What is acne?
Acne is a skin condition causing blemishes, pimples, plugged pores (blackheads and whiteheads), and larger lumps (nodules, cysts). It is the most common skin condition in the world. Nearly 80% of young people will face a breakout of acne. Acne affects both genders but young men are more likely to have more severe forms of acne.
Acne treatments do one or more of the following:
■Reduce sebum production
■Eliminate bacteria
■Improve skin exfoliation
■Reduce inflammation
What are Common Acne Medication
Many of the OTC products are topical and only address the overt clinical manifestation of Acne (pimples). With the exception of Accutane, which helps to decrease sebaceous gland secretions systemically administered Acne treatment drugs are restricted to broad-spectrum antibiotics, which non-specifically kill bacteria associated with Acne.
Topical OTC Treatments Benzoyl peroxide is the single most effective topical treatment of Acne and is available over-the-counter in preparations of 2.5% to 10% strengths (Clearasil Maximum Strength Cream, Clean and Clear, Oxy-10 Balance Maximum Medicated Face Wash, etc.). Available in lotion, gel, and cleanser forms, it should be used daily in order to be effective. Benzoyl peroxide targets bacteria in the skin. Salicylic acid products, are also available over-the-counter (such as Aveeno medicated cleanser, Neutrogena Clear Pore, Noxzema 2-in-1 Maximum Strength Pads, and Stri-Dex Clear Gel).
Prescription Drugs Systemic antibiotics such as tetracycline, minocycline, are mainstays of Acne therapy. For non-inflammatory Acne, two recent medicines for skin application are available, an anti-microbial cream Azelex, azelaic acid, which requires 4 weeks of treatment. Differin Cream, adapalene, is a retinoid-based topical medication with a recommended treatment phase of 8 to 12 weeks. Exacerbation of the existing skin condition is frequently observed with Differin prior to improvement.
For severe, persistent cases of Acne, Retin-A (tretinoin) Cream ($56.72 per tube) or Accutane (isotretinoin) oral tablets ($382.33 per month) are often recommended. Both products are retinoid derivatives and have a multitude of side effects. Accutane is a known potent teratogen and strictly contraindicated in women not practicing a proven method of birth control. Topical antibiotics such as Cleocin T (clindamycin solution) or erythromycin are often combined with benzoyl peroxide.
Summary
The treatment of Acne can be divided into two separate strategies. The first is the use of antibiotics, products that kill the microbes associated with Acne. These products are either administered either topically or orally. The oral antibiotics in particular are not specific for Acne and have systemic effects and side effects. The indiscriminate use of antibiotics is being strongly discouraged in the medical field due to the increasing appearance of bacterial resistance. The second strategy includes the use of topical cleansing or drying agents, and the retinoids. Only the retinoids are thought to directly effect the over-secretion of the sebaceous glands, which are considered the primary cause of Acne. Systemic use of retinoids (Accutane) is often considered the "last option" for the treatment of Acne due to its numerous side effects and in particular its teratogenic potential.
New Research- Common Acne Medication Doubles Risk of Eye Infections
As acne is multifactorial, it is important to use combination therapies to obtain the best results. The key to resolving acne is to comply with a treatment regimen and to understand that it takes time for acne lesions to resolve. There is no overnight cure. Typically it takes 6-8 weeks for improvement to be seen. Once acne does improve, treatment often needs to continue to prevent new lesions from forming. At ACC, an individualized treatment plan will be set up to treat your specific acne needs using the following therapies.
Millions of teenagers suffer from acne, and they deal with the embarrassing skin blemishes by taking popular prescription medications such as Accutane or Roaccutane. Now, however, research from Tel Aviv University shows that these pills can also cause eye infections such as conjunctivitis (pink eye) or sties. According to Dr. Gabriel Chodick of TAU’s School of Public Health at the Sackler Faculty of Medicine, clinicians have long theorized a connection between acne and eye infections, but there was little available statistical research on the subject. “Acne itself can increase the risk of ocular diseases,” he explains. “There is a greater tendency towards inflammation, and sometimes this leads to irritation.” His research revealed that patients who took these oral medications doubled the risk of developing an eye infection, compared to acne sufferers who did not. Published in Archives of Dermatology, the work was done in collaboration with Drs. Meira Neudorfer, Orna Shamai-Lubovitz and Varda Shalev from the Sackler Faculty of Medicine and Inbal Goldshtein from Maccabi Health Care Services.
The researchers looked at records of almost 15,000 adolescents from the Maccabi Health Care Services database, one of Israel’s largest health funds. They were divided into three groups: those who were acne-free; those who had acne but did not take oral medication; and those who had acne and were prescribed a medication such as Accutane or Roaccutane.Out of the 15,000 subjects, 1,791 people developed inflammatory ocular diseases, including 991 in the medicated group, 446 in the acne group, and 354 in the acne-free group. The most common infection was conjunctivitis, commonly called pink eye. Four percent of patients who were on acne medication contracted pink eye, compared to 2 percent for the normal population.“A very common side effect of Accutane and Roaccutane is dryness of skin and lips, so it’s only natural that these medications would also effect the lubrication of the eyelids — specifically the oil glands along the rim of the eyelid,” explains Dr. Chodick. Tears are crucial because they lubricate the surface of the eye and they wash away debris, including bacteria and viruses, that can lie on the eye or its lid. Infection of the gland itself can lead to sties, and more serious bacterial infections might lead to the swelling of the entire eyelid.
A simple solution
Though not a serious medical condition, acne is still worth treating, says Dr. Chodick. But dermatologists and patients should be aware of these side effects, because there is the potential for long-term damage. According to some studies, including one published in Clinical and Experimental Optometry, irritation and eye rubbing can lead to structural eye problems such as keratoconus, a degeneration of the cornea. Dr. Chodick advises that patients on oral acne medication ask their doctors how to minimize eye damage. One simple step is to use artificial tears, or eye drops, to keep the eyes lubricated. Local pharmacies can offer several inexpensive over-the-counter options, he says.
(Source-Published in Archives of Dermatology)
