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Q. What is the best strategy for treating acne?
A. Acne is most often an ailment we see in our teenage years however children as young as 9 as well as adults may also be affected by this skin disorder. It can take 4-6 weeks to see improvement in the skin once a treatment option is initiated and it is important to note that the acne may worsen before it begins to improve.
Benzoyl peroxide has antibacterial, comedolytic and some anti-inflammatory action and since it is available without a prescription and has limited potential for side effects, it is a good choice to try first for mild cases of acne. It is suggested to use a 2.5 or 5% preparation once daily (higher strengths may be more irritating to the skin and not any more effective). Benzoyl peroxide can cause skin sensitivity so it is best to trial a small area for 3 days to ensure tolerability. It can be used every other day if the skin appears irritated and increased to usual once daily application if your skin allows. Keep in mind that it may stain bedding or clothing so it is best to apply it at least a half hour before retiring so that it has time to dry upon the skin.
Topical retinoids (also known as the Vitamin A acid creams & gels), which reduce inflammation and prevent new blemishes from appearing, can also be tried, but they do require a prescription. It is recommended to start at a low dose, three times a week, and increase to every night as tolerated. Adapalene (Differin) and tazarotene (Tazorac) are more effective than tretinoin (Retin-A) but they are also more costly.
For persistent or moderate cases of acne, combining benzoyl peroxide with a retinoid (such as TactuPump) or with an antibiotic (such as Benzaclin) is more beneficial than using only one of the products alone.
If the acne has not responded to the topical treatments after 2 to 3 months or if the acne is of a moderate to severe case, oral antibiotics can be tried (for a maximum of 12 weeks).
Keep in mind that using antibiotics in conjunction with either benzoyl peroxide or a retinoid is recommended in order to reduce the risk of antibiotic resistance. Doxycycline or tetracycline are preferred choices over minocycline due to the latter’s possible severe effects of drug-induced lupus and hepatitis.
Oral contraceptives, which work by reducing the androgenic effects on the body, might be an option to consider instead of trying oral antibiotics. Sorry boys, this option is only acceptable for the female population. Another treatment option for women, particularly those that suffer with cyclic acne (i.e. acne that tends to worsen around the menstrual cycle), is spironolactone (usually used for fluid retention, blood pressure, congestive heart failure) at 25-200mg daily.
Since spironolactone may lead to hyperkalemia (high potassium in the body), it should be avoided for those that have renal (kidney) disease, or are already taking medications such as ACE inhibitors (such as ramipril), ARBs (such as telmisartan), sulfa antibiotics or potassium supplements.
Given that these medications tend to be used for problems seen mainly in adults and seniors, the interactions are unlikely to be relevant for the vast majority of teens but should be kept in mind, none the less.
For severe acne, oral isotretinoin (Accutane) is considered the most effective treatment. The usual course of isotretinoin is 20 weeks and due to its side effect of causing birth defects, women must ensure that they not get pregnant during treatment.
Along with its increased effectiveness comes the potential for an increased risk of adverse effects. These include common side effects such as dry skin, eyes, nose or the mouth and muscle pain and relatively rare events such as liver abnormalities, changes in our cholesterol levels and perhaps the potential for issues with mental health (although this remains controversial). While these potential side effects are not to be taken lightly, we have also seen this treatment work wonders for some of our patients whose acne was causing permanent scarring and hammering their self-esteem.
With such a wide variety of options, the vast majority of those affected should be able to find an effective and well tolerated treatment with the proper advice.
For more information on this or any other topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and at Port Elgin Pharmasave.
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Monday, February 08, 2016