aczoneA smattering of members of acne.org have tried Dapsone, a prescription anti-inflammatory medication which is best known as an oral medication for treating leprosy but is also prescribed topically in 5% concentration by the brand name Aczone. When taken orally, Dapsone comes with a host of worrying side effects, but when administered topically for acne, patients tend to suffer very few side effects. That is all well and good, but from the research that is coming in, it doesn’t seem to work very well, at least in the short term. Two studies have been performed recently on topical Dapsone. The first was a 12 week study which reported a 39% reduction in inflammatory acne. This is obviously not ultra-impressive, but when you consider that the placebo group experienced a 32% reduction, it becomes even less earth shattering. The second study was also a 12 week study which reported a 49% reduction in women and a 34% reduction in men. This is somewhat better news for women but the medication was still unable to even cut acne symptoms in half.

Longer term therapy: I spoke to a dermatologist a few years back who likes to prescribe Dapsone to her patients and claims that results only come after about the 3 month (12 week) mark. Therefore, I would like to see a study performed for a longer period of time.

Combination therapy: While Dapsone alone may not provide for sufficient clearing of acne, it may be prescribed alongside other drugs such as benzoyl peroxide or topical retinoids.

Have any of you guys taken Dapsone for longer than 3 months? How did it go?

References:

  • Tan J. “Dapsone 5% Gel – A New Option in Topical Therapy for Acne.” Skin Therapy Letter. 2012; 17(8): 1-3.

Evidence continues to mount that birth control pills help with acne. Interestingly, it has become apparent that just because a birth control pill is approved for acne, however, does not mean it will produce superior results.

First, it’s important to understand how oral contraceptives (OCs) help with acne. Almost all OCs contain an estrogen component and a progestin component.† The estrogen component helps reduce the production and expression of male hormones which can lead to acne. Depending on the progestin used, the effects of the progestin component can range from relatively inert to theoretically leading to increased male hormone levels. But the estrogen component is much stronger and outweighs progestin, thereby allowing all OCs to help with acne.

An article published in the International Journal of Women’s Health in 2010 took a look at all of the different options and research to date. As it turns out, no matter what OC you take, it will likely produce a 30-60% reduction in acne lesion count. According to the article, “Studies comparing oral contraceptives did not convincingly show superiority of one oral contraceptive to another in the treatment of acne.” They went on to note, “Compilation of evidence was difficult due to variable study designs.  More research needs to be done to draw conclusions about the comparative efficacy of different [oral contraceptives].”

In other words, it appears women who are looking for acne symptom relief with their oral contraceptive are not constrained to “approved” brands.

__

Important: Whether or not to embark upon hormonal acne therapy requires careful physician screening with a focus on risks and benefits.

†Note: Cyproterone Acetate (Diane, Dianette), which is a synthetic derivative of 17-hydroxyprogesterone approved for contraception in Europe and Canada but not the United States, and which can be used on its own or in combination with an estrogen component, was also considered as authors in this article drew their conclusions.

 

Isotretinoin (Accutane) is approved to treat people with severe acne. Typically, in order to achieve the best chance of long term acne remission, doctors are advised to prescribe patients relatively high doses of Accutane. Researchers have published two studies in the past two years attempting to gauge whether people with mild to moderate acne can achieve similar long term remission of acne with lower dosages of Accutane, and thus achieve similar success with lower side effects.

Study 1: Italian researchers looked at 150 people with “mild to moderate acne,” although most of them (114) were considered “moderate.” The average person only received around 3/4 of the amount of Accutane that is normally prescribed. After two years, only 13 people had relapsed, which comes to 9.35%, a very good relapse rate, even when compared with high doses of Accutane across the general population.  Note: After their Accutane course, the people in this study were then put on 1 full year of topical adapalene therapy which somewhat confuses the results of the study. 

Study 2: In this study, Korean researchers studied 60 people with “moderate” acne. These people were given either conventional treatment, low-dose treatment, or intermittent treatment (1 week out of each month). Although the amount of people studied was small, and thus we need to take these results less seriously than larger studies, outcomes were similar between people taking conventional and low-dose treatment. One year after therapy was discontinued, 2 out of 16 people in the conventional group and 3 out of 17 people in the low-dose group relapsed. Note: People on intermittent therapy did not fair nearly as well. More than half of these patients relapsed.

