Acne is a teenage plague, but it can persist throughout the adult years or pop up after a hiatus. The Nemours hospital network reports it affects 17 million people in the United States each year. Acne sufferers of any age can usually control their pimples with over-the-counter products that come as gels, lotions, creams or medicated wipes and pads. Sometimes these remedies are not enough to stop or lessen outbreaks. Dermatologists have several tactics to battle the most stubborn cases.
Isotretinoin
Isotretinoin is a very effective oral acne treatment, but it has potentially severe side effects. Because of this, the American Academy of Dermatology (AAD) explains it is usually only used when safer treatments have proven ineffective. It is a synthetic version of vitamin A that is generally prescribed for 16 to 20 weeks. It attacks acne by drying up oil, reducing inflammation and killing the bacteria that contribute to outbreaks. It leads to a remission that can last for months or years. It has been linked to depression and suicidal ideation in some patients, so people who are taking it must be closely supervised by a physician. It also causes birth defects and must not be taken by pregnant women.
Antibiotics
Antibiotics are often combined with over-the-counter products when the products do not solve the problem on their own. The AAD states most patients start out on a high dose, which is gradually cut back as the skin lesions improve. The medication kills bacteria and cuts down inflammation. It is usually discontinued as quickly as possible because of the potential for building up resistance, according to the Mayo Clinic.
Interlesional Corticosteroid Injection
Acne usually causes pimples, which may be solid or filled with pus, but severe cases sometimes result in cysts. They may rupture and cause scarring if they are not medically treated. The AAD explains they can be controlled with interlesional corticosteroid injections. The steroids used in these injections are highly diluted. They bring the inflammation down, and the treated cyst shrinks and heals within three to five days.
Drainage and Surgical Excision
Acne cysts are sometimes surgically drained and excised, according to the AAD. This procedure must be done by a skilled dermatologist to prevent infections and scarring. The procedure is done in the doctor’s office with a local anesthetic.
Birth Control Pills
Birth control pills are an option for women with severe acne who also wish to prevent pregnancy. The AAD explains that hormones in these pills suppress overproduction of oil. This helps prevent hair follicles from clogging and turning into pimples. Birth control pills are risky for women over age 35, smokers or those with blood clotting disorders and should only be taken by patients in those groups after discussion with a doctor. The Mayo Clinic warns they can increase the risk of high blood pressure, blood clots and heart disease.
