For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin (Accutane*), a retinoid. Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. Retinoids increase penetration and reduce comedones, while topical antibiotics primarily address inflammation. One side effect of topical antibacterial treatment is an increase in drug-resistant resident skin flora with gram-negative microorganisms prevailing, which can lead to gram-negative folliculitis. Topical retinoids work by increasing skin cell turnover promoting the extrusion of the plugged material in the follicle. They also prevent the formation of new comedones.
The patient should be told to wash his or her face with mild soap and to then wait 20 to 30 minutes before applying the retinoid. This helps reduce irritation. For patients with severe inflammatory acne that does not improve with medicines such as those described above, a doctor may prescribe isotretinoin (such as Accutane), a retinoid. Isotretinoin is an oral drug that is usually taken once or twice a day with food for 15 to 20 weeks. I am hesitant to take retinoids but it may be my only hope.
Adapalene (Differin) is a topical retinoid that was labeled by the FDA in 1997. Its mechanism of action is similar to that of tretinoin. It is often best to apply at night with a topical retinoid (e.g. The retinoids also enhances absorption of the other medications. Sometimes irritation reactions limit the use of this combination therapy.
Several formulas of topical retinoids are also extremely effective against acne. Common side effects from these medications is dryness and burning which can be minimized by applying medication to completely dried skin after washing and applying only the minimum of the medication necessary. The doctor may also prescribe newer retinoids or retinoid-like drugs, such as tazarotene or adapalene, that help decrease comedo formation. Many therapeutic options exist for treating acne, including topical benzoyl peroxide, topical and oral antibiotics, topical and oral retinoids, and oral contraceptives. Systemic antibodies also have anti-inflammatory and immunomodulatory properties.
Topical therapies for treating acne vulgaris include benzoyl peroxide, topical retinoids (tretinoin, adapalene, and tazarotene), and topical antibiotic agents (azelaic acid, erythromycin, clindamycin, sodium sulfacetamide). Systemic therapies include systemic antibiotic agents (erythromycin, tetracycline, doxycycline, minocycline), hormonal therapy (oral contraceptives, spironolactone), and oral isotretinoin.
They can cause birth defects if mothers are taking them when pregnant, so females must use two forms of birth control if they are under retinoid treatment. They can also cause liver damage and depression, so regular medical attention is needed to make sure the patient is not being adversely affected by retinoid treatment. Topical retinoids clear up moderate-to-severe acne by normalizing the way the skin grows and sheds. They can be used in combination with other acne products, such as benzoyl peroxide, and oral antibiotics. With some medications for acne, like retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. Patients should report prolonged or severe side effects to their doctor.