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Doctors' Answers to "Frequently Asked Questions" - Acne
Acne Treatment [posted
Answer: Best results are achieved with Accutane in most patients. I would not mix the Benzac with the Differin unless you test small areas.
Acne Treatment with Birth
Control [posted 1/6/99]
Answer: Birth control pills have been used for 40 years for acne, although only recently approved by the FDA. I would ask your gyn to match the one closest to this formulation. Also, if you haven't tried spironolactone, it's worth a try.
Acne Treatments [posted
Answer: Acne is due to testerone levels. Testerone in women is a product of conversion from either estrogen or progesterone and is done in the fat cells. Losing weight will help. Possibly birth control pills which change your sexual steroid levels. I suspect you have either gained weight or your estrogen levels are changing as you approach menopause. Sometimes spironolactone is helpful in women with acne, worth a try.
Salicylic Acid Use [posted
Answer: Possible but, uncommon in usual topical doses unless you have pre-existing liver or renal problems. Local irritation is usually the only problem.
Adult Pimple Outbreaks [posted
Answer: Acne vulgaris arises from heavy oil production by skin glands and subsequent infection by anerobic bacteria. Factors which increase oil production or bacteria will give rise to more acne. Humidity and lack of sunlight are thought to be two of the factors. Focus on using an anti-bacterial soap, use oxy 5 on the affected areas and if this is not sufficient see an MD for prescription treatment.
Suggestions for Acne Treatment
Answer: Accutane would be the next best if you have tried all of the above.
Acne & Norgestimate in Ortho
Tri-Cyclen Birth Control Pills [posted 10/23/98]
Answer:Can't say, maybe not specifically tested and approved by the FDA.
Acne Treatment [posted 10/13/98]
Answer: Benzoyl peroxide is about the only one available over the counter. If it works keep with it. Local and systemic antibiotics-usually tetracycline, erythromycin or clindamycin ;topical retinoic acid, and systemic isotretinoin are the usual regimen in about that order depending on the severity and scarring potential of your acne. Except for benzoyl peroxide all need prescriptions. This does not need to be done by a dermatologist. Most family docs and internists can care for this.
Acne Treatment [posted 10/2/98]
Answer: If you were to develop keloid, you would usually have one by 18 or 20 years of age, or have someone in the family with keloid. I'd restart it.
Acne Treatment [posted 10/1/98]
Answer: The acne will usually come back until you age enough to change your hormone levels and reduce the acne. It may not need to be treated with accutane;but, something potentially less toxic. It will not be "cured" with accutane since it does not eliminate the cause-generally high testosterone levels and excess oil production due to same. The liver problems can be permanent if left untreated and with very high levels. However, we stop the medication before there is a risk of permanent damage. Most patients will need cycles of this drug for several years. Some can get by with only a few cycles.
Acne Treatment [posted 9/29/98]
Answer: They have much the same effect. In general, we start with topical drugs for local disease that is not scarring in nature. Generalized acne vulgaris or acne with deep scarring usually necessitates the systemic drug regimen.
Adult Acne Treatment [posted
Answer: Usually 3-4 months.
Adult Acne [posted 8/7/98]
Answer: Topical antibiotics, systemic antibiotics, local application of benzoyl peroxide (available over the counter), Accutane in severe cases. All except benzoyl peroxide are prescription.
Acne [posted 8/6/98]
Answer: Sounds like acne. It wouldn't be a sebaceous cyst on the hand, but this is still a possibility. With dermatology you usually need to actually see the problem. It's hard to diagnose without visual clues.
Severe Acne [posted 7/30/98]
Answer: Did you try birth control pills? They are often overlooked and can be very effective adjunct therapy for women. Topical antibiotics will help the scarring some. Systemic antibiotics would also be recommended.
Acne Medication [posted 7/27/98]
Answer: The ones that advocate benzoyl peroxide are ok. Use the 5 % first. The rest are fairly worthless. The only good medications other than benzoyl peroxide (available over the counter at any drug store) are prescription.
Cryosurgical [posted 7/24/98]
Answer: Usually, but, you'll need to check with their benefits office.
Answer: It sounds like you have some permanent problems from cystic acne. Accutane is one of the preferred treatments for this problem and I'd stay on it. Local steroid injections may be of help (by your dermatologist or plastic surgeon). If this fails, ruby laser treatment to remove all the skin to the dermis is next (this is expensive but, works usually). I'd change to an electric razor and see if these "bumps" go away. Many of my patients with acne have difficulty with blade razors. I've never been sure if it is the shaving cream or the blade itself, but they tend to improve with electric razors.
