Tazarotene Tazorac gel is a retinoid product that the FDA has labeled for use in the treatment of psoriasis and mild to moderate acne. It comes in a 0. Studies comparing tazarotone with vehicle alone have shown that the medication is effective in treating noninflammatory acne lesions. Although comparative drug trials have not been performed, tazarotene and the standard form of tretinoin appear to have similar irritation rates.
The use of tazarotene in pregnant women is not recommended. Topical antibiotics work directly by killing P. Through their bactericidal activity, they also have a mild indirect effect on comedogenesis.
These agents are available in a variety of forms and are applied once or twice daily. Topical erythromycin and clindamycin Cleocin T are the most commonly used agents and have similar efficacy in patients with acne.
Almost all topical antibiotics are associated with some minor skin irritation. This adverse effect may be influenced by the vehicle used. Combination therapy is often employed when patients have a mixture of comedonal and inflammatory acne lesions. Because adequate clinical studies are lacking, it is difficult to compare various combination therapies. The combination of 5 percent benzoyl peroxide and 3 percent erythromycin Benzamycin is a highly effective acne treatment.
The agents come unmixed, and the pharmacist or patient must combine the erythromycin powder with the benzoyl peroxide gel. The mixture must be refrigerated. The benzoyl peroxide—erythromycin mixture is then applied to affected areas once or twice daily. This mixture has been shown to be superior to either product alone 26 and to clindamycin monotherapy.
The combination of 5 percent benzoyl peroxide and 1 percent clindamycin in a premixed gel has also been studied.
This combination gel has been found to be superior to vehicle and to both agents alone in the treatment of inflammatory and noninflammatory lesions, with equal tolerance. Other combination therapies may lack convenience but are also effective. In the patient with comedones and inflammatory lesions, a comedolytic agent such as tretinoin, adapalene or azelaic acid may be combined with benzoyl peroxide or a topical antibiotic. The combination of clindamycin and tretinoin causes less irritation than tretinoin alone.
When agents that cause irritation are used, patience is necessary, but the results may be well worth the wait. The therapeutic approach to acne should begin with patient education. It is important to dispel the many myths about this disorder. Patients need to know that acne is not a disease of hygiene. They should not try to scrub the lesions away, and they should not use alcohol-based astringents that can dry and irritate their skin.
Patients should be instructed to wash their face twice a day with a mild soap and water. Patients should also be informed that acne has no relationship to diet. For example, no evidence links acne to chocolate, pizza or soda. Many people think that acne is caused by stress, but no studies support this association.
It may be that the acne itself causes stress, not vice versa. Cosmetics have long been blamed for the development of acne lesions. Although the causal relationship between cosmetics and acne may be overstated, patients should be directed to use oil-free, noncomedogenic cosmetics.
Oil from hair products and suntan lotions can also exacerbate acne. Mechanical trauma can make acne worse. Therefore, patients should be encouraged to avoid picking at lesions, because doing so may cause more inflammation.
The physician needs to consider a number of factors in choosing a treatment regimen for the patient with acne. These factors include cost Table 2 , patient skin characteristics and types of lesions. An algorithm for the suggested management of acne is presented in Figure 5. Generic 5 percent gel. Generic 10 percent gel. Benzac 5 percent gel. Benzac 10 percent gel.
Cleocin T 1 percent solution. Cleocin T gel. Clinda-Derm 1 percent solution. Eryderm 2 percent solution. T-Stat 2 percent solution. Montvale, N.
Cost to the patient may be greater, depending on prescription filling fee. Patients with drier skin may benefit most from creams, whereas patients with oilier skin may do best with gels or solutions. Picking the appropriate vehicle can lead to better compliance by limiting side effects. In patients with comedonal acne, it may be best to initiate treatment with tretinoin or adapalene.
Salicylic acid is a less effective but more affordable alternative. The strength of the chosen formulation should be titrated upward as needed, and patients should be instructed that maximal benefit may not be achieved for four to six months.
Patients with mild inflammatory acne should be started on a twice-daily regimen of an antibacterial agent such as benzoyl peroxide, azelaic acid or a topical antibiotic.
They need to know that treatment of their acne will require time and patience. Therapy should be continued until new lesions no longer appear. In patients with more moderate inflammatory acne, the physician needs to decide whether to use topical therapy, systemic therapy, or both. If topical therapy alone is chosen, an anticomedonal agent and an antibacterial agent should be used. Possible choices include a topical retinoid and a topical antibiotic, or a retinoid and the benzoyl peroxide—erythromycin combination.
Topical antibiotics might be used in patients who are being weaned from oral antibiotics. The physician should not try to treat cystic acne topically but should use systemic antibiotics or isotretinoin Accutane. All patients with acne should be given realistic expectations about their treatment plan, along with good follow-up.
These measures can contribute to the ultimate success of treatment. Already a member or subscriber? Log in.
This feels like a really bad, persistent headache, along with nausea, vomiting, and problems with vision. It should be brought to the attention of your doctor immediately. You should also not take vitamin A in high doses while on oral isotretinoin therapy because it is in the same class of compounds and the combination can increase the risk of toxicity. It is uncommon to prescribe other anti-acne medications with oral isotretinoin; however, some dermatologists co-prescribe a nontetracycline antibiotic such as erythromycin for the first month of therapy.
Because most topical acne treatments are at least somewhat drying or irritating, they should be discontinued within 1 month of starting oral isotretinoin treatment. Topical exfoliating agents, retinoids, and drying agents should be avoided because isotretinoin has a drying effect on the skin and mucous membranes.
I take a shower. I get out. While drying off, I notice the veins in my arms and legs, neon blue webbing across my hands and feet, sticking out, throbbing, this overwhelming knowledge that there are miles of tunnels in my body, forever pulsing blood. They all hurt. I run through the possibilities. My veins might … pop out of … my skin? Is this possible? I consult Google. I remember one of the conflicting things I read in my hours of research, that Accutane makes the skin thinner by something like three cells.
In the fourth month, I realize something. I am depressed. But school begins and things are worse. It finally hits me. I am reluctant to quit. As someone who weighs 60 kg, I need to take Accutane for six months.
I go back to the scholarly journals to see how likely a relapse would be. I find studies suggesting that the medication is effective at a much lower dose — about half what the older studies recommend. But as I comb through the numbers, I read the relapse rate is sometimes as high as 50 percent, a much different percentage to a scientist than to someone who has suffered from acne for decades.
I can go a couple more months. I fail to mention, though, the time I was driving home from work and had to resist plowing my car into the concrete divider. I fail to mention how this reminds me of the time I was on antidepressants, when I was constantly followed by visions of my death — slashed wrists in a grocery store, car crashes, drownings. That time ended in a hospital. I know what is causing my depression. I know not to act on it.
I just have to use my coping mechanisms, the things I picked up in the decades of therapy: write, exercise, take baths. I tell the doctor this. He gives me another prescription. Shamban says. However, she notes that if you started with dry or extra-sensitive skin, there are new acne medications that won't irritate you and still be effective.
Just make sure you ask your dermatologist what your options are. Joining those match-made-in-heave. Honestly, there are almost too many brands vying for our attention via enticing Instagram ads, eleva.
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