About Medications for Cystic Acne
When plugged hair follicles, bacteria, excess oil production and inflammation in the skin come together, the end result is acne. Whiteheads and blackheads that cause mild surface inflammation may be resolved with good hygiene and use of topical medications. But cystic acne--painful lesions that form deep under the skin's surface--resists treatment, states the American Academy of Dermatology. Although one medication, oral isotretinoin, is considered the most efficient way to resolve cystic acne for good, other medications and in-office procedures may also be effective.
The drug isotretinoin, approved by the U.S. Food and Drug Administration in 1982 under the brand name Accutane, fights cystic acne by combating all the above factors that lead to its formation, according to the AAD. Patients take isotretinoin daily for 14 to 20 weeks, after which cysts resolve.
However, isotretinoin is a strong medication with potentially severe side effects in addition to those commonly noted during the course of treatment, such as extremely dry and flaking skin, nosebleeds, thinning hair and aching joints. In 2006, the FDA issued an alert notifying doctors and patients that isotretinoin may cause depression, suicidal ideation--and even suicide attempts. Because isotretinoin also causes birth defects, it is prescribed with caution to women of child-bearing age. Female patients must use two forms of birth control, undergo routine pregnancy testing and register with the FDA's iPLEDGE monitoring program implemented in 2007.
Isotretinoin is still considered the most effective medication for cystic acne, resolving acne in 90 percent of patients, says the University of Maryland Medical Center. However, medical experts emphasize that the decision to undergo isotretinoin treatment should be made jointly between doctor and patient.
The AAD refers to oral antibiotics as a "mainstay" in treating severe cystic acne. Oral antibiotics work systemically to reduce the bacteria that cause acne, which in turn decreases inflammation in the skin. Patients typically begin therapy with a high dose of an oral antibiotic and as acne begins to resolve, the dosage is decreased. Sometimes bacteria can become resistant to a certain antibiotic, necessitating a change to a different type of antibiotic. According to the AAD, the most common broad-spectrum oral antibiotics used to resolve cystic acne include doxycycline, erythromycin, minocycline and tetracycline.
Female patients may find a resolution to cystic acne in the form of oral contraceptives. Hormonal fluctuations are directly linked to excess oil production; oral contraceptives can clear up cystic acne in women by suppressing overactive oil glands. The AAD indicates that oral contraceptives can be used for a number of years for long-term treatment, but these may not be appropriate for all female patients--specifically those over the age of 35, those who smoke or those with migraines or problems with blood clotting.
In some cases, very large cysts may require individual treatment. A dermatologist may opt to drain the cyst during an in-office visit. Patients who attempt to pick or pop cysts on their own under non-sterile conditions can experience infection and subsequent scarring. A doctor may also offer to inject large cysts with a diluted corticosteroid, which dissolves the cyst in between three and five days.
For many years, the medication isotretinoin was sold under its trade name, Accutane. However, the patent for Accutane has since expired, and now there are many generic competitors. In June 2009, Roche Holding AG announced plans to remove Accutane from the shelves, purportedly because the company was experiencing financial losses due to less-expensive generic equivalents. Isotretinoin continues to be sold as Amnesteem, Claravis and Sotret.
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