Ortho TriCyclen

Severe acne or moderate acne that is not responsive to topical therapy may require systemic therapy. Such therapy may include oral antibiotics, oral isotretinoin, or hormonal therapy.

Oral Antibiotics

The front-line oral antibiotics for the treatment of acne are the tetracyclines. Tetracycline was popularized in the 1950s and has proven to be a safe and effective agent for treating acne for half a century. Today, it is generally acknowledged that minocycline and doxycycline are even more effective. All tetracyclines are contraindicated in pregnancy and in children who have not yet formed their permanent teeth (risk of discoloration). All tetracyclines may cause some photosensitivity and esophageal irritation. (This is especially true for doxycycline.) Side effects of minocycline may include vertigo, blue-gray discoloration of skin or teeth, and rare events such as a lupus-like syndrome. Both tetracyclines and all other antibiotics list numerous other possible side effects and these need to be reviewed prior to prescribing any oral antibiotic for acne.

Erythromycin has long been considered the preferred second-line oral antibiotic for acne therapy. It does have an excellent side-effect profile (with gastrointestinal upset generally the most common problem) and may be approved for use even in pregnant women. (I recommend clearing this with the patient’s obstetrician.) The major concern over the use of erythromycin today is antibiotic resistance, which has been reported in significant proportion in laboratory studies. Even though the clinical significance of these findings has not been confirmed, prudence would seem to favor restricted use of erythromycin (and other topical and oral antibiotics).

Other antibiotics that have been prescribed for acne include trimethoprim-sulfamethoxazole, dapsone, amoxicillin, and clindamycin. Each has its advocates and detractors. Trimethoprim-sulfamethoxazole and clindamycin are quite effective, but their use is tempered by side-effect concerns (pseudomembranous enterocolitis in the case of clindamycin and hematologic and severe cutaneous reactions such as Stevens-Johnson syndrome in the case of trimethoprim-sulfamethoxazole).

Isotretinoin

Since its introduction in 1982, isotretinoin (Accutane) has been considered the most effective therapy for severe nodulocystic and scarring acne. Today, the drug also is being used in less severe but persistent and/or psychologically damaging forms of the disorder.

Isotretinoin is an invaluable drug, but one with significant associated risks. The most frequent side effects are relatively minor: dry skin, eyes, lips; muscle or joint pain; mild hair loss. More significant concerns include liver damage and elevated triglycerides, both of which require frequent monitoring.

The most serious concerns over isotretinoin use are fetal abnormalities if used in pregnant women and the possibility of depression and suicide (especially in younger patients). Fetal damage with isotretinoin is an acknowledged risk and one that dictates very careful attention to both preventing pregnancies in patients taking isotretinoin and educating patients to this risk.

The relationship of isotretinoin to depression/suicide in acne patients is, however, controversial. While anecdotal reports have described such an apparent association, some studies have shown no statistical increase in depression or suicide in acne patients on isotretinoin compared with those on other therapies. This issue is clouded by the tragic fact that depression and suicide are quite common in teenagers and young adults, those most likely to suffer from acne. One must also consider that severe acne itself may be a cause of depression in these patients and thus merits aggressive therapy.

Due to the above concerns, the use of isotretinoin has been restricted recently. Any physician wishing to prescribe isotretinoin must be registered and pledge to adhere to strict guidelines for the use of the drug. In my opinion, patients who require isotretinoin therapy should be referred for dermatology consultation. Therefore, we will not discuss details of isotretinoin use in this article.

Hormonal Therapy

Oral contraceptives improve acne by decreasing the amount of circulating androgens, and may be appropriate for women with moderate acne who have no contraindications to hormone therapy. If a woman with acne is using oral contraceptives for birth control, it is important to determine that she is not using a formulation containing androgenic progestins that may actually provoke acne.

