The Complete Guide to Acne Prevention, Treatment and Remedies! by Pamela Archer - HTML preview

Part-VII: Treatment of Acne

40. Acne Treatment

The treatment of acne depends on the severity of it. With mild acne, home care - including proper diet along with nonprescription products – is often successful in controlling the disease. In more severe cases, it is essential to seek the help of a qualified health care practitioner. The following table shows some of the medical options used to treat acne, according to the severity of the case:

- Benzoyl peroxide

Mild acne

- Azelaic acid

- Topical Retinoids

- Antibiotics

Moderate acne

- Hormonal treatment

- Isotretinoin

Severe acne

- Surgery

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41. Treatment of Mild Acne

Mild acne can often be successfully treated with over-the-counter products such as mild washes, soaps, lotions and gels. Other mild medications include –

1. Benzoyl peroxide

Benzoyl peroxide is an extremely mild topical medication, and is used commonly to treat acne.

Studies have proven that it is safe for adults and children as well as pregnant women.

The properties that make benzoyl peroxide useful in treating the condition are –

It is an antiseptic: The product acts on the skin surface, reducing the number of bacteria and yeasts. It has the edge on antibiotics in that it doesn’t cause bacterial resistance to develop. It may actually reverse any resistance built up due to prior medications.

Acts as an oxidizing agent: Benzoyl peroxide is comedolytic; it reduces the number of comedones on the skin’s surface.

1 It is an anti-inflammatory

Benzoyl peroxide is available as a non-prescription product in the form of creams or gels. It can be combined with other topical drugs as well.

Possible problems with benzoyl peroxide products:

1 Mild skin irritation, including redness, dryness, and itching of treated area.

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2. Azelaic acid

Azelaic acid is found naturally, as the by-product of the yeast ( Pityrosporum ovale) living on healthy skin. It is available as a non-prescription drug, either as a gel or as a cream. It is applied directly to the skin, and it acts by exfoliating dead cells from the skin, thus preventing the clogging of pores.

3. Topical Retinoids

Retin-A (Tretinoin): This is a derivative of vitamin A. It helps by reducing inflammation, fighting bacteria and opening blocked pores. It comes in the form of a cream or a gel, and is applied directly to the affected area.

Caution: Retin-A (Tretinoin) can cause peeling of the skin, causing photosensitivity, irritation and redness.

Adapalene: This is a topical retinoid closely related to Retin-A. However, it is much milder than Retin-A and may cause less skin irritation.

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42. Treatment of Moderate Acne

If acne does not improve with home care (proper hygiene, diet, sleep, exercise and mild topical medication), the patient should seek medical help. In moderate acne, oral antibiotics, topical antibiotics and hormonal therapies are the three most commonly prescribed treatments.

1. Antibiotics

Antibiotics are anti-inflammatory in action. They act on the skin by reducing the number of bacteria in the hair follicles and on the skin surface.

Topical antibiotics

The most commonly prescribed topical antibiotics are -

1 Erythromycin

2 Clindamycin

Side effects of Topical Antibiotics

1 Contact dermatitis

2 Mild irritation of the skin

3 Dryness in and around the area treated

Bacterial resistance due to infrequent use of antibiotics. To lessen resistance, the antibiotic should be applied twice a day, and may be combined with benzoyl peroxide, subject to the advice of your medical professional.

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Oral antibiotics

The oral antibiotics most commonly prescribed for acne include -

1 Tetracycline

2 Erythromycin

Side effects

1 The patient can be allergic to the antibiotics in rare cases.

2 Photosensitivity can occur.

3 Nausea, diarrhea and gastrointestinal irritation

4 Women can get vaginal thrush/yeast infection.

5 One of the most severe side-effects of antibiotics is bacterial resistance 2. Hormonal Therapies

Androgenic, or male hormones such as testosterone, affect the sebaceous follicles and stimulate them to produce excessive sebum. Hormonal therapy is aimed at blocking the effect of androgens. This therapy is an option for women whose acne does not respond to other medication.

The options available in hormonal therapy are –

• Estrogen: Estrogen is the female hormone. Estrogen may counter the effects of androgens and hence decrease sebum production. Sometimes, doctors prescribe estrogen Copyright © 2006 All rights reserved

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alone. Then, the patient should be closely monitored throughout the treatment period, as estrogen can affect the physiology of the body in various ways.

• Estrogen-containing oral contraceptives: Oral contraceptives that have estrogen as one of their constituent hormones are the most commonly prescribed. They do not have as many side effects as estrogen alone, because the other hormones in the contraceptives balance its effects. However, women still need to be monitored for possible side effects such as menstrual spotting, tenderness in breasts and weight gain.

