Lifestyle Choices

If the acne is so severe that it cannot be effectively prevented or treated using topical medications, oral medications are often necessary. These are reserved for the tougher, more resistant cases of acne.

The most commonly used oral medications are antibiotics, the most widely prescribed of which is tetracycline. Tetracycline not only kills the bacteria but also reduces sebum secretion. It must be taken on an empty stomach (one hour before or two hours after a meal). Tetracycline binds to calcium, so it is not absorbed if taken with dairy products. Tetracycline should not be taken by children under ten or by pregnant women or women who are breastfeeding, since it can stain a child’s developing teeth.

Other effective antibiotics are minocycline, erythromycin and doxycycline. The effectiveness of each particular antibiotic is highly individual. Certain antibiotics work extremely well on some people, but not on others. Some people experience slight nausea when an antibiotic is taken in the morning before eating. Other frequent side- effects are diarrhea and vaginal yeast infections (Candida, monilia).

The type of antibiotic used and the dose must be determined under your doctor’s care.

Finally, there is a “magic medicine” for acne called 13-cis-retinoic acid or Accutane, a synthetic derivative of vitamin A. This is a very strong oral medication which is taken once or twice a day for four months, after which acne is usually cured. Before beginning this medication, your blood must be checked to be certain that the liver metabolizes normally. Throughout the course of medication, monthly blood tests of cholesterol and triglyceride are necessary, since any changes in triglyceride might alter the dose.

Everyone taking Accutane has some feeling of dryness of the lips and often skin sensitivity and dryness of the eyes and nose. Sometimes even individuals experience nose bleeds or sore gums because of the dry mucosal membranes. If these symptoms are uncomfortable, often the dose of the medication will be decreased. The most major potential problem with Accutane is that it would cause birth defects if ever taken by a pregnant woman. Women must not become pregnant while taking Accutane. Very strict birth control must be used when on Accutane, and pregnancy itself is not safe until two months after the course of the medication is completed.

What your dermatologist can do

Besides determining the exact cause of your acne and prescribing the correct medications, your dermatologist can very quickly treat blackheads, new spots and cysts. Usually the dermatologist accomplishes this by treating the affected area with a fine scalpel blade and expressing the contents. If you have a deep cyst, the dermatologist can drain it or inject medication. The sooner the inflammation is under control, the less likely there is to be any permanent scarring.

Finally, there are treatments for acne scarring. Most common are injections of collagen directly into the scar. Often each scar requires more than one treatment but after several treatments the correction is permanent. In some cases of extensive scarring, the surgical procedures of dermabrasion or the more modern laser abrasion can be effective. Fortunately with the medications now available, major scarring can usually be prevented.

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