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Dx Acne Treatment:


By consensus, acne is caused by hormonal changes that can be aggravated by high sugar and processed foods in the diet. Medical treatment starts with over-the-counter topical therapies (face washes), then prescription topical antibiotics, oral contraception for women, and lastly oral antibiotics. While most acne treatments are begun by pediatricians/family doctors after Proactiv®-like treatments fail, the dermatologist has more expensive options of light therapy and low dose oral Accutane®.

CONSENSUS: Medications Used in Treatment::
Over-the-counter: Benzoyl Peroxide 5-10%, Azalaic Acid 20%, Salicylic Acid 10%
Prescription Medications:
1. Clindamycin® Plegets (#1 jar with #69 swipes) benoyl peroxide wash twice daily is most cost-effective when compared to:
Cleocin®/ Clindamycin® 1%/ Clindamycin with Benzoyl Peroxide
2. Topical Retin-A:Retin A® .025%
3. Topical antibiotics:
Benzyamycin® erythromycin 3% with BP 5%; Erygel®, Klaron® 10%
4. Oral Antibiotic Medications:Minocin® 100mg
5. Oral Contraception for women:
LoEstrin, Seasaonale® or Yaz®, or Sprintec® or (any) Oral Contraceptive
6. Topical Compound Preparations:
Spirolactone 5%, Zinc with Dapsone® 5%

7. Nicomide(R): prescription dietary supplement for oral treatment of acne. Product contains niacinamide, Zinc, folate copper, selenium and chromium. Available only by prescription. Dermatologist's Treatments- Expensive
.........Low Dose myorisan [generic for Accutane®/ Isoretonin
.........Light therapy (any)

The Merck Manual Home Edition
"[Acne] is caused by a specific skin (Propioni)bacteria that flourishes with the hormonal shift of adolescence. Treatment can be directed to clearing the bacteria (washes, topical preparations, oral antibiotics) and secondly, an oral contraceptive that minimizes androgens. Accutane® and dermatological treatments are reserved for the most resistant few."

Further Discussion/ Recommendations:
1.Over-the-counter:  Benzoyl peroxide and salicylic acid are effective; if need add generic topical clindamycin.
2. Oral contraceptives (for women) the generic Gianvi®, Yaz®, (28 days) ,(3 months) or generic Daysee®/ Seasonique® may be slightly better than other oral contraceptives at reducing the sebum formation and inflammation caused by hormonal factors.
3. Topical Treatments: Clindamycin®, Cleocin-T®, Clindagel®, or Oral Antibiotic such as tetracycline (Minocin®, Vibramycin®), sulfa (Klaron®, Sumadan®) and Lincosamide (Benaclin®, Duac®): can be added, preferably for a short period of time.
4. Adding a Probiotic supplement both improves therapy and may protect the gut (Gastro-intestinal tract) flora.
5. Accutane®/isotretonin: New studies imply equally good results can be achieved with the lowest dosage, 5mg.
5. Dermatologic procedures: Photodynamic treatment was superior to placebo, but no better than adapalene (Differin®).
6. Compound Preparations: Topical Spirolactone 5%, Zinc and Dapsone® 5% may offer a non-antibiotic, non-toxic alternative topical therapy.

Suggested Links:
*N.H.S. Choices

*[Editor] : Spirolactone® 100mg daily reduces facial hair (hirsuitism) but clear proof of use for acne remains antedotal. Retinoids (Retin®-A, Renova®, etc.) are sometimes used, but the risk/benefits are not always clear.

*[Editor]: In an 1890 JAMA article (reprinted in JAMA May 28 2014:311(2): 2131, the treatment for acne was: (1) boric acid 2 drams, (2) glycerine, (3) petrolata, and (4)2 drams,sulphuric ether, 3 ounces to be applied to the face daily. "This may be allowed to dry and left there without attracting attention". Editor's Conclusion: not so different from over-the-counter preparations used today.

*[Editor]: An over-the-counter professional product is available from Henry Schein, item number 856-0011.

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