In most cases, acne can't be cured, but it can be controlled. The basic
premise behind acne treatment hasn't changed over the years, but the array of
therapies to choose from has expanded. According to Dr. Alan R. Shalita, MD,
chairman of the Department of Dermatology, SUNY Health Sciences Center in
Brooklyn, New York, the usual course of action includes one of two treatments.
Depending on the severity of the acne, topical treatments are the first line of
treatment, with oral medication added as necessary.
Topical treatments
Topical treatments include retinoids (vitamin A-derivatives) and antibacterial
agents. Retinoids unclog pores by accelerating the rate at which the skin's
layers peel off and renew. Antibacterials are used, usually in conjunction with
retinoids, to reduce bacteria and inflammation, thus reducing the likelihood of
acne lesions forming.
Retin-A is probably the most well known of the retinoids. While it has helped
millions of people with acne since its release in the 1970s, it can cause
redness, flaking, and irritation of the skin. Two new preparations with retinoid
activity microencapsulated tretinoin (trade name Retina Micro) and adapalene
(trade name Differin) are now being prescribed. Both seem to be as effective as
Retina at reducing acne lesions, but are much gentler on the skin.
Topical antibiotics, such as erythromycin and clindamycin, are used to combat
bacteria on the skin. The most common of these is benzoyl peroxide (the main
ingredient in Clearasil and other over-the-counter preparations). These are
useful, but many women find the texture of these medications chalky or pasty and
have a hard time applying makeup over them. For these women, Dr. Shalita
recommends a sodium sulfacetamide lotion (trade name Klaron). Klaron is not a
new drug, but has been reformulated and is being increasingly prescribed for
acne treatment. It reduces bacteria and inflammation, yet is smooth, absorbs
well, and goes on nicely under makeup.
Oral treatments
Oral treatments generally consist of antibiotics (such as tetracycline,
erythromycin, doxycycline, and minocin), hormones (in the form of birth-control
pills), and the potent retinoid, accutane.
- Antibiotic therapy is not new, but can be effective at
keeping acne at bay. However, some women experience side effects, such as
vaginal yeast infections, during chronic antibiotic therapy.
- Birth-control pills have been prescribed for acne for more
than 30 years, according to Dr. Shalita. This is because the low-dose estrogen
in some pills reduces the secretion of sebum from the sebaceous gland. Now,
for the first time, the U.S. Food and Drug Administration has approved a
birth-control pill (trade name Ortho Tri-Cyclen) for use in treating acne,
after clinical trials demonstrated it to be effective.
- Accutane For very severe cases of acne, in which all other
treatments are ineffective, and in which Dr. Shalita says there can be "both
physical and psychological scarring," accutane is indicated. Accutaneactually
shrinks the sebaceous glands and can be a cure for acne for some of its users,
but it carries with it the potential for serious side effects, including birth
defects if a woman becomes pregnant, so it is usually a last resort.
As Angela has found in her 10 years of battling acne, finding the right
treatment can be a hit-or-miss situation, and it may take some time to find
what's best for you. "I'd run the gamut of acne treatments," Angela said. "I'd
been on four different oral antibiotics, but after dealing with unwanted side
effects, I tried birth control pills. Those worked almost miraculously, but I
eventually developed migraine headaches and had to stop taking them. I figured
there was nothing else left, except Retina, which I had tried but made my skin
red and flaky. I was pleasantly surprised when I visited a different
dermatologist and found out there were some more choices."
Angela seems to have found what's right for her. "After eight weeks of using
Klaron twice a day and Differin at night, my skin looks great. It's not perfect,
but much improved. So, while I'm still waiting to "outgrow" acne, at least I
know I can control it."