Acne severity varies. Mild acne generally involves mostly noninflammatory blemishes such as blackheads and whiteheads. Moderate acne involves noninflammatory blemishes and small inflammatory blemishes. Acne becomes severe when large, inflamed blemishes called nodules or cysts are present. Severe acne requires treatment by a dermatologist.
Acne affects a large portion of teenagers and adults and is, in fact, the most common skin disorder in the United States, according to the American Academy of Dermatology. More than 40 percent of teenagers have acne or scarring that require dermatological treatment. Acne may require counseling, as well. The Dermatology Online Journal reports that acne can have profound psychological complications including clinical depression and social phobia.
All acne starts with the combination of skin oil, dead skin cells and bacteria. Excess sebum, or oil, allows bacteria to travel into the pores. Dead skin cells mix with excess sebum and clog the pores. Trapped bacteria multiply, inflaming the pimples. Cysts and nodules develop when bacteria multiply deep within the pore and cause the follicle wall to burst. Scarring develops as the pore and surrounding tissue become damaged.
Severe or clinical acne treatment requires more acne-fighting power than contained in the benzoyl peroxide and salicylic acid medications purchased at the drugstore. Dermatologists often recommend antibiotic treatment as a first line of defense for moderately severe acne. This fights skin bacteria and lessens inflammatory acne. Over time, bacteria may become resistant to a specific antibiotic. At this point, the dermatologist may choose to start a different antibiotic or move to a new treatment. Antibiotics have mild side effects --- most commonly gastrointestinal irritation.
Very severe cystic acne that has not responded to other treatments may warrant treatment with isotretinoin. Treatment with isotretinoin nearly always results in the eradication of even very severe cases of acne. The medication reduces sebum production, fights bacteria, unclogs pores and reduces inflammation. Dr. Naomi Craft writes in "The Little Book of Medical Breakthroughs" that early clinical trials of isotretinoin found that 13 of 14 people given isotretinoin for four months had complete clearing of their skin, with no recurrence of acne after five years.
Isotretinoin Side Effects and Warnings
Despite the efficacy of isotretinoin, dermatologists reserve this powerful drug as a last resort. Those undergoing isotretinoin treatment must practice complete compliance with doctor recommendations. Isotretinoin carries side effects including dry skin, skin-color changes, hair loss and bleeding gums. More serious side effects include chest pain, vision problems, ringing in the ears and bone pain.
Isotretinoin and Pregnancy
Because of the risk of birth defects, women taking isotretinoin cannot become pregnant. Women of child-bearing age must use two forms of birth control. They must also have two negative pregnancy tests before treatment, one negative pregnancy test each month of treatment, and a negative test 30 days after ending treatment. Treatment also requires enrollment in the iPLEDGE program, which involves checking in each month by phone to answer questions about the program and report pregnancy test results. If accidental pregnancy occurs during treatment or within 30 days of ending treatment, the doctor notifies the iPLEDGE program, the isotretinoin manufacturer and the Food and Drug Administration and refers the patient to a specialist in complicated pregnancies to discuss complications and options.
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