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.

Does sunscreen provide complete protection?

The Sun Protection Factor (SPF) of a sunscreen formula states the effectiveness of this cream when applied at an even layer of 2 milligrams per square centimeter, for blocking the effect of UV sunrays that cause sunburns. The SPF level is defined by comparing the effect of exposure to the sun causing burns to a body area with the evaluated sunscreen compared to the burns to a non coated area. SPF 15 means that compared to a body area without sunscreen, the area with sunscreen will require 15 times more UV to be equally burned compared to the same area without sunscreen.
SPF is evaluated per 2 milligrams of sunscreen per square centimeter, unfortunately most people apply less sunscreen than needed. This causes the SPF value to be reduced dramatically hence the person thinks he/she is protected but in reality the effectiveness of the sunscreen is reduced. Thinking that you are protected when in reality you are not is very dangerous as you might linger in the sun for longer.
Another problem with sunscreens is the fact that many of them protect mostly against skin burning, caused by UV-B.  There are three types of UV rays emitted from the sun, the skin cancer foundation has a good explanation about UV classification on their web site. The different types of UV are: UV-A, UV-B and UV-C. Both UV-A and UV-B pass the ozone layer and reach the earth, most of the UV-C is absorbed by the ozone layer and does not reach us.
UV-A is the most dominant UV radiation reaching us from the sun. It is present throughout the year and during all day light hours. UV-A penetrates glass and clouds and has a deeper penetration depth into the skin than does UV-B. UV-A is a main inducer of skin ageing, wrinkles and skin cancer. It is the main contributor to tanning, it does so by inducing changes in the cell’s DNA, the skin darkens due to synthesis of melanin to protect the skin from further damage form the UV exposure. Tanning salons use mostly UV-A as the tanning source, the intensity in the salons can be 12 times higher than the natural UV-A levels from the sun.
UV-B penetration depth to the skin is superficial and it plays a major role in skin burning. As apposed to UV-A, UV-B is present in lower levels during different hours of the day, different seasons and various locations on earth and it does not penetrate glass. Similar to UV-A, UV-B contributes to skin cancer, and skin ageing.
Sunscreens were created originally to prevent skin burning and to block mainly UV-B. In recent years manufactures of sunscreens have added UV-A protection too, however the level of protection from UV-A is not included in the SPF classification. It is important to verify, when purchasing a sun block, if the formula claims to protect from UV-A and UV-B. If not specified it is probably UV-B protection only.
The problem with sunscreen is that people feel protected from the damaging rays of the sun while they really are not safe. Most people will assume that if they apply sunscreen on exposed areas, they can allow themselves to walk freely in the sun during the extreme UV hours (10AM-4PM). This is a very dangerous assumption as applying the sunscreen needs to be in the correct amount and the sunscreen needs to be of good protection values. In addition, no sunscreen provides complete protection and it is wise to always stay away from exposure during the extreme hours mentioned above.
Another misconception is that after about 4PM and in early morning hours (6AM-10AM) there is no need for sunscreen as the UV radiation is lower. Very wrong assumption! As mentioned above, UV-A is present most hours of the day, so be ware!
Most people are not aware that they need to apply sunscreen when driving or sitting in a car, or if sitting in front of a sunny window at home, the windows will not protect you, (unless they are coated with a UV protection film).
Below are the Prevention Guidelines of the Skin Cancer Foundation for wise protection from the sun:

“Prevention Guidelines
•    Seek the shade, especially between 10 AM and 4 PM.
•    Do not burn.
•    Avoid tanning and UV tanning booths.
•    Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
•    Use a sunscreen with a SPF of 15 or higher every day.
•    Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours, or immediately after swimming or excessive sweating.
•    Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
•    Examine your skin head-to-toe every month.
•    See your physician every year for a professional skin exam.”

If your skin has been damaged by years of exposure to the sun’s damaging rays you might be happy to learn that you can help reduce the damage by treatments offered by various technologies. Sun spots (liver spots) can be removed by skin resurfacing technologies and photo-rejuvenation technologies. In addition, a RF technology exists, that targets reduction of wrinkles, collagen regeneration, skin tightening that improves skin texture and lessens the ill affects caused by UV radiation.  For example, TriPollar RF treatments, have been proven to effectivly reduce wrinkles and tighten the skin.  TriPollar based products are maufactured exclusively by Pollogen Ltd.    You do not have to wait till you are in your forties or later to begin treatments; the earlier you begin the better.
To finalize this write up, it would be nice if we adopted the fashion of un-tanned skin as our ancestors admired during the renaissance and earlier periods. Of course this should not include the discrimination against darker color skin that accompanied the earlier age admiration of non tanned skin.
And finally, if you do spend significant time in the sun, make sure to follow the guidelines mentioned above and minimize the damage to your skin.

