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a commonsense guide to effective acne treatments
by
David Collins
Disclaimer
The information in this guide comes from
my own experience, the experience of other sufferers, published information,
and medical sources.
It is as accurate as I can make it. However this information is not a substitute for seeking help from your doctor, and I would advise you to do so.
ver 1.0
© David Collins 1999. All rights
reserved. No part of this book or the original file shall be reproduced, stored
in a retrieval system, or transmitted by any means electronic, mechanical, photocopying,
recording or otherwise, without written permission from the author. Although
every precaution has been taken in the preparation of this information, the
author assumes no liablity for any errors or omissions. Neither is any liability
assumed for damages resulting from the use of the information contained herein.
Contents |
Page |
Introduction | 2 |
Acne Basics | 3 |
Psychological problems | 4 |
Over-the-Counter medications | 4 |
What your doctor can prescribe | 5 |
Benzoyl Peroxide compounds |
5 |
Retin-A |
6 |
Antibiotics |
7 |
Dapsone and Dianette |
10 |
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Accutane/Roaccutane |
11 |
Seeing your doctor and the dermatologist | 14 |
(Accutane/Roaccutane) |
|
Warnings |
15 |
Side effects |
15 |
Roaccutane face |
16 |
Mood swings |
17 |
Tiredness |
18 |
Hair Loss |
18 |
Get a pen-pal |
18 |
Post-acne facial reconstruction | 19 |
Diet | 20 |
Diet myths | 21 |
The results of Roaccutane/Accutane | 22 |
Maintenance doses | 23 |
Some natural remedies I can recommend | 23 |
Appendices: | |
1. Checklist for a course of Isotretinoin |
24 |
2. Dosage chart |
25 |
3. Medical abstracts | 25 |
Contacts | 34 |
Introduction
I suffered from acne for 25 years. In my
teens it was horrible. I had a pizza face in glorious technicolour. It
certainly didn’t do my self-esteem any good, and in those days doctors
just told you that you would "grow out of it". So I tried all the over-the-counter
preparations that existed, to conclude that they were marginally effective
at best, but mostly useless. In my twenties my acne settled down to being
"mild". Yep, the medical profession has a scale of how bad it is, going
from mild to severe. I have one too, from "disgusting but tolerable" to
"omigod it’s a breakout". For many years doctors did not take it seriously.
And I think acne sufferers colluded in this by suffering in silence. I
know I did. I kept telling myself that it wasn’t life-threatening; that
it was hardly noticeable, that other people had it much worse than me....but
I was deluding myself, as it was causing continuous, if low level, psychological
pain.
I then went on to antibiotics for about 5
years. These definitely were an improvement, but if I stopped taking them,
the acne returned,and I reasoned that they were just suppressing the symptoms,
not treating the cause. I kept up with the medical reports, and there were
talk of the new drug isotretinoin (Accutane/Roaccutane) which finished
off acne completely, but had terrible side effects.
The Porsche test
I have a test, the Porsche test... I have
now talked to quite a number of acne sufferers, from the very mildly afflicted
to the poor sods with severe acne, and I ask them which they would rather
have, a brand new Porsche or clear skin. Their answer is always the same
as mine: clear skin. Not one would go for the Porsche.
In this book I am going to tell you about
all the possible acne treatments, and as I’ve had most of them, the view
from the horse’s mouth. Or the view of the horse’s skin, all right, I’ll
shut up and give you my recommendation, first and foremost, is to get (Ro)
Accutane now! I’d say it is the treatment of first resort, not last, ‘cos
it works. Given that the medical profession moves in mysterious ways, I
enclose details of methods to pressure your doctor into getting you it.
Forget the scare stories: you are trading long-term psychological pain
for short-term mild discomfort - I reckon that’s a good bargain, and the
knowledge in this pamphlet will help you minimise the side-effects and
help you through the difficult six months of the course.
You can go through this book in chronological
order, or jump straight to section about Accutane/Roaccutane. All the advice
in here is either my own or from other sufferers like ourselves. But it
is not a substitute for talking to your own doctor. So please consult him
or her about your condition.
