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.

Birth Control Pills Approved for Acne

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.

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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 was surprised to read that Roche Pharmaceuticals, the makers of Accutane, decided to stop selling the name brand of the product in late June. The company cited declining sales as their reason. Since 2002, generic forms of Accutane (isotretinoin) have been available and it turns out over 95% of the time doctors prescribe a generic. Roche’s decision to stop selling also came shortly after a jury awarded $33 million in damages to people who claimed Accutane caused bowel disease.

What does this mean for us? Well, it gives me pause because yet again Accutane’s side effects are in the spotlight. While some people with recalcitrant, widespread, deeply scarring acne regard Accutane as a godsend, I would have to think twice before agreeing to have a loved one of mine take it for anything less than severe acne.

For people who choose to take it, isotretinoin, the active ingredient in Accutane, is still available in its generic form. However, that brings up another concern. Are generics reliable? This study performed in 2006 cast doubt over the quality of generic forms of isotretinoin. It is only one study, and more are needed, but I’d like to see further oversight and studies performed to ensure product efficacy. Let’s keep our eye closely on this issue.

Hey you guys. I’ve been swamped around here and haven’t had a half hour free to do a video. I miss it. I’ll try to get back to it on Monday.

I wanted to mention that few people have mentioned that their jojoba oil has arrived with cloudiness or particulates in it. This is normal and to be expected when jojoba oil gets very cold or freezes. The oil is still good and will work just the same, so no worries.

Also, Brandy sent me an interesting video regarding doxycycline, an antibiotic given for acne. Evidently it can get stuck in the esophagus and cause ulcers. Just something to potentially be aware of.

Have a great weekend everybody! :)

Hey you guys. I’m a little concerned that people are asking how well Accutane works for less severe forms of acne. Accutane is only approved for severe acne, and I think for good reason. It is a very powerful drug and in my opinion should be reserved for severe cases which do not respond to topical treatment. If it were me, I would try the Regimen first and follow it precisely and get cleared up that way. The exception would be if I had an extreme form of heavily scarring acne on my face, neck, and body. Perhaps in that case I would directly consider Accutane. I want to see you guys all happy and healthy for years to come. Please consider your options carefully.