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43. Treatment of Severe Acne

If there are more than ten lesions on any single part of your body, your acne is considered to be severe. The options to treat severe acne include the use of isotretinoin, accutane and surgery.

1. Isotretinoin

Isotretinoin is a retinoid derived from vitamin-A, and is extremely effective in treating severe acne. It helps to normalize exfoliation of skin cells in hair follicles affected by acne. It is a very potent drug, and patients taking it should be constantly monitored for side effects. Patients should ask their dermatologists about the medicine before beginning treatment. They should also know that only 50% of patients are completely cured by this drug. Many people experience relapses after a few years. In such a case, the same treatment needs to be done once more.

Isotretinoin may be useful in the following conditions –

1 Acne fulminans

2 Acne conglobata

3 Severe acne vulgaris

4 Recurring acne

5 Nodular acne

6 Acne which results in scarring

7 When the acne has a severe psycho-social affect on the patient’s life

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Properties of isotretinoin

1 Isotretinoin shrinks the sebaceous glands, thereby reducing sebum production.

2 It is an anti-inflammatory

3 It inhibits the growth of bacteria as it keeps the skin dry

4 It removes comedones and prevents the formation of new ones.

Side Effects and Precautions

Isotretinoin is a strong drug, and has several side affects. Some of these are: 1 It makes the acne flare-up before it starts to heal

2 All patients get dry and cracked lips

3 Dry, sore and red eyes

4 Risk of conjunctivitis

5 Dry and itchy skin

6 Nosebleeds in some people

7 Mild headaches occur in a percentage of people.

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8 Severe headaches and blurred vision occur rarely, but if they do, the patient should contact the dermatologist immediately.

9 Heavier and irregular menstrual periods

Some important precautions to be kept in mind are:

• Isotretinoin should not be taken with tetracyclines.

• Isotretinoin should not be taken with Vitamin-A.

• Pregnant and lactating mothers must not take this drug.

Monitoring the Patients

Patients taking isotretinoin need to be constantly monitored. Some of the tests they should undergo often are -

1 Blood tests to check for triglycerides and cholesterol levels

2 Total blood count

3 Pregnancy test

4 Liver function tests

2. Accutane

Accutane is an extremely potent form of isotretinoin, and is used only for very severe acne. It works by reducing the number of bacteria on the surface of the skin, reducing the level of sebum Copyright © 2006 All rights reserved

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and unclogging blocked pores. However, it has strong side effects such as behavioral changes and severe depression.

Women trying to start a family, already pregnant or lactating should not take accutane.

3. Corticosteroids

These are very powerful anti-inflammation drugs used to treat severe acne. When given in low doses, they help to stop the excessive secretion of androgens. However, corticosteroids can trigger steroid acne when used for a long time. So, they should not be taken over a long period.

4. Surgery

Surgery is required in cases of acne that does not respond well to other treatment, and in cases of severe scarring. The various surgical options include –

Comedo extraction: When comedones have not responded to any treatment, a dermatologist can extract them surgically.

Ultraviolet light therapy: This therapy is used more as a cosmetic treatment than a cure.

Ultraviolet light merely helps tan the skin, thereby masking some scars. However, tanning may increase the risk of skin disorders. If your dermatologist recommends this course of action, and you are concerned about the risk, let him/her know.

Chemical Peels: This therapy is used by a dermatologist to decrease the number of papules and to remove blackheads by applying chemical peels containing glycolic acid.

Dermabrasion for acne: Dermabrasion is used to smooth out scars near the surface of the skin.

The procedure is carried out as follows:

1 The affected skin is numbed

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2 It is then frozen by applying either liquid nitrogen or Freon

3 This skin is then removed carefully

4 The skin bleeds during the procedure, so the affected skin is bandaged after the treatment

The effects of the procedure can be seen after a week, when the skin starts looking smooth and shiny. However, dermabrasion can lead to discoloration of the skin. To prevent this, patients should avoid going out in the sun for at least 2 months after the treatment has been performed.

Collagen injections and gelatin implants for acne: Collagen injections and gelatin implants are commonly used to treat acne scars. They are injected directly into the scars, and help to smooth out the skin in the scarred area by raising the level of skin underneath the scar. The side effects of this therapy are few and not very serious. Injections may cause itching, redness and swelling of skin. The skin under the scar might harden due to gelatin implants.