What I take from this: As usual, more research is needed on this topic. However, from what these researchers are seeing, as long as someone is not suffering with severe acne, they may be able to get away with less Accutane, and thus suffer lower incidence of side effects. I’ll keep you posted as more research on this topic comes to light. As always, please keep discussing your own personal experiences with Accutane on the messageboards so we can follow along with your particular dosage and results.

The more I learn about antibiotic therapy for acne, the more wary and less enthused I become. Due to overuse and misuse over the past twenty years, antibiotic resistance has become widespread throughout the skin of the world population. This is evidenced by the increasing ineffectiveness of both oral and topical antibiotics in clinical studies. Antibiotics never worked very well for acne, and now they work even less well.

According to a “Global Alliance to Improve Outcomes in Acne” published in the Journal of the American Academy of Dermatology, antibiotics should be avoided as the sole treatment of acne. Researchers agree strongly that if antibiotic therapy is used, it should be combined with other therapies. When you look at the superior effectiveness of these other therapies the question arises as to why someone would want to include antibiotics at all. For example, when one takes into consideration the fact that benzoyl peroxide kills 99.9% of acne bacteria on its own and does not create resistant colonies of bacteria, one has to wonder why so many prescriptions for antibiotic acne therapy–over 11 million per year–are still written. According to an article published in the journal Expert Opinion on Pharmacotherapy, “…evidence demonstrates that [topical antibiotics] are no more effective against inflamed lesions than [benzoyl peroxide], and are less effective against non-inflamed lesions…To date, [benzoyl peroxide], as both mono- and combination therapy, is the most evidence-based approach.” Other acne treatments exist, and while they may not be as effective as benzoyl peroxide, they easily outpace antibiotics.

The misuse of antibiotics can also cause antibiotic resistance in other skin bacteria, especially the bacteria known to lead to impetigo and folliculitis. If all of this weren’t enough, when we look at how gene mutations work in bacteria, we see that genes which allow for resistance to antibiotics are easily transferred from acne bacteria to other bacteria in the skin, thus further promoting unwanted antibiotic resistance in other skin bacteria.

If your doctor has you on antibiotic therapy for acne and nothing else, it may be time to have a talk with her/him. The authors of the expert opinion review also note that topical antibiotics should be used for no longer than 3 months and oral antibiotics for no longer than 6 months. So, if you have been on antibiotic therapy for a long time, it may also be time for an appointment with your dermatologist. Since poor compliance with antibiotic regimens are one of the main causes of antibiotic resistance, just make sure you do not stop antibiotic therapy on your own without consulting with your physician first.

I’ve been getting requests to make a larger size AHA+ (12-16oz.) for people using the Back/Body Regimens. Anytime we make products larger we save on materials and can charge a little less per ounce. What do you think?

Larger Size AHA+

View Results

Loading ... Loading ...

For people using the AHA+ just for spot treatment or who just use it occasionally, a 2oz. would be less expensive. A 2oz. could also allow people who are new to alpha hydroxy acid to try it at a lower price point to decide if they like it. What do you think?

Smaller Size AHA+

View Results

Loading ... Loading ...

Please leave your other comments below.

SPF: We have been painstakingly sourcing each ingredient from around the world in an attempt to keep the price on the SPF within reason and within reach. We’re making good progress, and it’s my goal (perhaps I should say prayer since it’s not entirely up to me) to put a sample into FDA required stability testing soon so it can be out for at least part of this summer’s season. No promises, but we’re working on it every day. Depending on certain ingredient lead times and availability, my fingers are crossed that we can make this happen sooner rather than later.

Spot Treatment: The last spot treatment we designed seemed to have everything going for it, and then wham, our testers tried it under BP. It balled up and looked like mini cottage cheese curds on the skin. At the same time, my mind got piqued regarding other potentially beneficial ingredients, and I have been reading about some of them while having a team of people gather research on others. The spot treatment appears to be more of a long term project at this point. I want to launch a spot treatment only when it is revolutionary and amazing since the AHA+ already works so well for me. However, it is very much on the radar.

