne are confused and over-whelmed with acne treatment information i.e. recommendations from Facebook friends, neighbours, emails etc.

In an effort to debunk the acne treatment myths, I would prefer to refer to experts recommendations and to examine the evidence provided by them. How do we know what is credible and what is B.S.? Check this out: how to search for credible health information in the internet.


Clinical Practice Guidelines (CPG) are developed by medical experts for the use of healthcare providers. The problem with a CPG is that it's too technical for a lay person. Therefore, we have extracted and summarised the acne treatment guidelines for the public so that you could take practical proven steps to clear your acne.
  • These clinical practice guidelines (CPG) are meant to be guides for healthcare providers, based on the best available evidence at the time of development. Every healthcare provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally… 
  • Acne is a common problem among adolescents and young adults. There are different beliefs as to what causes acne especially in a multiracial country with different cultural practices. As acne is a medical disease, medical treatment by healthcare providers is required. If left untreated, acne may have a profound psychological and emotional impact… 
  • The aim of these Clinical Practice Guidelines (CPG) is to provide an evidence based guidance for primary care physicians and other healthcare providers to identify the appropriate management of acne… 
  • Risk Factors for Acne: i. Smoking ii. Stress iii. Facial therapy or salon facial massage
Don’t worry, you didn’t get it wrong. Yes, salon facial massage is a risk factor. If you have acne and are going for regular facial, please stop.

  • Low glycaemic load diet significantly reduces total acne lesion count… 
  • The GI (Glycemic load) is a numerical system used to classify carbohydrate food based on the impact they produce on the postprandial blood glucose level. The higher the GI value of the food, the greater the blood glucose response.35 In general, most refined carbohydrate devoid of fibre is high in GI while intact carbohydrate (whole grains products), legumes, milk (and milk products), fruits and vegetables are low GI foods.



In conclusion, you should take more of those foods with Low Glycemic Load (Gl).
  • There is no acne occurrence among two non-western communities (Kavitan in Papua New Guinea and Ache in Paraguay) who consume non-western diet consisting of high fibre and low fat content with negligible added sugars… 
  • There is no conclusive statement on the effectiveness of zinc supplement in Acne. In addition, there is no retrievable evidence on the efficacy of vitamin A, vitamin C, vitamin E and omega-3 fatty acids in the management of acne. 
  • Antibiotic therapy has been the mainstay in the treatment of acne for many years. However prolonged usage may lead to antibiotic resistance resulting in treatment failure… 
  • Management of acne is based on acne severity and the predominant lesions (refer to Section 7.1 on Grading Acne Severity). Modalities of treatment consist of pharmacological and non-pharmacological measures. This is summarised in the algorithm on Management of Acne.

  

  • Topical therapy is the mainstay of treatment for mild acne. It is also useful for moderate acne where comedones are predominant. It plays an important role in induction of remission and maintenance phases of the treatment. 
  • There are a variety of preparations available. The commonly used agents are topical benzoyl peroxide (BPO), retinoids and antibiotics. Newer agents available are fixed combination preparations of these agents. 
  • Topical retinoids are to be avoided during pregnancy. 
  • Oral antibiotics have been widely used for moderate to severe acne vulgaris. 
  • Tetracycline has been widely used in the management of moderate to severe acne. It has antimicrobial and direct anti-inflammatory properties. However, its use is contraindicated in children aged less than eight, pregnancy and lactation. 
  • Oral tetracycline, doxycycline, minocycline or co-trimoxazole are contraindicated in pregnancy. 
  • Sulfonamide antibiotics have been reported to cause severe adverse drug reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. 
  • Oral antibiotics should not be prescribed continuously for more than six months. 
  • Oral tetracycline, oral doxycycline, oral erythromycin or oral minocycline may be used as treatment for moderate to severe acne. 
  • Isotretinoin is teratogenic. Strict contraceptive practice is required for female patients and isotretinoin should only be prescribed by dermatologists. 
  • The disadvantages of comedone extraction include incomplete extraction, tissue damage and recurrence. 
  • Phototherapy and photodynamic therapy may be used as an alternative therapeutic options for patients who fail or unable to tolerate other standard acne therapies. (Grade B recommendation) 
  • The grades of recommendation relate to the strength of the evidence on which the recommendation is based. Grade A is better than Grade B in terms of the strength of the evidence. 
  • Complementary and Alternative Medicines (including snake oil) are commonly used to treat acne vulgaris. However, there is insufficient evidence on these therapies. 
You could download the full acne treatment clinical practice guidelines here >
http://www.moh.gov.my/penerbitan/CPG2017/7190.pdf

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