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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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