Moisturizer: For quite some time now, because of my extreme schedule and inability to read through the message boards as much as I would like, Brandy and C’est La Vigne have been updating me regularly on your posts. Rest assured that if you express your concerns to C’est or Brandy, they are likely to be expressed to me. Lately, Brandy and C’est have been telling me that several of you would like me to bring the old moisturizer back. I am hearing you and understand your frustration. However, with my apologies, I’m afraid this is not possible. First, since I would not be recommending it or mentioning it on the web site, I would need to produce it in very small amounts. This is an extremely expensive proposition on several levels–small label runs & small production runs would run the cost into an entirely new “private label” placement in which prices would reflect expensive boutique brands. Next, our full-time team is swamped with current products, and we do not have the resources to relaunch a product at this time. Finally, I feel more comfortable with people using the new moisturizer. While the new formula requires more generous application (at least 3 pumps), the increased gentleness and soothing ingredients that the new moisturizer keep me steadily on board with strongly recommending it over the previous version. For those of you who are experiencing increased dryness with the new moisturizer, please read this post for my recommendation on how much to use, but keep in mind that our current batch of pumps dispense a bit less, so you will need at least 3 full pumps, not 2.

Are any of you wondering why it seems like your moisturizer isn’t working as well as it used to? You’re not alone. Every year around this time people come to me complaining that their moisturizer just doesn’t seem to be as powerful as it used to be. “Aha!,” I’ve exclaimed, in the nicest way possible of course, “It is not your moisturizer! It’s just winter.” It’s true that people experience increased dry skin in the winter. But this year I decided to do a little more digging to find out exactly why. As it turns out, there is startlingly little scientifically sound explanation to be found, and myths abound.  As is often the case, it falls to us to sift through the nonsense and make some sense of this issue.

_____

First, let’s dispell the myths:

When weather gets cold, it gets dry. This is claimed so often and by so many “reputable sources” that I almost took it at face value myself. But when I decided to double check this pervasive claim, it completely fell apart. I looked at historical charts of humidity levels across the United States throughout the seasons.* It turns out that humidity levels show no particular trend from summer to winter. In fact, in many cities, even Northern cities, humidity levels are higher in the freeze of winter than in the bask of summer.

The winter is blustery and wind dries out the skin. Many of us can recall experiencing our share of cold, windy winter days, and could swear that we experience “windburn”, characterized by dryness, redness, and irritation after being outside on these blustery days. But a look at the evidence forces us to consider other possible causes. The only experiment I could find was performed all the way back to 1937, and was published in Popular Science. Scientists founds through using a wind tunnel that wind alone does not create “reddening or chapping” of the skin. Furthermore, upon browsing through historical wind speed charts, I found that that much like humidity levels, wind speeds show no yearly trend. There is no evidence of higher winds in the winter months. Regardless of all this evidence against the wind creating redness, dryness, and irritation, many sources not only talk about the existence of windburn, but will even explain why it occurs. The most widely used explanation is that wind removes surface lipids (oils) from the skin. Exactly how the wind performs this feat is conspicuously absent from all of these articles. Furthermore, if wind is just as strong in the summer, why don’t people seem to experience windburn as much in the summer? Another common explanation that attempts to explain windburn, which is the current explanation on Wikipedia, is that windburn is actually just sunburn caused by the wind removing surface lipids (oils) which help protect us from UV rays (another claim I am yet to find evidence to support). While the wind can remove some of these surface lipids year round, they say, the removal of the surface lipids in the winter coincides with a season when we do not protect our skin as valiantly from the sun. Thus the redness and irritation people experience is simply a sunburn. This explanation is incomplete at best, and completely misinformed at worst. Yet another explanation, albeit less frequently posited, claims that wind removes sweat, which normally helps filter UV rays. Again, how sweat helps filter UV rays is conspicuously absent.

_____

Whew. So, now that we have gone through the myths, the fact remains that many people experience dryer skin in the winter. Why? After looking at all of the available evidence, I have a hunch it can be attributed almost entirely to:

Artificial heat: Mother nature can heat up or cool down the great outdoors while keeping humidity levels steady, but when we heat indoor areas, this lowers humidity. When you look at the science of relative humidity (I won’t bore you), this is how it works. For an everyday example, notice how when you heat your bathroom while taking a shower there is less steam in the air. Since most of us live and work in artificially heated indoor environments in the winter, it’s likely we experience long-term exposure to lower humidity environments during the winter months. This dries out the skin, causing many of us to wonder why our moisturizer isn’t working as well as it used to. Back to my original point, “It’s not your moisturizer!” And introducing my new, improved answer, “You’re living in lower humidity indoor environments in the winter!”