I have been grey since my late thirties and have not had the urge to cover the grey. I believe you are as young as you feel or as old as you see yourself. To be honest, it has not been easy to withstand the pressure from society,  friends try to refer me to their favorite hairdresser or even better, say kind words like ”you look very young but you will look much younger if you dye your hair”. The hardest hit was when I came to pick up my son from kindergarten and heard the kids yelling “Your grandma is here to pick you up”!!!! But still I did not fall into the hair dying loop (once you start, it is hard to stop).

Ageing is a state of mind

Fortunately, grey hair has become accepted in some western countries. Images of graying models are accepted and are considered sexy and fashionable. It is not about the hair color, it is about how you carry your body, your skin complexion, what you wear and the energy levels you portray.

Ageing is a state of mind, rather than dyeing hair to conceal gray, I prefer dancing, going to rock concerts and staying young at heart. I think that if you feel younger when you dye your hair, than go ahead and do it, feeling younger makes you younger.

Declaring emancipation from hair dyes does not mean letting age take its toll and leaving all to nature. Personally, I use anti-ageing moisturizing creams every day and try to maintain a rigid exercise program to keep my body and spirit in high energy levels. I am fortunate to work in the aesthetic industry so I have accesses to variable technologies that target the ageing skin. I have found Radio Frequency (RF), particularly TriPollar RF face treatments to be to be very pleasant, relaxing and effective from the very first treatment. What I like about these treatments is the fact that the results are not so drastic so I do not look like I had a face lift. Don’t get me wrong, the results are noticeable, acquaintances that had not seen me for a while have all commented on my fresh looking skin and fine complexion. The wonderful thing about it is that it looks natural and is indeed a natural skin rejuvenation process triggered by the treatment; the skin creates new collagen during a few weeks causing the results to improve over time.

So, if you are in the early graying phase and have been pulling the gray out (ouch!), first, pulling them out will not induce growth of more gray than you pulled out so if you want to continue pulling, go ahead. However, you will have to pull out many more hairs as you progress in age, so let it be and learn to accept the random gray hairs and view it as exotic. Later when your hair is mostly silver it can help to adopt the positive attitude towards your hard earned silver crown and learn to enjoy the respect and beauty earned with silver hair. So, go wild – go gray and enjoy a youthful approach to life with a silver crown on your head.

RF is also used as a treatment for uncontrolled bowel movements, uncontrolled passage of urine or esophageal reflux syndrome. In these cases the treatment includes microscopic RF targeting of the collagen in the organ wall. The creation of such focal, microscopic treatment within the cavity wall, results in reduced dynamic tissue compliance, and improvement in the pathologic conditions.

RF energy is also deployed in orthopedics for gentle ablation of tendons and ligaments, it is also used to coagulate and decompress disc material, healing tears or fissures. Pain management is also a vast branch of medicine that deploys RF. The default treatment of pain is usually by prescribed pain killers; these can be problematic as they are addictive and do have side effects. RF is used for pain management via a few different methods. The first method is by identifying the problematic muscle and healing it by heating the muscle by targeting it with RF. Other methods involve targeting the nerve tissue directly: a process called Radio Frequency Lesioning (RFL).  In this process continuous radiofrequency current is transmitted to a small volume of nerve tissue hence inducing heat generation, this causes disruption of pain signals from that specific area. This procedure has a selective effect on specific nerve fibers, reducing pain in target areas, but without affecting other sensory capabilities of the specific nerve.

Radio Frequency has been established in aesthetic medicine as a means to induce skin tightening and reduction of wrinkles, improvement of cellulite and body contouring. RF current is transmitted into the skin and heat is generated due to the resistance of the skin to the RF current. The heat induces shrinkage of existing collagen and stimulation of the fibroblast to generate new collagen. In addition, heat generated in the hypodermis adipose tissue (fat layer in the hypodermis) causes  release of liquid fat from the fat cells, thus inducing shrinkage of the fat cells in the adipose tissue which leads to circumference reduction and  improvement in  the appearance of cellulite.

