Prescription acne medication

Acne Vulgaris is associated with hormonal changes typical to adolescence and early adulthood due to increase levels of testosterone hormone levels typical  to teens and young adults of both genders. Acne is an infection of the sebaceous glands and hair follicles on skin surface. It typically affects the surface of the face, back, armpits, neck or other sweaty areas.  Acne can have several levels of severity in terms of surface size of affected skin, type of breakout and depth of lesions.  If an acne cyst becomes severely inflamed, there is a good chance that it will rupture and scarring may result. Prescription acne medication can be very helpful in the prevention of acne breakouts and with treatment of existing acne to avoid scaring and shorten acne breakout duration. Acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection, reducing the inflammation or doing all the above. With most prescription acne medications, improvement may appear only four to eight weeks after treatment begins, and at times the skin condition may get worse before it gets better. Prescription oral acne medication should be avoided during pregnancy especially during the first trimester.

The American Association of Dermatologists (AAD) publishes useful guidelines and information for treating severe acne. This includes useful information regarding possible side effects and wise words of cautiousness and things that are good to know about these available acne treatments.

Prescription acne medication can be divided into:

• Topical – creams and lotions applied to the skin –  may be prescribed for mild to severe acne.
• Oral prescription acne medication – (Systemic – works internally through the full body) prescribed to treat severe acne and may be used for moderate cases too.  It is very important that patients treated with oral prescription acne medication be in constant medical supervision as side effects can be harmful if left undiagnosed.

Topical prescription acne medication

If acne doesn’t respond to Over the Counter (OTC) topical treatments such as Benzyl Peroxide meant to dry up the oil, kill bacteria and promote sloughing of dead skin cells, a doctor or dermatologist can prescribe a stronger lotion.

There are two main types of topical prescription acne medications:

1. Topical products derived from vitamin A – work by promoting cell turnover and preventing plugging of the hair follicles.

Topical Retinoids are a common derivative of vitamin A used in topical prescription acne treatment. Retinoids work by unclogging  pores and preventing whiteheads and blackheads from forming as they increase oxygenation in treatment area hence preventing growth of the P. acne that thrives in an anaerobic environment ( without oxygen) . Topical retinoids can cause skin irritation, in addition, increased sun sensitivity of the skin is another common side effect. It is important to use sun protection and follow the dermatologist’s directions to maximize effectiveness. Topical retinoids currently prescribed for acne treatment in the United States include: Tretinoin, Adapalene, and Tazarotene. When using Tazarotene it is extremely important to combine treatment with a secure contraceptive regimen as it is known to cause skeletal birth defects.

1. Topical antibiotics – work by killing excess P.acnes bacteria on the skin, hence preventing acne bacterial infections.

In most cases, a combination of both topical types is required for optimal results. A number of benzoyl peroxide, an OTC topical, combined with prescribed antibiotic medication are available, including different dose combinations of benzoyl peroxide and clindamycin (Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin (Benzamycin). Some side effects of topical treatments include: stinging, burning, redness or peeling. A dermatologist can assist with reduction of these side effects by using a short application duration gradually increasing the dose or switching to another medication.

Oral prescription acne medication

Oral prescription acne medication can be classified as:

• Oral antibiotics
• Oral contraceptives
• Isotretinoin (Accutane)- Oral retinoid.

Oral Antibiotics
Oral antibiotics are prescribed for patients with moderate to severe and persistent acne. They work by reducing the P. acnes bacteria population, hence, decreasing inflammation. Treatment dosage with oral antibiotics varies; usually the dosage is reduced as acne conditions improve. In most cases, antibiotics are prescribed for a duration of about six months or less. When using oral antibiotics the P. acnes bacteria might become resistant to the specific antibiotic medication. If resistance occurs, an alternative antibiotic or alternative treatment should be prescribed. Some research has demonstrated that combining topical treatment using Benzyl Peroxide along with oral antibiotics, reduces the incidents of resistance to the antibiotic drug. Oral antibiotics may cause some common side effects, these include: upset stomach, dizziness or skin discoloration. These drugs also increase the skin’s sensitivity to the sun and may also reduce the effectiveness of oral contraceptives. According to a report on the AAD web site most common oral antibiotics used for treatment of acne in the United States include:

• Erythromycin. This antibiotic is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.
• Tetracycline and its derivatives. Tetracycline reduces the inflammatory lesions of acne. Tetracycline should not be taken by pregnant or breast feeding woman as it can affect the development of the child’s bones and teeth, causing skeletal defects. Long-term, low-dose tetracycline therapy may be continued for many months to suppress acne. Higher doses may be prescribed for very severe acne.