And what about the cold? Strangely, none of the authors or reporters writing about winter and dry skin mention the effect cold air itself has on the skin. However, I have a hunch extreme temperatures may figure into a complete explanation of why some people experience dry skin in the winter. When we expose our skin to freezing temperatures, the skin reacts through natural protective methods, most prominently by withdrawing blood from the surface of the skin to protect core temperature. This is the first step which ultimately leads to the skin freezing which causes frost bite and cell death. My hunch is that perhaps even during shorter duration exposure to freezing temperatures which people sometimes experience on cold days, the skin still reacts through a more mild form of cell death. This mild cell death, while not as apparent as the blisters caused by frostbite, is evidenced by flakiness or dryness as the dead cells flake off. The redness experienced by many people after exposure to winter weather, while it would require further research for me to be more definitive, could be the result of cell death or simply the body returning blood to areas where it has been withdrawn.

_____

So, what can we do about it?

1.  Humidify your home/workplace. Install a humidifying system into your central heat. Alternately, if you use wood burning stoves or kerosene heaters, you can place pots of water on top and let the water evaporate, then repeat. You can always boil a large pot of  water on the stovetop as well, being careful to keep a close eye on it of course. There are commercially available electric stand-alone humidifiers as well. 60% humidity is a good general goal to shoot for. You can measure humidity with widely available humidity measuring devices which are available at most hardware stores, or you can be more relaxed about it and just notice how you–and your skin–feel. When the humidity reaches a comfortable level you will feel less dry and generally more comfortable. You should also notice less static electricity, less shocks, and less frizz to your hair. An easy way to tell if you’ve gone too far and over-humidified your space is if your windows start to pool water at their bases.

Perk: Adequately humidified air feels warmer than dry air at the same temperature. In other words, you can get away with heating to a lower temperature.

2.  Use more moisturizer: An extra pump or two of moisturizer each time you apply should help.

3.  Add jojoba oil: Since jojoba oil does not evaporate, 5-6 drops of jojoba oil added into your moisturizer each time you apply it will provide a boost of all-day moisture support.

*Yes, I know. There is more to the world than the United States, but…well, okay fine, I have no excuse. I’ll make a note to look outside the U.S. for my next research-related blog. :-)

We’re getting ready to fill the new, improved moisturizer. It should be for sale sometime in mid September if all goes well.

Overview: I tell people if it’s not the best moisturizer they’ve ever tried, I’m not happy. Usually it does end up being the best they’ve tried. I have seldom felt so confident about any product release. I have been using it for about six months very diligently every evening and have not found any issues in the short term or long term. I have also sent out about 100 samples and received lots of responses. Feedback is almost entirely positive, with some people begging me for more. I think you guys are going to be completely in love. I’m bursting at the seams waiting to get it out to you guys.

What’s different about it: It has a completely new ingredient list, carefully chosen for non-comedogenicity as well as effectiveness and gentleness. I chose to rebuild it from the ground up in order to completely resolve the old issue of stinging that some people experienced. This issue should be completely resolved with this new formula. It also has none of the “tack” that people sometimes experienced with the old moisturizer. In other words, it will not leave an afterfeel. Your skin should just feel great.

It just goes on smoothly and absorbs quickly. The new formula is slightly thicker than the old formula due to the new ingredients. This thicker feel takes a little getting used to and requires a bit of extra care during application to avoid irritation.

It contains licochalcone, the licorice root extract we use in the AHA+, and is thus has a yellow color. This yellow color does not show on the skin. As many of you know, I love licochalcone for how it soothes and calms acne-prone skin.

Lastly, the new moisturizer is best when used generously. I recommend two full pumps. It is so good that in my experience it actually improves my skin, both my skin’s ability to stay perfectly clear as well as my skin’s overall feel and tone. I’m going to want everyone to be generous with it and receive all its benefits.

Price: I’m pricing out each ingredient now, and as always I’ll charge as little as I can. Some of the new ingredients are expensive–licochalcone in particular–but you guys have been asking for me to put it into the moisturizer for years now, and I agree that it’s worth it. The price will almost certainly need to go up from the previous formula, but I will do everything I can to price it affordably.

Hey you guys. You’ve asked and I’m listening. We’ve designed new labels and taken ACNE.ORG off the front of the label. It only whispers about the web site on the back of the label. We have also added longer, more specific directions to the labels so that “The Regimen is on the labels.” This is the “duh” idea that you guys told me you supported not too long ago. The new labels are much more medical looking, and that’s on purpose. Acne.org products are the very highest quality out there. I want the labels to reflect this.

The products themselves won’t change, just the labels. The one exception is our moisturizer, which if you’ve been reading the blog you know is changing to a new, improved version. Here is our moisturizer label, which will most likely roll out first.