Acne Basics
Acne is caused by hormones making the normal
sebaceous glands which lubricate the skin go wild. They produce great amounts
of oil, which clogs up the tunnel leading to the surface - the pore - and
you get white or blackheads. This allows the completely normal P. acnes
bacteria which live on your skin to multiply in the blocked pore and you
get zits and cysts. Blackheads are not dirt, they’re pores blocked with
dried oil (sebum) and dead skin cells, that’s why washing doesn’t get rid
of them.
It’s horrible. Usually - but not always - it starts in adolescence, and should die away by the time you’re about 22. Or so the medical statistics have it.
Nonetheless that doesn’t mean that you have
to suffer it as a teenager, you still should go for treatment, though a
relapse on Accutane/Roaccutane is more likely the younger you are. If you’ve
reached 22 + and it isn’t going away you’ve got clinical acne, a recognised
disease, and need proper medical treatment.
But a number of people have acne that is
severe, doesn’t go away (or bursts out again at the menopause or pregnancy).
Some women get horrible flare-ups at period time. I suffered it for years;
and it was only "mild" by clinical standards. I reckon anyone with it worse
than that (the scale continues from "moderate" to "severe") should go straight
to the dermatologist, do not pass Go, and get treated. I base this on my
own experiences and those of other sufferers. You don’t want to look like
crap all the time.
Remember doctors don’t know what you’re feeling.
Many of them are not attuned to the grief that acne causes, though this
attitude has improved in recent years. I am looking at a medical publication
to help (!) acne patients right now, and it has splendid pictures of how
you define "moderate" and "severe" acne. It’s painful to look at them.
Their idea of moderate (which I looked like at 17), is my idea of never
mind the topical antibiotics, start them on oral isotretinoin now!
This guide to acne (written in 1995, and
trying hard to be helpful), talks about managing clinical acne. If your
acne doesn’t go away and you see the doctor, you do not want your acne
managed, you want it effing cured.
There’s only one treatment that actually
cures acne that hasn’t gone away by itself and that is Isotretinoin (Accutane/Roaccutane).
In my twenties and thirties I had mild acne; Roacc was only given to "severe"
patients, and I was too ashamed to go to see the doctor - I used all the
over the counter medications I could find and they’re crap. On the basis
of this, I recommend anyone reading this, and by my reckoning you are suffering
psychological distress, or you wouldn’t have bought it, should go to the
doctor, armed with my arguments below. It’s the most sensible thing to
do. Don’t suffer in silence like me. If you don’t feel assertive, or think
your doctor will not be responsive, take a sympathetic friend and ask them
to be an advocate on your behalf. Dermatology specialists, generally, are
much more aware of the problem than your ordinary doctor and so once you
get to see them, you should be alright.
Psychological problems
If you don’t want to go out in daylight, avoid going swimming, can’t face looking at yourself in the mirror, suffer from depression, you are not alone:
"low self-esteem, picking spots with a kind of masochistic satisfaction, and depression are experienced (in all degrees) by acne sufferers in general"
(Acne Support Group Newsletter). In a questionnaire the A.S.G. found that
84% of the 645 respondents felt that their
socialising had suffered because of their acne, and 72% felt that their
relationships had been affected by the disease. 50% avoided sports, 46%
avoided leisure activities, 28% avoided work and 1% avoided "everything".
I also know female sufferers who are obsessive about makeup and will not
be seen without it to cover up. You are suffering from a serious problem,
not something trivial.
But this is not primarily a psychological
problem. It all stems from the physical: if that is cured then the other
problems will diminish or vanish. if they don’t after you have had proper
medical treatment, then is the time to seek counselling or therapy.
Over-the-Counter medications (OTC) that you
buy in the pharmacy, chemist or drugstore
Marginally effective at best, expensively
useless at worst. They are usually either anti-bacterial washes or exfoliants
containing benzoyl peroxide (see below) or salicylic acid in low concentrations
(look at the label). The anti-bacterial washes sometimes irritate the skin,
and if you think about it, can’t really reach the problem: the P.Acnes
bacteria are festering underneath the top layer of your skin in blocked
pores, zits and cysts.
