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for treating Acne CBC
Register or Log in to take part in quizzes. Don't have an account? Register to use all the features of this website, including selecting clinical areas of interest, taking part in quizzes and much more. This item is 5 years and 8 months old; some content may no longer be current. Oral isotretinoin is a highly effective treatment for severe acne, however it is associated with a number of adverse effects, including teratogenicity, increased blood lipids, and transient increases in liver enzymes.
Isotretinoin can be prescribed by General Practitioners under Special Authority criteria. Prior to March , isotretinoin was only available fully subsidised if prescribed by a registered dermatologist.
This report summarises the testing recommendations for patients starting a course of isotretinoin using data from the Ministry of Health National Collections, between July and June Between July and June , primary care registered patients in New Zealand started a course of isotretinoin. Patients in this report may also have had previous courses of treatment with isotretinoin. Your doctor should perform these tests periodically, but especially a month later, to make sure everything is in order.
If you have a hot date coming up, be warned -- no treatment will work right away. You'll see a gradual difference in a few weeks, although it could take months for your skin to really clear up. Most dermatologists recommend sticking with a treatment for one to two months before making a change.
However, if something clearly isn't working, you should ask about trying something else -- many strains of bacteria involved in acne have become resistant to certain antibiotics, and you could have a stubborn strain.
If you feel depressed about your progress, don't hesitate to ask for help. Having severe acne can be tough -- although it will certainly get better with treatment -- and some people need psychological support as well. Wash your skin twice a day gently with water and a mild soap, but don't overdo it. Using a harsh soap and scrubbing too hard can actually make acne worse, and toners with alcohol can overdry your skin, especially if you're using other strong acne treatments.
After a hard workout, shower and shampoo right away so sweat doesn't combine with surface oils to block pores. Be sure to use skin-care products that won't clog your pores these are sometimes labeled "non-comedogenic" such as oil-free skin creams and sunscreens.
Also, some hairsprays and styling products can irritate your skin -- see what happens if you stop using them for a while, or switch brands if you can't tame your hair without them.
Shaving can be tricky when you have to navigate bumps and pits on your face. Electric razors can give you a close shave over scarred skin with less chance of nicking yourself. If you use a safety razor, be sure to soften the skin with soap and warm water before using shaving cream. Shave as lightly as possible on inflamed or scarred areas, and always use a sharp blade. Dermatologists and plastic surgeons have a host of methods to repair skin scarred by acne. Chemical peels employ an acid to dissolve the superficial top layers of damaged skin.
In dermabrasion, a wire brush buffs or sands down irregular acne scars. Microdermabrasion is a technique in which aluminum oxide crystals are used to gently scrape away the scarred skin. Repeated treatments may be needed. Lasers are used to fix complex scars by vaporizing the outer layers of skin so the underlying skin will eventually heal more tightly and smoothly.
Doctors can also inject fat or other filler substances into depressed scars to soften the scar tissue and lessen the pitting. Questions and Answers About Acne. American Academy of Dermatology. Acne By Deepi Brar, M. Why do I have acne? Why are boys more likely to get it? What else can cause a breakout? Lots of other things can trigger acne-like rashes or aggravate a breakout, including: Changing hormone levels, especially during puberty, menstruation, and pregnancy Hot, humid weather Sweat, pollution, and smoke Pressure or friction on skin from tight collars, telephones, hats or bike helmets Greasy or oil-based lotions, cosmetics, and hair products Some medications: Lithium Eskalith, Lithane , steroids, and hormones such as testosterone and estrogen What about stress?
I'm way past my teenage years-- so why do I still have acne? How can acne be treated? Different ingredients do different things: Benzoyl peroxide has an antibacterial effect and also helps dry out the oil that bacteria feed on. Doxycycline and minocycline are first-line drugs; both can be taken with food.
Tetracycline is also a good first choice, but it cannot be taken with food and may have lower efficacy than doxycycline and minocycline.
Doxycycline and minocycline dosage is 50 to mg po bid. Doxycycline may cause photosensitivity, and minocycline may have more adverse effects with chronic use, including drug-induced lupus and hyperpigmentation. Tetracycline dosage is or mg po bid between meals. To reduce the development of antibiotic resistance after control is achieved usually 2 to 3 mo , the dose is tapered as much as possible to maintain control. Antibiotics may be discontinued if topical therapy maintains control.
Erythromycin and azithromycin are other options, but they can cause GI adverse effects and antibiotic resistance develops more often. Long-term use of antibiotics may cause a gram-negative pustular folliculitis around the nose and in the center of the face. This uncommon superinfection may be difficult to clear and is best treated with oral isotretinoin after discontinuing the oral antibiotic.
