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ACNE
This is a common disorder that affects most individuals at one
time or another to varying degrees. While most common in the teen
years, acne can present initially much later in life and, importantly,
"teen-age acne" can, if untreated, persist for many years
often into the third decade.
MISCONCEPTIONS ABOUT ACNE:
[1] The pimples and black heads of acne are reflections of
dirty skin. Not so! Acne is a hormonal condition and the
patient with acne will make it worse if he/she scrubs her/his
face. Gentle washing with a soft clothe and mild soap twice a
day to remove naturally occurring oils is all that is needed.
Gently pat dry with soft towel. The use of harsh cleansing can
make the treatment of acne more difficult since it irritates the
skin that is to be treated with anti-acne medications that are
themselves irritants. The compounding effects can impede a treatment
plan.
[2] A bad diet causes or aggravates acne. Not so! A good
healthy diet is good for many reasons, but there is no proof that
acne is influenced by one’s diet.
[3] Picking acne of the face causes scarring. Not so!
Manipulating acne lesions may cause discoloration around the damaged
acne lesion and lead to unsightliness, but the acne is not affected
directly. Scarring is related to the type of acne from which an
individual suffers and often can be minimized by aggressive management
of the disorder. When we recognize such forms of acne we refer
to a dermatologist at once since special management is required.
[4] Cosmetics and other applications aggravate acne. Not so!
Experts in the field say that the application of cosmetics, emollients,
etc. has no effect on acne and it is OK to use them. It seems
clear, however, that applying materials that irritate acne lesions
can, as with overly aggressive cleansing, compound the irritating
effect of anti-acne medication.
[5] Stress influences acne adversely. Probably true! Keep
in mind that acne is most often a problem of the teen years when
stress is as natural as adolescence. If one can manage stress,
perhaps one’s acne will be easier to manage, but be realistic
about this one. Although we are happy to refer any patient to
a dermatologist upon request, experts say that the majority of
cases of acne can be managed quite nicely by a physician who is
willing to assist patients with treatment if the patient is agreeable
to the proposed regimen and will adhere to it for an extended
period. Acne responds slowly to any/all proven treatments.
As a rule one can expect to see some positive results of treatment
in about 8 weeks with progressive improvement over the ensuing
4-6 months. If there is worsening or no change in the condition
after 8 weeks of diligent treatment another plan may be devised.
WHAT DO YOU NEED?
[1] A mild soap and a soft clothe for twice a day cleansing.
[2] Medication described below.
[3] A positive attitude and determination to carry out the treatment
plan.
MEDICATION
[1] BENZAMYCIN We prefer to start with a topical gel,
Benzamycin that contains 3% erythromycin, an antibiotic, and 5%
benzoyl peroxide, a keratolytic and desquamative agent. A pea-size
amount of gel for the forehead, another for each cheek and one
for nose and chin applied twice daily is recommended. Apply
after washing the face and other sites of acne. Gently rub medication
into skin.
Benzyol peroxide is an irritant that removes the top layer of
skin. It also has properties that affect the acne directly. The
topical erythromycin is effective against the bacteria that play
a role in acne. Improvement can be expected in about 8 weeks.
[2] RETIN-A If Benzamycin is not working at the end of
8 weeks the second line of topical agents is Retin-A or tretinoin
gel 0.025%. This regimen calls for 4 pea-size applications once
a day before retiring in the evening. This medication often
causes irritation requiring a reduction in frequency of application
to every other evening. Acne may seem worse initially as the medication
acts on it. This agent makes exposure to the elements particularly
irritating. Sunscreen in generous amounts and emollients such
as petrolatum can be used freely after the medication is applied
, but they must be washed off with mild soaps or detergents before
subsequent applications. Positive results should be observed within
8 weeks.
[3] SYSTEMIC ANTIBIOTICS Sometimes a systemic antibiotic
is required to control acne. There are many approaches to this.
We are using a new one with azithromycin for five days every month.
Rx: Azithromycin 10 mg/kg day 1 and 5 mg/kg days 2-5 once a month.
This is an unusual treatment for acne so don’t hesitate to ask
about it; we’ll gladly discuss it with you.
[4] ACCUTANE (isotretinoin) is probably the most effective
agent used to treat acne. It is, however, associated with the
most severe adverse effects and is very expensive. Laboratory
testing is required before and during treatment. Accutane causes
serious deformities of the fetus. One must be certain that
the patient is not pregnant and the patient must not become pregnant
during treatment and for a period of one month following discontinuation
of treatment. A pregnancy test must be negative before treatment
begins and at monthly intervals during treatment. The most common
adverse effect of Accutane and the one that hampers treatment
regimes is painful "chapped" lips and cracking at the
corners of the lips (cheilitis). Other adverse effects are less
common. Additional information on adverse effects can be obtained
from a pharmacist and will be included in the material accompanying
the prescription. It is the total or cumulative dose of Accutane
that is important. We generally refer patients who are candidates
for this medication to a dermatologist who had more experience
with this treatment.
[5] BIRTH CONTROL PILLS Certain birth control pills are
excellent agents for the treatment of acne. We generally refer
to a dermatologist or gynecologist for this approach.
FOLLOW-UP VISITS We like to see patients on acne treatment
once a month to observe effects, to review the treatment plan and
to answer questions. Later in the procedure visits can be less frequent.
For more on acne access http://www.aap.org
or http://www.aad.org
©2002 South Valley Pediatrics
page updated April 7, 2002
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