"Special cleansers"
Your skin needs some oil to lubricate it,
and it also has bacteria on it. It’s normal: acne is the abnormal production
of oil and bacteria, and a cleanser doesn’t help: sometimes it makes things
worse as the skin produces more oil to replace that which has been stripped
off.
What your doctor can prescribe
Fortunately the medical profession has begun
to be much more responsive to acne than before. Your own GP can prescribe
antibiotics, Retin-A, or benzoyl peroxide containing creams (which are
essentially the acno-shite you can buy over the counter). If you take antibiotics,
particularly in combination with Retin-A, you will see a definite improvement,
which will last for as long as you take the antibiotics. Some medicos will
tell you if you take antibiotics for long enough it will "turn off" the
acne. This is of course bullshit. I’ve come across no cases in medical
literature where this has happened; of course some people’s acne eventually
stops, but I don’t think it is to do with the antibiotics.
Benzoyl Peroxide compounds
These are creams, lotions, or gels. They
come in different strengths, form 2.5% to 10%. You can either buy them
OTC (over the counter in a pharmacy) or have them prescribed (often a higher
concentration) by your doctor. Their main drawback is they are utterly
ineffective, and if you buy them, expensive as well. I reckon that they
sell so well because so many people feel embarrassed to go to their doctor.
Don’t delay, see your G.P. today!
The only time they are more than marginally
effective is when combined with antibiotics and Retin A (see below).
Side effects
They do cause irritation to the skin. Although
gradually the skin gets used to it, so don’t stop if you get an irritated
skin immediately.
Retin-A
This is a cream, gel , or lotion, which comes in strengths of 0.25% or 0.05%
It is a derivative of vitamin A and encourages
skin cell turnover, thus unblocking the pores, so the black or whiteheads
are expelled. It then stops the formation of further "microcomedones" the
initial stage of black- or white- heads forming. It has little effect on
inflammatory acne, other than if there are fewer blackheads, there are
fewer sites for inflammation. It can dry the skin quite noticeably so often
you need a moisturizer. It is also supposed to keep your skin young-looking.
(Cher is reputed to use it. Hey ho, I’ve given away that I read tripe celeb
mags, oops).
It is effective, but you need to keep putting
it on your skin regularly. Unfortunately there are various side-effects.
Side effects
Redness and irritation of the skin, particularly
at first. This dies away a little as you keep using it. Your skin becomes
very sun-sensitive: if you want the British Lobster Complexion, go out
and catch some rays. Fair skinned people are affected more than those with
a darker skin type.
My advice
I found the irritation to be minimised when
I alternated a benzoyl peroxide OTC cream with the Retin-A, and this seemed
to have good results on both zits and blackheads. So I tended to use Retin-A
and the cream on alternate days.
Antibiotics
Antibiotics come in two types: oral, which
means you take them with water, usually between meals, and topical, which
means you plaster them on your skin. I’ve found the oral method to be more
effective.
Topical Antibiotics
These are Tetracycline, Erythromycin, and
Clindamycin. They come as a lotion and you put them on the affected area.
They have few side effects, so are good if you don’t get on with the oral
antibiotics. They reduce the number of zits and cysts, but don’t affect
black- or white-heads. So they are often combined with Retin-A. They are
usually used in the mildest cases. if you have sensitive skin, Clindamycin
is the least likely to irritate it. Topical tetracycline is coloured yellow,
so it can stain clothing, and also fluoresces under ultra-violet light,
so be careful if you are going to a rave or something.
Oral Antibiotics
This is the main treatment for acne. Courses
are supposed to last for 6 months, but mostly your doctor keeps repeating
the prescription till you or the medico dies of old age. The following
antibiotics are generally used: Tetracycline family (including Minocycline),
Erythromycin, Trimethoprim, and Clindamycin. They kill the bacteria that
cause acne. This has a powerful effect on zits and cysts but little or
none on blackheads. Again this can be combined with Retin-A, to zap the
blackheads.
