I believe I've got what is called cystic acne. Does this mean I need different acne treatment than if I were to have a simple form of acne?
Are There Acne Treatments for Different Types of Acne?
Doctor Answers 1
Acne treatments for different types of acne
Cystic acne requires more aggressive treatment to be effective.
In cystic acne the contents of the pilo-sebaceous unit ( the pore) have spilled out into the surrounding dermis setting up an intense inflammatory response. Unless this inflammation is quelled, scarring ensues due to the body's efforts to limit the damage.
Patients with cystic acne should be placed on an antibiotic for starts. Minocycline is the strongest, but Doxycycline and Tetracycline may also be used. I prefer Zithromax as an alternative. Erthryomycin has fallen out of favor due to possible drug interactins and cardiac effects. ( Let me digress a bit here. New Beauty magazine ran an article on acne treatment during pregnancy about a year ago. They interviewed a cosmetic dermatologist who offered the suggestion that Erythromycin be used during pregnancy. I feel this is out of date information and, though the cosmetic dermatologist meant well, he probably has not treated a pregnant acne patient in years. Erythromycin can cause heart defects, heart arrythmias, and pyloric steosis when given in utero. In many European countries such as Sweden its usage during pregnancy is banned. When I wrote to the editor of New Beauty magazine suggesting that they write a correction, my letter was ignored. I realize it may be more convenient, and less embarassing, than to admit an error. However, I do not feel they are being fair to their readers.)
Topical treatment should be utilized. In fact the Ortho people have been showing us dermatologists for years that use of Retin A may stop the cascade plunging the skin into immunologic chaos.
Other measures which can be taken include hormonal adjustments. This would mean the use of oral contraceptives in women ( Yaz preferred) and/or Aldactone. The latter blocks the male hormone ( androgen) both at its end site ( the sebaceous gland) and at its point of origin ( the adrenal gland). Potassium levels must be watched since both Yaz and Aldactone raise potassium. A recent article in our literature did show that such an elevation did not cause a clinical problem, but still caution must be taken if these two are used in combination.
Of course, any answer to this question would not be complete without bringing upthe drug Accutane. Seasoned dermatologists such as myself recall the days prior to Accutane. We can remember the woe that was laid on the backs of cystic acne sufferers before Accutane. Dapsone and high dose pulse steroids were used, drugs that made me far more nervous than Accutane. Accutane works by interfering with the production of sebum by the sebaceous gland. In many cases, if not most, cystic acne is cured with a 5 month course.
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