revolving doorI remember back in middle school when I started getting acne and asking my mom to take me to the dermatologist. I always felt better after seeing the dermatologist. He or she always wrote me a prescription for a medication which was supposed to clear me up. I tried oral antibiotics, topical antibiotics, retinoids, sulfur, and a few other prescriptions. Inevitably, they didn’t work, and I’d come back for another prescription, this time hoping that this one would actually clear me up. What all of these dermatologists failed to tell me is that most prescriptions only work to clear up acne to a degree.

As the researcher for Acne.org, I read hundreds of clinical trials and studies on acne each year. The latest article I just read was to test the “…efficacy and tolerability of tazarotene foam, 0.1%, in the treatment of acne…” Like most other articles on prescriptions for acne, the conclusion to this study sounds familiar: “Tazarotene foam, 0.1% significantly reduced the number and severity of acne lesions after 12 weeks and had a safe and acceptable tolerability profile.” That sounds great, doesn’t it? But when you read the article, you find that the decrease in acne lesions hovers around 50%. Sure, results are scientifically significant, but is someone with 20 zits on their face going to be happy with 10? That is still full fledged acne if you ask me. In my opinion, dermatologists should communicate clearly that most prescriptions will help improve the skin, but will not clear you up.

1 exception: Accutane (isotreinoin) completely clears acne in most people who take an adequate dosage for a long enough period of time, but comes with side effects, some of which can be long-term and some of which can be severe.

1 other exception: When used within The Acne.org Regimen, 2.5% benzoyl peroxide will also completely clear the skin, and does so without any severe or long-term side effects. It’s refreshing to be able to tell people what dermatologists were never able to confidently tell me. The Acne.org Regimen will clear you up. Completely.

References:

  • Feldman SR, Werner CP, Alio Saenz AB. “The efficacy and tolerability of tazarotene foam, 0.1%, in the treatment of acne vulgaris in 2 multi center, randomized, vehicle-controlled, double-blind studies.” Journal of Drugs in Dermatology. 2013; 12(4): 438-46.

Antibiotics vs. Benzoyl Peroxide
I have been saying for years that if benzoyl peroxide is so good at killing bacteria on its own, then why do we need topical antibiotics like clindamycin, which do not work nearly as well as benzoyl peroxide in clearing acne, and have contributed to creating massive amounts of resistant bacteria across the world? It is a simple question and I have yet to meet anyone who can give me a compelling reason why a doctor would prescribe topical antibiotics for acne.

Perhaps the medical community is finally seeing what I am seeing. In a recent article in The Journal of Drugs in Dermatolgy, Dr. Kircik from Mount Sinai Medical Center in New York shows that ears and eyes are perking up to the massive over-prescription of topical antibiotics, especially when a better and safer alternative exists: “…we have recently noticed BP’s benefits as monotherapy in the treatment of acne. Benzoyl peroxide works rapidly on P. acnes (bacteria) without causing antibiotic resistance. Hence, we may have to reconsider the role of topical antibiotics such as clindamycin in the treatment paradigm of acne vulgaris.”

Halleluiah.

References:

  • Kircik LH. “The role of benzoyl peroxide in the new treatment paradigm for acne.” The Journal of Drugs in Dermatology. 2013; 12(6): s73-4.

accutane pillsIn all the years I’ve been researching acne, I’ve consistently read in most dermatology texts, “there is no cure for acne.” Until a few years ago, I echoed this prevailing wisdom in my writing for Acne.org. However, during my rewrite of Acne.org for our mobile-friendly web site–which is coming soon–I decided to start referring to Accutane (isotreinoin) as a “cure” more plainly in certain circumstances. This is not to say that I feel any differently than I ever have about Accutane. My personal opinion is that it is best left for more severe cases of acne, especially if one tends to scar.

Merriam-Webster defines cure as “a complete or permanent solution or remedy.” This is what Accutane provides for the majority of people who take it. Clinical research shows long-term remission of acne symptoms in approximately 2/3 of people who take an adequate dosage (1mg/kg). Therefore, I feel it is time for me to plainly use the word “cure” in certain circumstances when referring to Accutane, while at the same time noting that it cures most people, but not all people.

A still unanswered question?: I do not recall reading any studies on Accutane (isotretinoin) which follow up with participants past the five year mark, checking in on remission. If any of you have read a study like this, please contact me to let me know. If we do not have good data on this, then we cannot comment with complete certainty on long-term remission. However, anecdotally, based on years of input from Acne.org members, the effects of Accutane tend to be permanent.

A note on the permanency of Accutane: The permanency of Accutane is a reflection of the drug’s power, but also brings urgency to the need to consciously enter into a careful decision-making process alongside a trusted physician if you decide to pursue Accutane treatment.

I forgot to mention the cost of cortisone shots in the blog yesterday. It sounds like they are between $10 and $100 depending on where you go and whether your insurance covers it. You can read more on this cortisone shot cost post on Acne.org.

btw, no video today. I was at the dentist all day again and didn’t have time to shoot anything. I’ll do my best to get one up tomorrow!

Dan