Acne Treatment: Adult Acne

Acne Treatment : Adult Acne

Continued...

Non Prescription Therapy Options For Acne*

• Glycolic Acid (M.D. Forte)
  
• Oil-Absorbers (Clinac O.C.)
  
• Oil-Absorbing Therapeutic Masques (Cellex-C BetaPlex Clear Complexion Mask, Peter Thomas Roth Therapeutic Sulfur Masque, AHAVA Advanced Mud Masque for Oily Skin)
  
• Combination Products (Peter Thomas Roth BPO Gel 10% And Sulfur, M.D. Forte Glycare Perfection Gel)
  
• BPO (Peter Thomas Roth Medicated BPO 5% Acne Wash)
  
• Drying Agents/Keratolytics (Rezamid Acne Treatment Lotion)
  
• "scar" therapy
  
• discoloration therapy
  

*This list is not meant to be fully comprehensive. Some products may have been inadvertently left out of this list.

While there is no single perfect prescription item in the treatment of acne, I still find topical Azelex 20% Cream to be a personal favorite. This medication is great for treating small inflammatory papules and pustules, and also works well for folliculitis and "hair bumps". This product works well in conjunction with Retin A. It is applied twice daily (ideally morning and dinner time), while the Retin A is applied by itself at bedtime.

A few tips when treating acne.

• Blackheads require some form of prescription topical vitamin A product for best eradication.
  
  
• Cysts respond best to pill therapy.
  
  
• A corollary: If you’re under 13, nursing or pregnant, tetracycline based medications are off limits as they can permanently discolor the tooth enamel. If you really need oral medication, usually it’s limited to Erythromycin.
  
  
• Consistency of treatment is your best asset when trying to get results. Don’t pick, it can lead to scar formation.
  
  
• Allow at least 6-8 weeks for every new therapy to kick in before giving up on it.
  
  
• Don’t scrub your face or get facials if you’re acne prone. This simply traumatizes the glands and leads to further flare-ups.
  
  
• Keep your bangs off your forehead and your hands off your face. This deposits excess oils that can further clog pores.
  
  
• Avoid the use of heavy skin care products like cocoa butter, they will smother the skin and flare your acne.
  
  
• Don’t apply your acne creams/lotions, etc. heavily like a masque (unless it is one). There is no reason that your cream needs to be seen in order to work.
  
  
• Remove your make-up when you’re at home. Let your skin breathe!
  

Skin care for those who are acne prone can be enhanced by the use of high potency glycolic acids. "Medical grade" tends to be at least 8%, preferably about 15% and above. I have found the product line M.D. Forte, available only through physicians, to be great at removing excess oils and surface debris, thus unclogging pores. Used in conjunction with other topicals such as Azelex at the same time, it helps to draw the medication in deeper and become more effective.

Many times, patients will also have a great number of inflammatory papules and/or cystic lesions. In this case, oral medication is needed in addition to topical therapy for effective resolution. The tetracycline family is the most effective. Regular tetracycline (aka sumycin), is used in doses of 500mg twice daily. Minocin is a more aggressive member of this antibiotic family. It also is much more expensive. I save this for patients who show no response to tetracycline, or patients with mostly cystic acne. Doxycycline is similar to minocycline, however, I have not had nearly the response rate to this medication as I have to Minocin so I tend to avoid its use. Erythromycin is not nearly as effective for treating acne and tends to cause significant stomach upset. I save this for patients who are younger than 13 (tetracycline products will discolor dental enamel in this age bracket) or for patients who for some reason cannot take tetracycline. If you are on Erythromycin, take it on a full stomach you’ll be more likely to tolerate it.

Regardless of which antibiotic you might be on, here are some things to keep in mind. After you’ve cleared in let’s say 8 weeks, that doesn’t mean you suddenly go off the medication like you have had a sinus infection. If you do, odds are you are going to break out again. Once I have found the best mix of medications that clears a patient, I usually keep them on the same routine for another 3 months. At that time, assuming all is well, I will start to slowly wean them off their oral prescription antibiotics if at all possible. If there is a flare, I go back to the dose before that kept them clear. Some patients come off the meds altogether (this is rare), most are able to take the medicine less frequently (timing will vary with the patient) and a few won’t be able to decrease their dosage whatsoever.

Unfortunately, I still come across many first time acne patients who have very severe cystic acne. These are the grade 4 cystic acne patients for whom aggressive treatment is required right away. Accutane has been a blessing for these patients. Accutane is a drug to be taken seriously. It is the closest drug we have to an acne "cure", however, it can have potential side effects. For this reason it is not offered to patients with mild acne. Occasionally, I will have a patient with significant non-cystic acne unresponsive to accepted aggressive therapy who may be placed on Accutane. Pregnancy must be avoided while on Accutane as well as for 1 month after discontinuing the drug due to the risk of birth defects. It is important to understand that the medication does NOT affect ovaries, eggs or sperm. Only a developing fetus is at risk. Treatment is for only 5 months and has repeatedly shown great results. While on Accutane, blood work is done for screening, every 2 weeks for the first month of use and monthly for the final 4 months of use. This is to monitor potential problems with blood counts, liver and kidney function as well as monitor triglyceride levels that can skyrocket during Accutane use.

Two product candidates in the acne pipeline under study include topical versions of oral medications that have been used to treat cystic acne. Topical Accutane is being used in Canada and Europe. I have had some patients present who have been given "home made" forms of this product which consisted of their pharmacist poking holes in the Accutane capsule and mixing it into a cream base. So far they have reported all it did was locally irritate and dry the skin without helping clear the acne lesions. It remains unclear whether a consistent formulation marketed after FDA approval would be more beneficial. Another medication called Dapsone used to be prescribed for severe cystic acne before the availability of oral Accutane. Dapsone continues to be used in dermatology mainly in the treatment of certain blistering disorders. So far I have heard very little about early study results of its topical use for acne therapy.

Foot Loose and Oil-Free

Finally, it is necessary to avoid the use of routine skin care products that might exacerbate or cause acne. Typically dermatologists try to recommend oil free products right away to their acne patients. Another term for these items is non-comedogenic. Products such as M.D. Forte Advanced Hydrating Complex - Gel Formula, Peter Thomas Roth Ultra Lite Oil-Free Sunblock SPF 30 and Neova Purifying Facial Cleanser are often recommended as appropriate for acne prone patients without the concerns of causing further acne flares. It is important not to dry out your skin in your enthusiasm to try to clear your face. It is natural to want to repeatedly use a helpful item or try one that is quite strong to help speed up the healing process. But overly dry skin or red, irritated, inflamed skin is not meant to be the end point. There are some acne patients who have normally dry or sensitive skin despite the presence of acne. If you fall into this category, try keeping the use of drying items to a minimum. Rarely, some acne patients are unable to use any topical acne therapy as it is simply too irritating and the use of pills again becomes necessary.

Too many acne sufferers go untreated far too long. Acne can have a real impact on an individual’s self esteem. Dermatologists are specially trained to treat skin diseases including acne. We have so many effective therapies that weren’t available in the 70’s when I was growing up. I can’t emphasize enough that NO ONE needs to suffer from acne. If you have acne that doesn’t respond to over the counter treatment, please check with a board certified dermatologist in your area.

Adult Acne Treatment (back)

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

Audrey Kunin, M.D.
DERMA Doctor, Inc.

(Any topic discussed in the this newsletter is not intended as medical advice. If you have a medical concern, please check with your doctor.)

Article posted July 18, 2002.

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