Thermage were the first to introduce the first generation of mono polar RF for the purpose of body contouring and skin tightening in 1997. In mono polar RF one electrode is used to transmit the RF energy to the skin and a return pad is placed on the body to close the circuit. Mono polar RF devices use very high power (250-300W) as the treatment is not focused and the electrical current aimed at the dermis will actually dissipate throughout the body. The treatment is painful due to the high power it requires and a topical anesthesia is needed to tolerate the treatment.

Bi polar RF technology is the second generation of RF aesthetic devices; it uses 2 electrodes to transmit the RF current and does not require a return pad. The penetration depth is about half the distance between the 2 electrodes.  Most Mono and Bi polar devices require surface cooling in order to protect the epidermis during treatment.

TriPollar technology is the 3^rd generation of RF aesthetic devices. It uses 3 electrodes to transmit the RF current into the dermal and fat layers while protecting the outer most skin layer. The energy field created using this method is very condense and requires substantially less energy to achieve the desired heating of the treated area, hence enabling a safe pleasant treatment with the positive immediate and long term results of RF aesthetic treatments.

Even skin aging and wrinkles are associated with sugar consumption, so face it, there is no place for denial, any way you look at it…sugar is bad for you, too bad so many of us are  addicted to it…but how can one help the sugar addiction, when it adds that little sweetness and passion to life.

The cause of ill effects of sugar on the skin is the glycation process, in which the sugar in our blood attaches to protein molecules to form harmful new molecules called Advanced Glycation End-products (AGEs). The more sugar consumed, the more AGEs are developed.

Many clinical studies have been performed on the effect of high level of AGEs on collagen. Studies have found that excessive AGEs will cause collagen in different areas to go through changes that eventually will cause the collagen to become brittle and in skin this will cause wrinkles and dry, dull, and sagging skin.

Not only this but excessive sugar is also associated with inhibition of Human Growth Hormone (HGH) activity, since HGH is associated with tissue repair and rejuvenation, obviously, this will affect the aging process too.

The good news is that it is not too late to turn back the clock. First, you can decrease the amount of sugar you consume (not only pure sugar but fruit and carbohydrates in general). In addition, it is possible to generate new collagen through stimulation of the fibroblast present in our dermis and hypodermis. Stimulation of Collagen skin regeneration can be induced via the TriPollar Radio Frequency technology. Tripollar treatments can also help reduce circumference. The apollo and regen are two TriPollar technology devices that induce secretion of liquefied fat from the fat cells in the hypodermis adipose layer, thus reducing their size and leading to a decrease in circumference along with added skin tightening. Unfortunately, treatment with these devices is not an alternative to exercise and diet if one is a sugar addict.

It is important to note that a sugar rich diet cannot be balanced by collagen regeneration or other anti-aging treatments as the accelerated aging caused by excessive sugar will cause damage to the new collagen generated too.

The bottom line is always a negative outcome to sugar consumption, even anti-aging treatments will not help the ill affects of sugar if we swallow the chocolate while we treat our skin for anti aging and wrinkled skin.

It sounds strange having the most advanced beauty equipment, the apollo system powered by TriPollar®, in a military hospital, but the General Hospital of Beijing military command is one of the largest modern hospitals in China. The hospital was founded in 1953 and is under the auspices of the People’s Liberation Army, its mission includes assuring the health of PLA and the Country’s leaders.

Since its foundation it has developed into a large general hospital that integrates medical care, health care, education and research in all disciplines, numerous professional talents, state-of-the-art equipment, unique predominance and a perfect medical care environment.

A strong professional team works for the hospital, and over 1000 persons hold senior professional titles and 5 are academics from  the China Academy of Engineering. Senior experts and professors of the hospital are well known for their wide range of knowledge, great academic accomplishments and good reputation both at nationally and internationally. Many middle-aged specialists with rich experience also work in the hospital. In addition, a large number of promising and enterprising young doctors are coming to the forefront in their respective specialties.

The hospital has large outpatient clinic (Laser Beauty) near the entrance gate, dedicated to aesthetic treatments. Most of the patients are civilians from the Beijing area.

When we visited the clinic we found Dr. Fan performing facial anti aging treatment with the apollo system on a 42 years old woman. Dr. Fan prefers the TriPollar treatments because of the ease of use and the pleasant treatment for the patient. Before having the apollo, he was unable to treat the neck area when performing facial anti aging treatments since the patients couldn’t tolerate the pain associated with the mono-polar system he has.