If you are going to have this treatment,
antibiotic of choice is Minocin (Minocycline). It is easily tolerated,
and more effective than other oxytetracylines. You can also take it with
food, and it does not have the antibiotic resistance buildup that the other
tetracylines have. The normal dose is 100mg or 50 mg twice a day.
Oxytetracycline is usually prescribed at
1 gram a day. This can be divided into four 250 mg doses, or two 500mg
doses.
Side effects of tetracyclines:
They interfere with the effectiveness of
the contraceptive pill, so you need to use a condom as well. They can also
cause vaginal thrush. A very small number of people get an odd, itchy rash
with Minocycline.
Erythromycin
This is a treatment for inflammatory acne
which does not affect the contraceptive pill, or the developing foetus,
and so some doctors prefer to use it for women of child-bearing age. the
dose is 1000mg per day for the first two months then the dose is usually
reduced slowly over the next 4-6 months.
Side effects
Again this can cause thrush, but is safe
to use during pregnancy.
Trimethoprim
This is a drug which is kept for last resort
treatment of acne. Doses are 400-600 mg per day.
Side effects:
Trimethoprim has few side effects (well tolerated
in medical jargon). But some people find that they feel sick taking the
tablets, and very rarely, patients get painful lumps on the front of their
legs.
Clindamycin
This is a powerful antibiotic that is used
in severe acne. It is only used if other antibiotics fail to control the
condition. It is particularly effective against inflammatory acne where
there are large cysts. Doses 300 mg per day, usually in two 150 mg portions.
Side effects:
Very very rarely diarrhoea. If this happens,
stop taking the tablets and see your doctor straight away.
Problems with antibiotic use:
The main problem with long-term antibiotic
use is that the bacteria get resistant. As acne patients are on average
on antibiotics for 8-12 years (yikes) the bacteria get resistant. Erythromycin
is the antibiotic which was found to have most resistance. Because acne
runs in families, if you are on antibiotics, skin will pass this
resistance onto your younger brothers and sisters. So if they go on antibiotics,
their treatment will probably be less effective.
Scare stories
There was a story in the UK press about Minocycline
causing hepatitis and arthritis. This was wildly exaggerated. The British
Medical Journal found 27 cases of unwanted side effects had been reported
over the last 23 years. Professor Bill Cunliffe, Director of the Foundation
for Dermatological Research reported that having treated 25,000 patients
for acne with Minocycline, only two had developed the unwanted effects.
So the chances of getting these problems are minuscule.
Other treatments your doctor may prescribe:
Dapsone and Dianette are other options. I
haven’t had any personal experience with either: Dianette contains the
female hormone oestrogen and is only given to women so that counts me out
rather.
Dapsone
This is effective on the inflammatory cells
in the body, so its used for cystic acne which has failed to respond to
high-dose antibiotics. Normal course is 50 mg a day for four weeks. It
can have complications, so a blood test is advised if you are on it for
more than four weeks.
Dianette
This pill is a combination of oestrogen and
a drug called Cyproterone Acetate which combats the effect of testosterone
in the body. It is only prescribed to women. Like the above it is given
to patients who have failed to respond to high-dose antibiotics. It starts
with a minimum 6-month course, but can be continued for up to 24 months.
Often there is a nasty flare-up at the beginning of the course; it also can cause depression or stomach upsets.
* * * *
(the rest of this report is available for GBPounds 7.50 from
http:pages.zoom.co.uk/acnehelp/buy2.htm).
It contains information about Accutane/Roaccutane; diet myths; post-acne
facial reconstruction; natural remedies, and medical abstracts (summaries)
about Accutane/Roaccutane and other useful information.
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This site is copyright David
Collins 1999. Although every precaution has been taken in the preparation
of this site, the author admits no liability for errors or omissions. All
trademarks are acknowledged. This site is for your information only and
is no substitute for proper medical treatment of your condition.