Birth Control Pill and Acne
Answer: Acne is by far the most common skin disease in the United States. It effects upwards of 85% of people between the ages of 12 and 25 and not infrequently persists into the 30's and 40's. It is accepted that in part, one of the contributing factors in producing acne is sebum, or sebaceous gland fluid. This is in part effected by hormones in both male and female patients, and therefore the hormonal state of females during their menstrual cycle will often give rise to a waxing and waning pattern of acne. There are a great many therapies for typical acne (so called "acne vulgaris"). Many of these therapies overlap with those used for other, less common forms of acne. All acne patients should use a gentle anti-bacterial soap, washing with nothing harsher than the fingertips. Avoidance of oil-containing cosmetics is also helpful, and use of moisturizing lotion for patients with mixed oily-dry skin should be confined to just the dry patches. Picking or manipulating acne pimples should be avoided, as this can lead to scarring. Commonly used antibiotic preparations be they oral or applied to the skin, in addition to salicylic acid containing compounds, often produce good results. Retinoic acid can also be used, although this should not be used unless other therapies fail, as retinoic acid can cause a rather severe redness/peeling reaction on the areas to which it is applied. Skin applications of benzoyl peroxide are also commonly used and are helpful. Overall, it is typical for many patients to require combination therapy to obtain results, and usually, these improvements are seen in 6-8 weeks after starting therapy. Hormonal therapy (including birth control pills) has been used in the past for the specific purpose of treating acne, but other, less systemic-effecting treatments are now available and usually yield good results. See your health care provider. They can provide appropriate therapy and determine if referral to a specialist is in order.
Answer: These will usually need a plastic surgeon or dermatologist. They can inject steroids into the area. Dermabrasion or topical laser treatment can also be used to remove this discoloration depending on the depth and severity of the color problem.
Answer: Unfortunately, you will have acne as long as your testosterone levels are high. For men this is usually into the 40s or 50s. I assume you have tried topical medications while on accutane holiday? Accutane only is effective while you are taking it. It does not "cure" acne - it merely addresses the effects while you are taking it.
Answer: Treatment of Acne Vulgaris aims at killing the bacteria in the skin responsible for the infection of the oil glands. This is accomplished in several ways from topical benzyl peroxide to local antibiotic ointment to systemic antibiotics to topical Retin-A. Treatment will take several weeks to be effective and should usually be continued for several months to years. Itching will occur as the skin is affected and is fairly normal. Redness of the skin and sun sensitivity occasionally occur with topical treatment.
Answer: Any soap that is drying (this is, removes oils) works fine. This means that deodorant soaps usually work the best. Also, topical use of benzoyl peroxide (available over the counter) is extremely effective as a first line in acne vulgaris.
Answer: Acne vulgaris is a common and troubling problem. In minor cases it produces social embarrassment and the perception of a flawed complexion. In more severe cases, like cystic acne, it produces permanent scarring and occasional serious systemic infections seeded from the skin infections. The infections are due to both overproduction and subsequent plugging of sebaceous glands and growth of mainly anaerobic bacteria in this oil. There seems to be a good correlation with testosterone production in both men and women, implying that this hormone is part of the trigger for excess oil production. Treatment centers on keeping the glands from becoming plugged and killing the bacteria from infecting the plugged glands. Any rubbing or contact with the face or other areas prone to having acne should be minimized, wear hair short, etc. Cosmetics and any other skin preparation should be eliminated and the skin should be washed 2-3 times a day to minimize oil. Sun exposure is helpful, whether in tanning salons or naturally(although long term increases the risk of skin cancer and ages the skin). Local agents such as benzoyl peroxide or retinoic acid are very helpful. Also, local antibiotics such as clindamycin, tetracycline or erythromycin are used. Oral antibiotics are used if these measures are not eliminating the problem. In severe cases, systemic isotretinoin is used. This drug is not to be used in women who might be pregnant and may have effects on sperm. Patients receiving isotretinoin will have extremely dry skin and calcifications of tendons have been reported. Birth control pills are occasionally helpful in women, presumably by changing the testosterone levels. Dilantin, isoniazid, steroids, and phenobarbital may also cause acne vulgaris.
Answer: There have been many new developments in the treatment of Acne Vulgaris in the last several years. These pores can often be minimized in appearance. This may be accomplished by collagen injection or by dermabrasion usually performed by a Dermatologist or Plastic Surgeon.
Answer: Nausea, diarrhea, occasional increased sun sensitivity, occasional drug allergies(rash, itching etc.).
Answer: Retin-A(tretinoin) is the acid of Vitamin A. It is available in liquid, gel, and cream. It is topically applied once a day to treat acne vulgaris. The method of action is not currently known; but, it appears to affect the aggregation of follicular cells. Side effects include sun sensitivity, rash, allergic reaction. Using the drug more than once a day will not improve its action. It should probably not be used in pregnant women; but, studies are inconclusive currently.
Tourette's Syndrome & Acutane
Answer: I understand your concern; but, I doubt that Accutane would have any effect. On the other hand triggers for Tourette's are debated; however, I would be surprised if it started up as a result of the Accutane.
Answer: Retin-A is still the best. Topical antibiotics are also of help and occasionally systemic antibiotics.
Answer: There are several; but, the most effective is often birth control pills. Antibiotic therapy either topically or systematically is also effective. Ensure your hair is off your face and try to lose weight( the fat changes estrogen to testerone-the cause of acne).
Answer: Spirolactone was initially used as a potassium sparring diuretic and still is. Due to the fact that part of its structure resembles estrogen(it has the same A ring) it has a mild estrogen like effect-consequently, useful in treating acne and hirsuitism in women. In men, it tends to produce breast development and decreased hair as well since it tends to interfere with testerone.
Back & Shoulders
Answer: Very common. Topical drugs such as benzoyl peroxide is usually available
over the counter(that is, without a prescription). Topical antibiotics, retin-A etc would
all be effective for your problem.
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