Cryotherapy for acne: In Cryotherapy, dermatologists apply solid carbon dioxide or liquid nitrogen to bring down the temperature of a person’s skin. This causes the outer layer of the skin to peel away, which removes the comedones as well. Cryotherapy has few side effects, which include redness, itching and stinging of the skin.

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44. The Powerful Effects of Accutane

-The Risky Miracle Drug

What is Accutane?

Accutane is a member of the family of drugs called retinoids, Accutane is the most potent and effective drug available for treating acne at the time of writing. With its main, or active, ingredient being Isotretinoin, a single course of the drug can clear severe acne permanently. The other side of the coin is that, along with its powerful healing potential, the drug can cause severe side effects.

The U.S.A. Food and Drug Administration has categorized it as a ‘high-risk’ drug, and allows its usage only in cases of ‘severe, recalcitrant, nodular acne’ – acne which is resistant to other drugs.

The medication guide on Accutane is to make you aware of the adverse effects of the drug.

However, it does not take the place of your physician. Before you start to take the drug, consult in detail with him or her about the side-effects you might experience, as well as its possible benefits to you.

Here are some of the many side effects that Accutane can cause.

1. Risks during Pregnancy and Lactation

Accutane is a teratogenic drug, i.e. it can cause severe birth defects in babies born to mothers who take Accutane before or during pregnancy. It is thereby a ‘Category X’ drug, one that must be avoided during pregnancy as well as lactation. Here are the various ways in which accutane can affect unborn babies -

1 There is a high risk of miscarriage

2 The baby could be stillborn at birth

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3 It may be born prematurely

4 If born, the baby could have severe deformities. These include facial deformities, heart defects, mental retardation, an abnormally small head (microcephaly) and enlargement of fluid-filled spaces of the brain (hydrocephaly).

It is important that women do not become pregnant while being treated with accutane. If you are taking accutane, you should ensure that you do not conceive beginning from 1-month before the start and 1-month after completion of the course.

As a precaution, you should use at least two different forms of contraception. However, if despite taking these precautions, you miss a period or get pregnant, stop taking Accutane immediately and consult your doctor.

To ensure that such a situation is avoided, doctors do not prescribe the drug without prior confirmation of two negative pregnancy tests. Once prescribed, they will conduct routine tests to rule out pregnancy.

2. Psychiatric Distress

Accutane can cause serious psychiatric problems in some people. These can range from depression or psychosis to suicidal thoughts. If you experience any abnormal symptoms after beginning the medicine, consult your doctor immediately. These symptoms may include; 1 Low energy

2 Trouble concentrating

3 Becoming more temperamental than before (i.e. easily irritated, aggressive or angry) 4 Trouble sleeping

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5 Sleeping for longer periods than before

6 Feeling sad and having bouts of crying

7 Loss of interest in hobbies or work

8 Loss of interest in meeting or being with family and friends

9 A sudden change in body weight or appetite

10 Feelings of guilt, worthlessness

11 Suicidal thoughts

Caution: Merely stopping the course of Accutane does not resolve the psychiatric problem.

Patients should seek help from a counselor or a psychiatrist to alleviate their problem.

3. Abdominal Problems

Some patients may experience abdominal distress, which may be a symptom of damage to the internal organs (i.e. the pancreas, liver, intestines and the esophagus). Some symptoms of abdominal problems include -

1 Diarrhea

2 Dark urine

3 Pain in the chest, stomach or bowels

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4 Heartburn

5 Pain while swallowing

6 Rectal bleeding

If you notice any of the symptoms mentioned above, stop taking Accutane and call your doctor immediately. Do not delay in stopping the drug, as damage to the organs can become permanent.

4. Effects on the Bones and Muscles

Accutane can cause bone and muscle ache and, in severe cases, can cause damage as well. If you experience pain or weakness in your muscles and joints, a broken bone without apparent reason, or slow recovery of a broken bone, stop taking Accutane and consult with your doctor immediately.

5. Brain Problems

Accutane can affect the brain by increasing the level of pressure in it. The signs of increased brain pressure include -

1 Dizziness

2 Nausea

3 Headaches

4 Difficulty focusing (blurred vision)

5 Seizures

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If you get any of these symptoms, stop taking Accutane immediately. Failure to do so may let the problem progress, which can lead to loss of eyesight and, in extremely severe cases, even death.

6. Problems with Vision

Symptoms include -

1 Dryness of eyes

2 Pain in eyes

3 Problems seeing in the dark (night blindness)

If you get any of these symptoms, stop taking Accutane and consult your doctor.

