Acne
How Is Acne Usually Treated?
By the time
many people consult a specialist for their acne, they usually have tried
many of the over-the-counter (OTC) medications.
The main goal
of acne treatment is to prevent scarring. Additional goals are to reduce
the number of painful lesions and to minimize the psychological stress
and embarrassment caused by this disease. Doctors often use drug therapy
as the first choice for treating acne. One should also give
consideration to proper care of the skin and diet first.
Drug therapy is aimed at reducing
several problems that play a part in causing acne: abnormal clumping of
cells in the follicles, increased oil production, the bacterium P.
acnes, and inflammation.
Patients with
moderate to severe inflammatory acne generally treated with an OTC or
prescription topical medication, a prescription oral medication, or a
combination of these.
People with
severe nodular or cystic acne should be treated by a specialist. For
patients with severe inflammatory acne that does not improve with other
treatments, a
retinoid, may be perscribed. Isotretinoin is an oral drug and is usually
taken once or twice a day for 16 to 20 weeks. It is believed to markedly
reduce the size of the oil glands so that much less oil is produced. As
a result, the growth of P. acnes is decreased. Isotretinoin also
reduces cell shedding and the stickiness of cells in the follicles,
which helps prevent the development of comedones.
For some
female patients, treatment-resistant acne is caused by excessive
production of hormones called androgens. Clues that help the doctor
diagnose hormonally influenced acne are adult-onset acne, hirsutism
(excessive growth of hair or hair in unusual places), premenstrual acne
flares, irregular menstrual cycles, and elevated blood levels of certain
androgens.
The doctor may
prescribe one of several drugs to treat women with this type of acne.
Low-dose estrogen birth control pills help suppress the androgen
produced by the ovaries. Low-dose corticosteroid drugs, such as
prednisone or dexamethasone, may have an anti-inflammatory effect and
suppress the androgen produced by the adrenal glands. Finally, the
doctor may prescribe an antiandrogen drug, such as spironolactone, which
helps prevent androgens from causing excessive oil production.
Spironolactone also stops androgen production in the ovaries and adrenal
glands. Side effects of antiandrogen drugs may include menstrual
irregularities, breast tenderness, headache, and fatigue.
Reprinted from the
Archives of US NATIONAL
INSTITUTES OF HEALTH, National Institute on Aging
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