Cystic Acne can it be treated?
I'm currently taking Tetracycline for a cystic acne problem but I'm
finding that the required dosage causes me gastric problems. Just 10
minutes after taking a capsule I have this unawarkward feeling in my
throat like I swallowed some foreign object or something.
Anyway, what are the treatment options for cystic acne?
How I treat acne-- cystic and otherwise
BTW, I'm originally a PhD pharmacologist/toxicologist with many papers in skin
pharmacology/toxicology. I also have five patents ( 2 European, three US )
on skin pharmacology. I get difficult cases from primary care docs.
FWIW, ths is more or less the procedure I go thru. Yes, I know there are
other ways and do use them. Not point in saying " Well, what about ----- ?"
First, find out what's worked before. No point in trying ( e.g. )
erythromycin or tetracycline if the patient has failed it before.
Also, make sure it's acne and not Rosacea. Two good screens: Retin-A
and/or sunlight usually make acne vulgaris better while they often make
Rosacea worse. Ask-- " Does your acne get better or worse in the summer or
winter ?." Sometimes rosacea looks a whole lot like acne. I see cases of
it all the time which have been misdiagnosed. The therapy is different--
"Metrogen for Months", possibly plus sulfacet and/or tetracyclines.
First line treatment for acne vulgaris--- Retin-A plus an antibiotic. The
patent on Retin-A has expired, but so far, there are no generics, so it's a
little expensive. You can use the antibiotic alone. As I have noted here
before, I prefer erythromycin, particularly in combination with benzolyl
peroxide ( which does work alone ). It's cheap and it usually works at
least for a while. Also, when the patient gets tolerant to it after a year
or so, you can rotate them onto another antibiotic until that one does not
work. Then when you put them back on erythromycin, it often works again.
Oral or topical: In mild acne, I prefer to start with topical treatment.
In cystic acne or in acne that does not respond to topical treatment ( most
does ), I will usually give oral erythromycin ( say ) qid and then follow it
with qd. You can look up the doses.
An oral teracycline can be used the same way. These tend to mess up the
GI flora more, so I use them iff erythromycin fails. I am very reluctant to
use tetracyclines on women for two reasons: First, they like to get
pregnant and you can get fetal mottling of teeth ( yes, I know this happens
fairly late ). This is a guaranteed law suit. Further, ladies tend to
get vaginal candidiasis on tetracyclines. This makes them and their
significant others mad at you. OTOH, tetracyclines may have sifnificant
antiinflammatory properties besides being antibiotics.
If oral erythromycin, etc. don't work, I'll often use a brief course of
Cipro ( say 250 mg, bid for 10 days ). It ain't a published indication, but
a lot of docs around here use it. It does work, and often fairly quickly..
If all else fails for cystic acne and ( very rarely ) for other types of
acne, I'll use Accutane. This is a real pain. It takes several months and
can cause a lot of patient discomfort. You gotta monitor serum lipids, etc.
With women, you really gotta make sure they aren't pregnant with trips to the
gynocologist, etc. All of this really annoys everybody and sometimes
compliance isn't that good, particularly in persons with less serious acne.
Again, all of this is in combination with Retin-A, except for the
accutane. Further, a treatment response may take 2-3 months. BTW,
sometimes patients on Retin-A will have a flair of their acne at 3-6 weeks.
Donno why. I warn patients about this and tell them not to chunk the stuff.
For some reason, this flair is nearly always associated
with a good response later. I tell them this also. After years of
experience, I've come to the conclusion that the best way to use Retin-A is to
titrate the dose so you get a little bit of pealing and irritation and then
back off, forget a formal qd, etc. treatment schedule. If the patient can
tolerate it, 10% unbuffered, unesterified glycolic acid qd helps, as do,
stuff like sulfacet, washes, etc.