7. Effects on Hearing

Accutane can cause hearing loss in a few people. If you notice symptoms such as a ringing in the ear, problems hearing or consistent worsening of hearing, consult your doctor immediately.

8. Effects on Lipid Levels

Accutane can lead to higher than normal levels of cholesterol and other lipids in the bloodstream.

As serious as this problem is, it usually subsides once the treatment is over. However, you should have regular checkups to monitor the lipid levels in your blood.

9. Allergies

Some people are allergic to accutane. While many of these allergies are mild, some are extremely severe and require emergency aid. Here are some symptoms of allergies.

Symptoms requiring immediate medical attention:

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1 Swelling in face or mouth

2 Hives

3 Breathing difficulties

Symptoms for which you should consult your doctor:

1 Fever

2 Rashes

3 Bruises on the legs

10. Blood Sugar Problems

Accutane can cause serious problems in the blood sugar level. If you get any of the following symptoms, tell your doctor immediately -

1 Excessive thirst

2 Frequent urination

Symptoms of other Serious Problems

1 Fainting episodes

2 Shortness of breath

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3 Generally feeling unwell

4 Convulsions

5 Speech problems

6 Difficulty moving

Some less Serious Side-Effects

1 Dry skin

2 Dryness of eyes and nose

3 Bleeding from the nose

4 Chapped lips

5 Initial worsening of acne (however, people should continue taking the drug as prescribed by their doctor)

6 Difficulty wearing contact lenses due to dryness of eyes

This is not a comprehensive list, but these are some of the more important side effects of Accutane. Keep a look out for any symptoms other than the ones mentioned here, and report them to your physician immediately.

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Precautions for Patients

Patients taking Accutane should not -

1 Get pregnant

2 Breast-feed

3 Take supplements containing Vitamin A

4 Donate blood

5 Expose themselves to sunlight and ultraviolet light

6 Take birth control pills that do not contain estrogen

7 Get cosmetic skin-smoothing procedures such as waxing (avoid these procedures for at least six to seven months after completion of the course.)

The Treatment Procedure

One course of Accutane lasts for five months. A single course is usually sufficient to clear up the acne permanently, though some people require more than one. You should adhere to these guidelines while taking Accutane:

1 Discuss your family history with the doctor. Include all information, including psychiatric or physical problems, allergic reactions and asthma, etc.

2 Once prescribed the drug, ensure that your prescription has a yellow label on it. The chemist will not give you the medicine without such a sticker.

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3 Only take the dosage prescribed by your doctor.

4 If you miss a dose, do not take a double one the next time.

5 Go for complete, regular checkups to monitor any changes and rule out serious symptoms.

6 Get a pregnancy test every month.

7 Discuss if you are taking other drugs (allopathic as well as herbal). Discuss in advance, whether you are or will be using corticosteroids or anticonvulsants during the treatment, as these can cause the bones to get brittle. One drug to avoid is ‘St. John’s Wort’, as it lowers the efficiency levels of some birth control pills.

8 Do not take antibiotics, as some can combine with Accutane to increase brain pressure.

9 Finally, and most importantly, do not give Accutane to people to whom it has not been prescribed.

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45. Budget Friendly Home Remedies for Acne

Try these inexpensive home remedies to reduce your acne:

1 Clean your face thoroughly with saltwater and put cotton balls soaked in vinegar on your acne.

2 Apply egg whites around your acne for around twenty minutes.

3 Apply a few drops of tea tree oil directly to your acne. You may find positive effects with a month of regular usage.

4 Mix a teaspoon of fresh limejuice and groundnut oil. Apply this mixture to the acne.

Similarly, apply paste of fenugreek leaves on a clean face at night and wash off after fifteen minutes with warm water to reduce occurrence of acne.

5 Raw papaya juice, including the juice of its seeds and skin, can be a powerful help for swollen acne.

6 Apply pulp of ripe tomatoes on acne and wash off within an hour.

7 Apply a paste of cinnamon powder (one teaspoon) and three teaspoons of honey on your acne before going to bed at night and wash with warm water next morning. You may be free of acne within two weeks.

8 Applying fresh garlic (an antibiotic) to acne may do the trick.

9 Apply paste containing equal portions of lemon juice and cinnamon powder as a remedy for acne.

10 Cooked and cooled oatmeal relieves acne.

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11 Apply a paste of ground nutmeg and milk and acne may disappear without scars.

12 Apply a thin layer of Milk of Magnesia on your acne and wash with warm water for quick relief from acne.

13 Apply a paste of orange peel on and around acne for quick relief.

14 Turmeric paste on acne may help.

15 Dilute lavender oil with rose wate