There are many prescription medicines to control moderate to serious acne. Some are topical (applied to the skin surface); others are taken orally, as pills, or subcutaneously (under the skin), as shots. All necessitate at least one visit to a dermatologist, a physician who specializes in skin problems. While your general physician can and may prescribe these medications and treatments, it is recommended that you see a specialist (dermatologist). Fortunately, the majority of these treatments have pros and cons that are comparatively simple to delineate.
Isotretinoin (Accutane)
Accutane is a synthetic Vitamin A derivative that creates potentially long-lasting change in the cells lining the pore. This allows cells to slough off naturally without clumping and clogging the pore - the first step in the development of acne. The quantity of oil produced is decreased, as Accutane temporarily regulates the oil gland to produce less.
Accutane has been the most important drug to date in the arsenal of prescription medication to treat severe and persistent nodular, cystic acne. It has provided dramatic improvement to millions who have been treated with it. More than half of patients treated respond satisfactorily with one course of Accutane; after a second course, only 10% failed to permanently respond. If you have severe acne that has not responded to other treatments, your dermatologist may advise that you are a candidate for a 5- to 6-month course of Accutane.
One of the advantages of Accutane is that its benefits may last years, and in some cases are permanent. In the last decade, however, it has been linked to serious side effects, such as depression and suicidal thoughts. If you are taking Accutane, or have a teenager taking it, you need to be hyperaware of these side effects. Other severe, but rare, side effects include nosebleeds and joint and muscle soreness. Another downside is that it causes drying of the skin, and not just facial skin. However, severe side effects are rare, and most patients who take Accutane suffer only from dry skin and chapped lips.
If your dermatologist has recommended Accutane, don't be afraid to ask questions about its side effects. The dermatology medical community is well aware of the pros and cons and they are prepared to answer questions about it.
Oral Antibiotics
Acne is caused, in part, by a bacteria (Propionibacterium acnes). Oral antibiotics work by removing this bacteria and decreasing inflammation. One of the growing problems, however, is that overprescription of antibiotics is leading to a growing resistance of bacteria to these drugs, and antibiotics should be used only under the direction of a physician, and only as directed by that physician. Do not "borrow" other people's leftover antibiotics or buy them online.
Typically, the first antibiotic a physician will prescribe is tetracycline. It's a broad-spectrum antibiotic and is very inexpensive. Tetracycline has been prescribed for decades to reduce acne inflammation. It is easy to tolerate, with few side effects. Erythromycin is also frequently prescribed; however, it has been so ove prescribed for a variety of conditions that 50% of people are resistant to it. Both have value for moderate to severe acne, because of their anti-inflammatory potential. Side effects include primarily intestinal upset, sun sensitivity and discolored teeth. Patients will be advised to avoid unnecessary exposure to sun and to use sunscreen for necessary exposure, and to take the antibiotic with food. If you are pregnant or suspect you may be pregnant or actively trying to get pregnant, you should consult your obstetrician before taking any medication, as these antibiotics are contraindicated for women who are pregnant.
Clindamycin is a second-line antibiotic used in treatment of acne, but can cause reactions such as serious skin allergies and bone marrow suppression, as well as the digestive tract upset and possible colitis.
Your dermatologist will typically prescribe antibiotics for a course of one to six months, with regular followups to check progress. Oral antibiotics may also be used in conjunction with topical treatments.
Topical Treatments
A few topical antibiotics can attack the Propionibacterium acnes bacteria directly through the surface of the skin. They are typically employed to address less serious cases of acne. They may even be utilized in cases of acne vulgaris, a mild form of acne.
Benzoyl peroxide is probable one of the most popular over-the-counter acne treatments, because it attacks the P. acnes bacteria very effectively. There is also evidence that it may penetrate the oil in the plug, control excess sebum production and less skin inflammation. Benzoyl peroxide has been used for over 40 years, without any evidence that the P. acnes bacteria has developed any resistance to it. If you use it and it works, it will continue to work because the bacteria cannot become immune to it. If you are trying benzoyl peroxide for the first time, buy the lowest-strength (2.5%); only progress to stronger compositions if the lowest strength doesn't appear to work, but give it at least 2 weeks.
Topical antibiotics, such as clindamycin, erythromycin and sodium sulfacetamide, remove bacteria. However, topical erythromycin loses effectiveness within a few months, because bacterial resistance develops quickly. Clindamycin is a favorite topical antibiotic, but it also is showing more and more bacterial resistance.
Benzoyl peroxide and erythryomycin (benzamycin), and benzoyl peroxide and clindamycin (Benzaclin or Duac) are formulas combining an antibiotic with benzoyl peroxide; they may work better than either medication used alone.
Retinoids are another topical treatment in the acne treatment arsenal. These stop the formation of microcomedones, the precursors of pimples. The brand name most people are probably familiar with is Retin-A. All retnoids cause dryness, redness, chapping, irritation, flaking, and sometimes an initial worsening of acne. In the first months of treatment, acne impurities are brought to the surface and these will cause a flare. However, it improves over the next three to four months.
Anyone who has attempted over-the-counter medications or treatments and not experienced acceptable results has numerous additional alternatives. Almost all acne can be treated medically with success.
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