Ampicillin is an alternative treatment for gram-negative folliculitis. In women, prolonged antibiotic use can cause candidal vaginitis; if local and systemic therapy does not eradicate this problem, antibiotic therapy for acne must be stopped.
Oral isotretinoin is the best treatment for patients with moderate acne in whom antibiotics are unsuccessful and for those with severe inflammatory acne.
If adverse effects make this dosage intolerable, it may be reduced to 0. After therapy, acne may continue to improve. Most patients do not require a 2nd course of treatment; when needed, it is resumed only after the drug has been stopped for 4 mo, except in severe cases when it may be resumed earlier.
Retreatment is required more often if the initial dosage is low 0. With this dosage which is very popular in Europe , fewer adverse effects occur, but prolonged therapy is usually required. Isotretinoin is nearly always effective, but use is limited by adverse effects, including dryness of conjunctivae and mucosae of the genitals, chapped lips, arthralgias, depression, elevated lipid levels, and the risk of birth defects if treatment occurs during pregnancy.
Hydration with water followed by petrolatum application usually alleviates mucosal and cutaneous dryness. Increased risk of depression and suicide is much publicized but probably rare. It is not clear whether risk of new or worsened inflammatory bowel disease Crohn disease and ulcerative colitis is increased. CBC, liver function, triglyceride, and cholesterol levels should be determined before treatment. Each should be reassessed at 4 wk and, unless abnormalities are noted, need not be repeated until the end of treatment.
Triglycerides rarely increase to a level at which the drug should be stopped. Liver function is seldom affected. Because isotretinoin is teratogenic, women of childbearing age are told that they are required to use 2 methods of contraception for 1 mo before treatment, during treatment, and for at least 1 mo after stopping treatment.
Pregnancy tests should be done before beginning therapy and monthly until 1 mo after therapy stops. Intralesional injection of 0. Local atrophy may occur but is usually transient. For isolated, very boggy lesions, incision and drainage are often beneficial but may result in residual scarring. Pyoderma faciale is treated with oral corticosteroids and isotretinoin.
Acne conglobata is treated with oral isotretinoin if systemic antibiotics fail. For acne caused by endocrine abnormalities eg, polycystic ovary syndrome, virilizing adrenal tumors in females , antiandrogens are indicated.
Cyproterone acetate is used in Europe. Small scars can be treated with chemical peels, laser resurfacing, or dermabrasion. Deeper, discrete scars can be excised. Wide, shallow depressions can be treated with subcision or injection of collagen or another filler. Fillers, including collagen, hyaluronic acid, and polymethylmethacrylate, are temporary and must be repeated periodically.
Oral antibacterial therapy for acne vulgaris: Am J Clin Dermatol 18 4: High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol Guidelines of care for the management of acne vulgaris from the American Academy of Dermatology.
If noninflammatory, acne is characterized by comedones and, if inflammatory, by papules, pustules, nodules, and cysts. Recommend that patients avoid triggers eg, occlusive cosmetics and clothing, cleansers, lotions, high humidity, some drugs and chemicals, possibly a high intake of milk or a high-glycemic diet. Prescribe a topical comedolytic eg, tretinoin plus, for inflammatory acne, benzoyl peroxide , a topical antibiotic, or both. Prescribe an oral antibiotic for moderate acne and oral isotretinoin for severe acne.
Treat cystic acne with intralesional triamcinolone as needed for acute lesions. Tap to switch to the Consumer Version. This is the Professional Version. Click here for the Consumer Version. Acne and Related Disorders Acne Vulgaris. Acne occurs through the interplay of 4 major factors: Colonization of follicles by Propionibacterium acnes a normal human anaerobe. Characterized by papules, pustules, nodules, and cysts. The most common trigger is. Hormonal changes that occur with pregnancy or the menstrual cycle.
Assessment for contributing factors eg, hormonal, mechanical, or drug-related. Classification of Acne Severity Severity. Oral antibiotic plus topical therapy as for mild acne. Drugs Used to Treat Acne Drug.
Laboratory testing for isotretinoin
No tests are necessary for most patients with acne. Tests may be requested to look for infection, to investigate the cause of the disease, or to monitor treatment. Acne with reactive hyperpigmentation; before treatment. . Once a level dose is used and the lipids, liver enzymes, and CBC count are normal. Oral isotretinoin is a highly effective treatment for nodulocystic acne; for lipid levels, complete blood cell count (CBC), and liver function tests.