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The most commonly used antibiotics are:
Tetracycline
Minocycline
Doxycycline
Erythromycin
Trimethoprim
Azithromycin
Isotretinoin (Accutane®): Isotretinoin (Accutane®) is a retinoid or vitamin A analog, which means that its molecular structure is similar to Vitamin A. It was first approved in the US in 1982. Capsules come in either 10mg or 40mg doses.
How do I use this medication?
You should take capsules as directed with fat-containing food. (For example with 2% or whole milk) The fat in the food helps the acne medication to be fully absorbed so that enough can be delivered to your skin to make it effective.
Women who are of childbearing age need to use two reliable forms of contraception while taking this medication, and for one month after completing the treatment.
How well does it work?
For severe acne, it cures approximately 35-38 percent of patients after one course of treatment.
70 percent of the people who take Accutane® experience long-term remission.
Adult women have higher relapse rates than teenagers.
One course of treatment will take on average, 4-6 months.
The daily dose is most often determined at 0.5 - 1mg per kg of your body weight.
The total dose, that is, the total amount taken over the whole treatment period should be not less than 120mg per kg of body weight for long lasting benefit.
If you have very oily skin and giant blackheads, are a younger teenager, or have acne on your chest and back, then you have a greater chance of having a relapse of your acne.
Most dermatologists believe it is a remarkable acne medication.
Some people's acne clears quickly while in others improvement is gradual.
Multiple courses can be taken.
How does it work?
Isotretinoin basically helps the sebaceous gland to mature. It does so in several ways. Testosterone drives this oil gland to produce a number of different oils that influence the lining of the hair follicle. Accutane® brings the amount of oils to a more normal level and helps to change the composition of the oil so that it does not allow the pores to clog up. It prevents an excess of keratin from being produced, which means that comedones are not so readily formed.
This is the most effective therapy currently available. It can be used to treat your acne, if it is severe, and will reduce the risk of scarring. However, only doctors who have experience in its use should prescribe this medication. This is because regular monitoring, including periodic blood testing, is necessary. Women and girls who are using this medication must follow the manufacturer's Pregnancy Prevention Program.
Acne Approved Hormone Therapy
ALESSE® - 0.020mg EE + 0.10mg levonorgestrel
This has been shown to have a superior anti-acne effect when compared to placebo. It has a lower estrogen dose (0.020mg) than most other oral contraceptives, which may reduce the potential cardiovascular side-effects of estrogen. Furthermore, trials show that weight gain does not appear to be a side-effect of with this pill.
Two placebo-controlled parallel, double blind, randomized trials involving 700 women in the reproductive age group treated for 6 months showed a 46% reduction of inflammatory lesions when compared to 29.3% for the placebo group. (In: Gynecological Endocrinology 24:RT61 (2000).
ORTHO-TRICYCLEN® - 0.035mg EE + norgestimate
This is a combination of ethinyl estradiol (0.035mg) and norgestimate in increasing doses of 0.180mg, 0.215mg, and 0.250mg. Two clinical studies, involving 507 women with moderate acne, showed that this medication provided significant improvement of their acne after 6 months of therapy compared to those using a placebo. Orhto-tricyclens are approved in the USA and Canada for acne.
In another study, 256 women with moderate acne were given Ortho-Tricyclen® or placebo for 6 months. Among the women taking Ortho-Tricyclen®, 53.1% had their acne completely cleared up, compared to 26.8% of those using the placebo.
DIANE-35® - 0.035mg ethinyl estradiol (EE) + 2.0mg cyproterone acetate (CPA)
Cyproterone acetate acts as an anti-androgen. Multiple clinical studies have shown that this medication is effective for the treatment of acne. Diane-35® is approved in Canada and has been approved for two decades in Europe. (Note: This product is not approved by Health Canada for the indication of oral contraception.) Results have shown that Diane-35® is as effective as oral tetracycline or minocycline after 6 months of use.
Topical Acne Treatments
The most commonly used topical acne treatments include:
A) Benzoyl Peroxide: can improve acne by killing the acne bacteria and by unblocking oil gland pores.
B) Retinoids: This acne medication is used to unblock the pores of oil glands, and is usually the first choice of treatment for whiteheads and blackheads.
Types of retinoids include:
Tretinoin (Steiva-A®, Retin-A®, or Avita® cream/gel, and Vitamin A Acid®)
Adapalene (Differin® 0.1% cream or gel solution)
Tazortene (Tazorac® Gel 0.05%, 0.1%)
C) Topical Acne Antibiotics, including:
Clindamycin
Erythromycin
Sulfacetamide
D) Azelaic acid: Has antibacterial and anti-inflammatory properties
E) Combination topical products, such as:
Topical retinoid with erythromycin (Stievamycin® by Stiefel)
Topical benzoyl peroxide with erythromycin (Benzamycin® by Dermik)
Topical benzoyl peroxide with clindamycin (BenzaClin® by Dermik)