In 1997, the United States Food and Drug Administration (FDA) approved a triphasic, combination oral contraceptive (Ortho Tri-Cyclen) for the treatment of acne. Two large multicenter trials showed that this oral contraceptive significantly reduced acne lesions compared with placebo. The most frequent adverse reaction in these studies was nausea.

The antiandrogen spironolactone may be used in women with new-onset or worsening adult acne, premenstrual acne flares, and in women who have not responded to traditional systemic therapies. The most effective dosage varies from individual to individual, and finding the optimal regimen may require time and adjustment.

If the treating primary care physician suspects that hormonal problems, such as PCOS, may be the cause of acne in a female patient, a referral to a dermatologist or endocrinologist would be in order.

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Acne treatments impact by reaction oil production, motion up skin radiophone turnover, conflict bacterial infection, reaction the rousing or doing all four. With most medication acne treatments, you haw not wager results for quaternary to eight weeks, and your skin haw intend worsened before it gets better.Your student or specialist haw propose a medication medication you administer to your skin (topical medication) or verify by representative (oral medication). Oral medication medications for acne should not be utilised during pregnancy, especially during the prototypal trimester.

Types of acne treatments include:

* Topical treatments: Acne lotions haw parched up the oil, blackball microorganism and encourage sloughing of departed skin cells. Over-the-counter lotions are mostly temperate and include benzoyl peroxide, sulfur, resorcinol, salicylic Elvis or lactic Elvis as their active ingredient. These products crapper be adjuvant for rattling temperate acne. If your acne doesn’t move to these treatments, you haw want to wager a student or specialist to intend a stronger medication lotion. Tretinoin (Avita, Retin-A, Renova) and adapalene (Differin) are examples of topical medication products derivative from vitamin A. They impact by promoting radiophone mass and preventing plugging of the hair follicles. A sort of topical antibiotics also are available. They impact by ending immoderateness skin bacteria. Often, a compounding of much products is required to attain best results.

* Antibiotics: For medium to nonindulgent acne, medication test antibiotics haw be necessary to turn microorganism and fisticuffs inflammation. You haw requirement to verify these antibiotics for months, and you haw requirement to use them in compounding with topical products.

* Isotretinoin: For unfathomable cysts, antibiotics haw not be enough. Isotretinoin (Accutane) is a coercive medication acquirable for scarring cystic acne or acne that doesn’t move to another treatments. This medicine is distant for the most nonindulgent forms of acne. It’s rattling effective, but grouping who verify it requirement near monitoring by a specialist because of the existence of nonindulgent lateral effects. Isotretinoin is related with nonindulgent birth defects, so it can’t be condemned by meaningful women or women who haw embellish meaningful during the instruction of treatment or within individual weeks of last treatment. In fact, the take carries much earnest possibleness lateral personalty that women of reproductive geezerhood staleness move in a Food and Drug Administration-approved monitoring information to obtain a medication for the drug. In addition, isotretinoin haw process the levels of triglycerides and cholesterin in the murder and haw process liver enzyme levels.

* Oral contraceptives: Oral contraceptives, including a compounding of norgestimate and ethinyl oestrogen (Ortho Tri-Cyclen), hit been shown to meliorate acne in women. However, test contraceptives haw drive another lateral personalty that you’ll want to handle with your doctor.

* Laser and light therapy: Laser- and light-based therapies accomplish the deeper layers of skin without harming the skin’s surface. Laser treatment is intellection to alteration the oil (sebaceous) glands, feat them to display inferior oil. Light therapy targets the microorganism that causes acne inflammation. These therapies crapper also meliorate skin texture and alter the attendance of scars, so they haw be beatific treatment choices for grouping with both active acne and acne scars.

* Cosmetic procedures: Chemical peels and microdermabrasion haw be adjuvant in controlling acne. These aesthetical procedures — which hit traditionally been utilised to alter the attendance of dustlike lines, solarise alteration and secondary facial scars — are most trenchant when utilised in compounding with another acne treatments.

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