For some female patients, treatment-resistant acne is caused by excessive production of hormones called androgens. With extra androgens in your system, your oil-producing glands go into high gear — and so does your acne. Several clues can help your doctor identify acne that may be influenced by hormones: acne that appears in adults for the first time; acne flare-ups preceding the menstrual cycle; irregular menstrual cycles; hirsutism (excessive growth of hair or hair in unusual places); and elevated levels of certain androgens in the blood stream.
Adult women and teenage girls whose acne has resisted treatment with antibiotics or topical retinoids may be candidates for hormonal therapy. Once a patient’s acne is identified as hormonally influenced, the doctor will be able to prescribe a number of different therapies, or perhaps a combination of several different drugs; “combination therapy” is often the best approach to this kind of acne. Following are a few common components of therapy for hormonal acne, but remember to consult your doctor before using any of the remedies listed here.
Acne / Birth Control Pill – Oral contraceptives. Birth-control pills (a combination of estrogen and progestin taken orally) are often prescribed for hormonal acne. Low doses of estrogen help suppress the androgens produced by the ovaries, and the newer progestin agents, including desogestrel and norgestimate, are less androgenic than those found in older formulations. While only Ortho Tri-Cyclen and Estro-Step are currently approved by the FDA for this indication, experts agree that low-dose contraceptives improve acne regardless of which formula is used. Consult your gynecologist to find the formula that’s right for you. While side effects are uncommon, some women may experience brownish blotches, or melasma (hyperpigmentation) on the skin. These can be treated with topical bleaching agents.
Acne / Birth Control Pill – Anti-androgens. In combination with oral contraceptives, doctors also may prescribe an anti-androgen ; these drugs inhibit androgen production in the ovaries and adrenal glands and help prevent existing androgens from causing excessive oil production. Spironolactone, a high blood pressure medicine with anti-androgenic properties, has proven quite effective in the treatment of acne. Side effects may include breast tenderness, menstrual irregularities (in women not using oral contraceptives), headache and fatigue; since it’s also a diuretic, you may experience frequent urination as well.
NOTE: Spiranolactone is tetrogenic and can cause feminization of a male fetus. If you are sexually active and not taking “the pill,” it’s imperative that you use another form of birth control.
Acne / Birth Control Pill – Corticosteroids. Small doses of corticosteroids, like prednisone or dexamethasone, may curb inflammation and suppress the androgens produced by the adrenal glands. Keep in mind that in some acne sufferers, corticosteroids may actually aggravate acne; they’re most effective when used in combination with oral contraceptives.
In conclusion, if you think your acne is hormonally induced, see your doctor right away. While this kind of acne requires a different course of treatment, it is highly treatable. More about your hormones.
For patients who suffer from moderate to severe acne, doctors may prescribe a combination of topical remedies and oral antibiotics. The most common oral medications used to treat acne are tetracycline, minocycline, doxycycline and erythromycin.
Antibiotics for Acne – HOW THEY WORK
Like Benzoyl Peroxide, antibiotics control breakouts by curbing the body’s production of
P. acnes, the bacteria that causes acne, and decreasing inflammation. This process may take several weeks or months, so be patient. And remember, you’re not “cured” just because your breakouts have subsided. That’s the medicine doing its job — so if you stop taking it, your acne will probably come back. Likewise, doubling up on your medication won’t make your skin clear up twice as fast. Using your topical antibiotics more frequently than prescribed may actually induce greater follicular irritation and plugging, which slows clearing time. And taking your oral medications more often than prescribed won’t help your skin clear faster — but it will increase your chance of experiencing unpleasant side effects.
Antibiotics for Acne – WHERE TO GET THEM
If you have moderate to severe acne, consult your dermatologist; he or she will discuss your options and help you make the best choice. Once you’ve begun treatment, give it time to start working. Keep your doctor apprised of your progress, so he or she can make changes to the course of treatment if necessary. And again, don’t stop using your medication when your skin clears — let your doctor make that call.
Antibiotics for Acne – COMMON SIDE EFFECTS
With most of the antibiotics used to treat acne, side effects may include photosensitivity (higher risk of sunburn), upset stomach, dizziness or lightheadedness, hives, lupus-like symptoms and skin discoloration. Some women report a higher incidence of vaginal yeast infection while taking antibiotics; these can usually be treated with over-the-counter antifungal medication or a prescription antifungal, such as diflucan. Tetracycline is not given to pregnant women or children under 12 years of age because it can discolor developing teeth. Lastly (and least common), because doxycycline is also the treatment of choice for Lyme disease, there is the theoretical possibility that a patient who takes this medication for a long period of time would build a resistance, and therefore be unable to fight Lyme.
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