ACNE PART II: Treatment (b)
Although some oral contraceptives may actually aggravate acne, others may reduce oil production and promote acne clearing. Women with persistent acne who do not respond to more traditional therapies may be candidates for such hormonal manipulation. Certain birth control pills (Ortho Tri-Cyclen, Estrostep, Yasmin, and Yaz) have even been approved as a treatment for acne. The drug spironolactone helps counteract the male hormone and may also prove useful for women with moderately severe breakouts.
In 1982 a powerful medication for the treatment of severe acne was released in the United States. Called isotretinoin, this “miracle” drug will actually “cure” selected cases of acne. Trade names include Amnesteem, Claravis, and Sotret. The flagship product, Accutane, was voluntarily withdrawn from the market in July, 2009. The manufacturer cited business reasons with no relation to safety and efficacy.
Isotretinoin is a derivative of vitamin A and is available in capsule form. The medicine is taken for a five- to six-month period. Within three weeks of commencing the medication, varying degrees of skin dryness invariably occur and may be accompanied by dry eyes, cracked lips, and nosebleeds. These annoying side effects may last for the duration of therapy. Isotretinoin may also raise the level of circulating fats, and for this reason periodic blood tests are mandatory.
For those with cystic acne, the results of isotretinoin therapy are well worth any transient aggravation. The disfiguring cysts resolve, and for the majority of people undergoing the treatment, new cysts rarely appear. Some 80 percent of such patients achieve long-lasting remission. By preventing deep cysts, isotretinoin abruptly halts the dreaded sequelae (scarring) of acne. Some individuals with chronic, less severe, forms of acne may benefit as well.
Controversy exists regarding the association of isotretinoin with mood changes, depression and colitis; direct links, if they do occur, are certainly rare. This drug must never be taken by pregnant women because of the high incidence of birth defects. Women of childbearing age must practice strict birth control. Isotretinoin should only be administered under a dermatologist’s care. Indeed, persons taking this drug must be registered in a central government-mandated database called I-Pledge.
What about the physical methods used to treat acne? Again, please remember not to pop pimples or further manipulate acne lesions unless properly instructed by a dermatologist. Extraction of open comedones (blackheads) can be accomplished under proper supervision by use of a comedone extractor. This instrument features an open loop that is placed over the blackened pore, allowing the contents to be expressed when firm pressure is applied. Comedone expression has minimal influence on the course of acne. The widened pore will reaccumulate its blackened contents within a month’s time; however, many persons obtain cosmetic and psychological benefit from this procedure and welcome the removal of these unsightly black dots.
Most recently, lasers, IPL (intense pulsed light), blue and red light sources, and even a topically applied solution activated by light have been employed as acne therapies. Such interventions, of varying costs, may lessen the need for oral antibiotics. The verdict is still out as to the overall effectiveness of these physical modalities, which are somewhat expensive and generally not covered by health insurance.
Persons who develop large, disfiguring cysts benefit from the injection of a steroid solution (Kenalog) directly into each cyst. This medicine often dramatically reduces the size of a lesion within twenty-four hours and may prevent subsequent scarring.
What can be done for those already scarred by acne? Dermatologists and plastic surgeons possess several tools for the correction of scarring, including dermal filler implants (such as Cosmoderm, Juvederm, Radiesse, Zyderm), dermabrasion (mechanical sanding), and lasers. Which procedure(s) to use depends on a number of factors, including the extent and depth of scarring. Shallow, concave, pliable scars respond immediately to dermal filler injection. More superficial scars may respond to multiple laser sessions. Good results are being reported with fractional laser photothermolysis. Consult with a dermatologist who is knowledgeable in all facets of scar correction. Keep in mind that although 100 percent correction is unlikely, some degree of improvement may be achieved. Often the changes are dramatic.
In summary, the immediate goal of acne therapy is to clear up existing pimples and blemishes and prevent new ones from appearing. You may have such mild acne that daily washing coupled with an over-the-counter benzoyl peroxide or salicylic acid preparation is all that will be needed to control the disorder. However, if these measures fail, an appointment with the dermatologist would be prudent. The skin care specialist has at his disposal a variety of beneficial treatments for acne. Two or more different medications are commonly employed at the same time. One must bear in mind that such regimens rarely produce instant results; acne does not clear up overnight. Be patient! You should always give a new regimen a minimum of three to four weeks for visible results to occur.
Those with cystic acne that is unresponsive to antibiotics should experience considerable improvement following a several-month-long course of isotretinoin. Certain scars may improve with injectable fillers or laser therapy.
Acne is a cosmetically disfiguring problem. If left untreated, the condition may lead to immense physical and emotional scarring. Today acne is certainly controllable, and select cases may even be cured.
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