Two available synthetic derivatives of tetracycline are doxycycline and minocycline. Doxycycline is especially effective in treating inflammatory acne. It can cause sun sensitivity in some patients. Minocyline is often effective in treating acne that has not responded to other oral antibiotics. Minocycline also seems to produce fewer incidents of antibiotic resistance.

Oral Contraceptives.

Oral contraceptives are a treatment option for the improvement of acne in women. Commonly used oral contraceptives for treatment of acne include a combination of Norgestimate (progesterone hormone) and Ethinylestradiol (Estrogen commonly used in medications) Common names of these medications include Ortho-Cyclen, Ortho Tri-Cycle. Side effects common to contraceptives include: headaches, breast tenderness, nausea and depression. The most serious potential adverse effect of these medications is a slightly increased risk of heart disease, high blood pressure and blood clots.

Isotretinoin (Accutane)

In sever acne cases, when antibiotics are not effective, for example in cases of deep cysts, Isotretinoin (Accutane) which is an oral retinoid drug. Isotretinoin is a powerful prescription acne medication reserved as a last resort option.  Isotretinoin/Accutane is very effective, but people who take it need close supervision by a dermatologist because of the possibility of severe side effects. It is associated with severe birth defects, therefore women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Additional common side effects of Isotretinoin may include: dry membranes in eyes, mouth, lips, nose and skin, as well has itching. Other side effects may include nosebleeds, muscle aches, sun sensitivity and poor night vision. The drug may also increase the levels of triglycerides and cholesterol in the blood and may increase liver enzyme levels. Even though it has not been clinically proven there have been reports as if Isotretinoin may be associated with increased rates of depression and suicide. This following link proves no significant link between depression and Isotretinoin: http://archderm.ama-assn.org/cgi/content/abstract/136/10/1231

This link claims reduction of depression following treatment with Isotretinon:

http://www.eblue.org/article/S0190-9622(87)70166-2/abstract

An alternative assumption could be made claiming that if indeed patients who consume Isotretinon are those that suffer from depression, this could be as a result of the fact that these are also the acne patients that suffer from the most aggressive and disfiguring type of acne.

Alternative methods for treatment of acne

The TriPollar solution

Alternative methods of acne treatments are available suitable for patients who are not willing or capable of adhering to a daily treatment regimen. Alternative acne treatment are also a relief for those who have failed medical management and for patients who prefer to avoid long-term drug treatment due to concerns or experience with the significant side effects associated with prolonged treatment using  isotretinoin and other acne medications. Alternative acne treatment options include laser therapy, phototherapy and TriPollar radio frequency. A study recently published following the treatment of moderate to mild acne using TriPollar RF technology, demonstrated that TriPollar Radiofrequency (RF) technology is a safe and effective solution for the treatment of acne vulgaris. (http://informahealthcare.com/doi/abs/10.3109/14764172.2011.564626)

The patients that participated in the research showed an average of 42% decrease in acne vulgaris lesions after six weekly treatments as well as at a follow-up visit four weeks later. Having a safe and effective alternative acne treatment provides additional options for acne patients and broadens the options of available acne management.

Acording to EnDouceur, Dermolissage can be used effectively for the treatment of dry skin, Acne, Hyperpigmentation, Rosacea, Telangiectasias (broken blood vessels) and rough skin.

A very effective treatment for aging skin rejuvenation and tightening would be to combine the Dermolissage, which treats the superficial skin layer, with a device that targets the aging skin from deep from inside, for example the TriPollar RF treatment.

A good combination treatment will include a 10 minutes facial anti aging treatment with the TriPollar RF technology. TriPollar will induce immediate results of tightening the existing collagen and will also induce a long term anti wrinkle process by building of new collagen due to stimulation of the fibroblasts. Following TriPollar treatment, performing a Dermolissage diamond microdermabrasion session will be very beneficial as the TriPollar will ‘prepare’ the skin for the Dermolissage treatment and enable an enhanced penetration of the treatment solutions used during the diamond microdermabrasion. This combination treatment is great for targeting the skin’s most superficial layer while also affecting its inner layer and inducing long term anti aging effects of collagen growth.