Le principe de traitements médicamenteux de l’acné est de prendre en charge le problème à la base : réduire la séborrhée, supprimer la rétention sébacée et limiter la réaction inflammatoire.
Il existe des traitements à appliquer localement, des médicaments à prendre par voie orale. Il est préférable de consulter un médecin et d’éviter toute automédication.
Traitements locaux
Dérivés de la vitamine A – Rétinoïdes
Ils débouchent les follicules pileux, permettant au traitement antibiotique topique d’y entrer et de combattre les bactéries qui s’y sont accumulées. Ils sont contrindiqués chez la femme enceinte.
Peroxyde de benzoyle
Réduit très vite et très nettement le nombre de Propionibacterium acnes, la bactérie responsable. Ainsi, il a un effet anti-inflammatoire par réduction de ces bactéries et a essentiellement une action sur les lésions inflammatoires.
Antibiotiques topiques (érythromycine et clindamycine)
Ils ont une action anti-inflammatoire par réduction de la population bactérienne (le P. acnes).
Laser
Il traverse les couches de l’épiderme et atteint les glandes sébacées. Il peut ainsi favoriser l’élimination des bactéries et réduire le sébum. Cette technique est peu répandue.
La microchirurgie de l’acné
Communément appelée nettoyage de peau, cette microchirurgie a pour but l’expulsion du contenu des lésions rétentionnelles. Complément très utile des médicaments, elle permet, dans certaines formes d’acnés rétentionnelles, d’éviter certains cas de poussées inflammatoires. Dans la plupart des cas, elle ne doit pas être faite au tout début du traitement, il est préférable d’abord d’agir sur l’hyperkératose avec un traitement local d’au moins deux mois. Les points noirs seront alors ramollis, moins cohérents et donc plus faciles à extirper.
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Antibiothérapie orale
Leur action est surtout anti-inflammatoire. Les tétracyclines sont les plus utilisés mais en cas d’allergie, on utilise plus volontiers l’érythromycine. Le problème qui se pose avec l’utilisation des antibiotiques est la survenue de résistances. Il faut donc respecter la durée prescrite par le médecin (trois mois au minimum) ; reprendre le même antibiotique en cas de rechute ; préférer le peroxyde de benzoyle à l’antibiothérapie topique.
Isotrétinoïne orale
L’effet essentiel est sébosuppresseur, par réduction majeure du volume des glandes sébacées. L’Isotrétinoïne diminue également la rétention sébacée. Elle est contrindiquée chez la femme enceinte. Ce traitement entraîne de nombreux effets secondaires et nécessite un suivi et un contrôle rigoureux.
Hormonothérapie
Ce traitement est lié à une contraception orale adaptée et également au traitement d’une éventuelle hyperandrogénie. Il agit par une réduction des secrétions sébacées.
Gluconate de zinc
Il a une action anti-inflammatoire et peut constituer une alternative thérapeutique intéressante dans des acnés inflammatoires. L’amélioration apparaît après deux mois et porte uniquement sur la composante inflammatoire. Si au bout de deux mois de traitement il n’y a pas d’amélioration, le sujet est considéré comme non répondeur au gluconate de zinc.
Corticothérapie générale
Son effet anti-inflammatoire est utilisé dans le début de traitement de certaines formes d’acnés graves avant de passer aux traitements antiacnéiques à proprement parler.
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