|
Acne
treatments are directed at reducing sebum
production, blackhead formation, inflammation, and infection
Selection of treatment is generally based on severity; options
are:
Drugs Used to Treat Acne
affected areas should be cleansed daily, but extra washing,
use of antibacterial soaps, and scrubbing results in no
added benefit. Changes in diet are also unnecessary and
ineffective. Peeling agents such as sulfur, salicylic acid,
and resorcinol are minor therapeutic Acne remedies.
Some antibiotics and accutane have been used with good results.
Mild
acne:
Single-agent
therapy is generally sufficient for blackhead acne; pustules
generally requires dual therapy (eg, the combination of
RETIN-A with benzoyl peroxide or topical antibiotics). Acne
Treatment should be continued for 6 wk or until lesions
reveal good results. Maintenance treatment may be necessary
to maintain control.
A
commonly used topical for treatment for comedones (blackheads)
is daily topical tretinoin.
RETIN-A
in increasing concentrations as tolerated. Daily use of
adapalene gel, tazarotene cream or gel, azelaic acid cream,
and glycolic or salicylic acid in propylene glycol are alternatives
for patients who cannot tolerate topical tretinoin.
Adverse effects include redness, burning, stinging, and
peeling. Adapalene and tazarotene are retinoids. Retin-A
tend to be somewhat irritating and causes sensitivity to
light. Azelaic acid has blackhead and antibacterial properties
by an unrelated mechanism and may be synergistic with retinoids.
Mild
inflammatory acne should be treated with topical benzoyl
peroxide, topical antibiotics (eg, erythromycin, clindamycin0
CLEOCIN and/or glycolic acid. Combinations of these agents
may help slow down development of resistance to these combinations.
None have significant adverse effects other than drying
and irritation of the skin (and rare allergic reactions
to benzoyl peroxide).
Physical
extraction of blackheads using a comedone (blackhead) extractor
is an option for patients who don't respond to topical treatments.
Blackhead extraction may be performed by a physician, nurse,
or physician assistant. One end of the blackhead extractor
is like a blade or bayonet that punctures the closed blackhead.
The other end applys pressure to extract the blackhead.
Oral
antibiotics that are prescribed for acne:
ACHROMYCIN V
TETRACYN
TETREX
MINOCIN
doxycycline
PERIOSTAT
VIBRAMYCIN
erythromycin can be prescribed when topical applications
are not working.
Moderate
acne:
Moderate
acne responds best to oral antibiotics. Antibiotics
effective for acne include tetracycline ACHROMYCIN V TETRACYN
TETREX minocycline erythromycin, and doxycycline PERIOSTAT
VIBRAMYCIN Full benefit takes greater than12 wk.
Tetracycline
is usually a good first choice: 250 or 500 mg bid (between
meals and at bedtime) for 4 wk or until lesions respond,
after which it may be reduced to the lowest effective dose.
Rarely, dosage must be increased to 500 mg 4 times a day,
Because relapse ordinarily follows short-term treatment,
therapy must be continued for months to years, although
for maintenance tetracycline, ACHROMYCIN V TETRACYN TETREX
ACHROMYCIN V TETRACYN TETREX
250 or 500 mg once/day is often successful.
50 or 100 mg twice a day causes fewer stomach upsets, is
easier to take, is less likely to cause sensitivity to light,
but is the most costly choice.
PERIOSTAT
VIBRAMYCIN because both can cause GI upset.
|
