Acne (cont.)
What are other things you can do for acne?
- Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups
or even foundation, as long at it is water-based or oil-free (which makes them noncomedogenic). There are many
quality products available.
- Facials: While not absolutely essential, steaming and "deep-cleaning" pores
is useful, both alone and in addition to medical treatment, especially for
people with "whiteheads" or "blackheads." Having these pores unclogged by a
professional also reduces the temptation to do it yourself.
- Pore strips: Pharmacies now carry, under a variety of
brand names, strips which you put on your nose, forehead, chin, etc., to "pull out"
oil from your pores. These are, in effect, a do-it-yourself facial. They are
inexpensive, safe, and work reasonably well if used properly.
- Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.
What is a good basic skin regimen?
These are all good basic skin regimens that may help with the acne battle:
- Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for
those who are allergic to benzoyl peroxide is 2% salicylic acid.
- Apply a gel or cream containing 5% benzoyl peroxide; an alternative is
sulfur or resorcinol.
- At night, apply a spot cream containing sulfur to the affected areas.
- Use a light skin moisturizer and oil-free makeup.
What can the doctor do for acne?
If you haven't been able to control your acne adequately, you may want to
consult a primary-care physician or dermatologist. Here are some of the things
they can assist with:
- Topical (externally applied) antibiotics and
antibacterials: These include
erythromycin,
clindamycin (Benzaclin, Duac),
sulfacetamide (Klaron), and
azelaic acid (Azelex).
- Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become
milder and gentler while still maintaining its effectiveness. Newer retinoids
include adapalene (Differin) and
tazarotene (Tazorac). These
medications are especially
helpful for unclogging pores. Side effects may include irritation and
a mild
increase in sensitivity to the sun. With proper sun protection, however, they can
be used even during sunny periods. In December 2008 the U.S. FDA approved the combination medication known as combination preparation, known as Epiduo gel, which contains the retinoid adapalene along with the antibacterial cleanser benzoyl peroxide. This once-daily prescription treatment was approved for use in patients 12 years of age and older.
- Oral antibiotics: Most doctors start treatment
with tetracycline or one of the related "cyclines," such as
doxycycline and
minocycline. Other oral antibiotics that are useful for treating acne are
cefadroxil,
amoxicillin, and
the sulfa drugs.
- Problems with these drugs can include allergic reactions (especially
sulfa), gastrointestinal upset,
and increased sun sensitivity. Doxycycline, in particular, is generally safe but
can sometime cause esophagitis (irritation of the esophagus, producing
discomfort when swallowing) and an increased tendency to sunburn.
- Despite many people's concerns about using oral
antibiotics for several months or longer, such use does not "weaken the immune
system" and make them
more susceptible to infections or unable to use other antibiotics when
necessary.
- Recently published reports that long-term antibiotic use
may increase the risk of breast cancer will require further study, but at present
they are not
substantiated. In general, doctors prescribe oral antibiotic therapy for acne
only when necessary and for as short a time as possible.
- Oral contraceptives:
Oral contraceptives, which
are low in estrogen to
promote safety, have little effect on acne one way or the other. Some
contraceptive pills have been to shown to have modest effectiveness in treating
acne. Those FDA-approved for treating acne are Estrostep, Ortho Tri-Cyclen, and Yaz. Most dermatologists work together with primary physicians or gynecologists when recommending these medications.
- Spironolocatone: This drug blocks androgen (hormone) receptors. It can cause breast tenderness, menstrual irregularities, and increased potassium levels in the bloodstream. It can help some women with resistant acne, however, and is generally well-tolerated in the young women who need it.
- Cortisone injections: To make large pimples and cysts flatten out fast,
doctors inject them with a form of cortisone.
- Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) Isotretinoin is an excellent treatment for severe, resistant acne and has been used on millions of patients since it was introduced in Europe in 1971 and in the U.S. in 1982. It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. Those with milder forms of acne often relapse shortly after finishing a course of isotretinoin, making this drug less useful in such cases. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."
- Used properly, isotretinoin is safe and produces few
side effects beyond dry lips and occasional muscle aches. This drug is
prescribed for five to six months. Fasting blood tests are monitored monthly to check
liver function and the level
of triglycerides, relatives of
cholesterol which often rise a bit during
treatment, but rarely to the point where treatment has to be modified or
stopped.
- Even though isotretinoin does not remain the body after therapy is stopped,
improvement is often long-lasting. It is safe to take two or three courses of
the drug if unresponsive acne makes a comeback. It is, however, best to wait at
least several months and to try other methods before using isotretinoin again.
- Isotretinoin has a high risk of inducing
birth defects
if taken by pregnant women. Women of childbearing age who take isotretinoin need
two negative pregnancy tests (blood or urine) before starting the drug, monthly
tests while they take it, and another after they are done. Those who are
sexually active must use two forms of contraception, one of which is usually the
oral contraceptive pill. Isotretinoin leaves the body completely when treatment is
done; women must be sure to avoid pregnancy for one month after therapy is
stopped. There is, however, no risk to childbearing after that time.
- Another concern, much discussed in the popular press,
is the risk of depression and
suicide in patients taking isotretinoin.
Government
oversight has resulted in a highly publicized and very burdensome national
registration system for those taking the drug. This has reinforced concerns in many patients and their
families have that isotretinoin is dangerous. In fact, large-scale studies so
far have
shown no increased risk for depression and suicide in those taking isotretinoin
compared with the general population. Although it is important for those taking
this drug to report mood changes (or any other symptoms) to their doctors, even
patients who are being treated for depression are not barred from taking
isotretinoin, whose striking success often improves the mood and outlook of
patients who have suffered and been scarred by acne for years.
- Laser treatments: Recent years have brought reports of success in treating
acne using lasers and similar devices, alone or in conjunction with
photosensitizing dyes. It appears that these treatments are safe and can be effective, but it is not clear that their success is lasting. At this point, laser treatment of acne is best thought of as an adjunct to conventional therapy, rather than as a substitute.
- Chemical peels: Whether the superficial peels (like glycolic acid)
performed by estheticians or deeper ones performed in the doctor's office, chemical
peels are of modest, supportive benefit only, and in general, they do not substitute
for regular therapy.
- Treatment of scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed scars and laser resurfacing to smooth out shallow scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and they may need to be repeated
three or more times. These treatments can help, but they are never completely successful at eliminating scars.
Next: How
would you sum up current-day treatment of acne? »
- doxycycline, Vibramycin, Oracea, Adoxa, Atridox and Others - Learn more about Doxycycline, including a description, generic and brand names, drug class and mechanism, preparations, storage, reasons for prescription, dosing, drug interactions, effect on pregnancy and nursing mothers, and common side effects.
- Photodynamic Therapy - Read about photodynamic therapy (PDT). PDT uses a photosensitizing agent and light source to treat cancers (skin, lung, esophageal, Barrett's esophagus), acne and rosacea.
- Boils - Learn about boils (skin abscess), localized infections deep within the skin that begins as a reddened, sore area. Eventually, the area hardens and fills with pus. Boils may be caused by ingrown hairs, clogged sweat glands, or foreign material that becomes imbedded in the skin. Treatment typically involves heat application, draining the boil, and antibiotics to eliminate bacterial infection.
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