All You Ever Wanted To Know About Acne - The Definitive Guide (Part 6)

TOPICAL TREATMENTS (CONTINUED)

Erythromycin & Benzoyl Peroxide (POM)
We have already explained both the benefits of erythromycin and Benzoyl Peroxide. When combined into one product, not only does it save you double costs (i.e. both are available on prescription) but it can also be much quicker to apply.

Tip - This needs to be kept in the fridge. Be aware of any children with prying fingers who may mistake it for a pot of cream! Expires in five weeks.

Clindamycin & Zinc (POM)

This is a once-a-day lotion combined with zinc.

Erythromycin & Tretinoin (POM)

This is another variation of a topical antibiotic (erythromycin), combined this time with tretinoin (see Vitamin A acid section). So, as well as helping reduce the blackheads and whiteheads, it can help with any inflammation at the same time. Some types include ingredients to help reduce skin intolerance.

Azelaic Acid (POM)

Azelaic acid has an antibacterial effect and also removes the dead skin cells from the top layer of skin that helps in unblocking the hair duct. It can therefore work on both inflammatory and non-inflammatory spots. It may also have a beneficial effect on the brown pigmentation, occasionally seen after a spot has cleared. This type of pigmentation, known as post inflammation hyper-pigmentation, is more common on dark skins.

ORAL TREATMENTS

Some doctors prefer to prescribe tablets for treating acne and it is fair to say that many patients prefer to take medication by mouth. As mentioned above, it is common to be offered a combination of both tablets and creams.

The most common type of tablet to take will contain an antibiotic. These are designed to reduce the bacteria that are present in the ducts of the grease glands. Some also have a direct effect in reducing the inflammation. They also reduce (to some extent) the non-inflamed type of acne.

Oral Antibiotics (POM)

There are many types of antibiotics that are particularly useful for treating acne. As a general rule, these should be given for a period of time, usually no less than 6 months. The most common types of antibiotics used are: tetracyclines, erythromycin, minocycline, doxycycline, or lymecycline.

Antibiotics reduce the effectiveness of the contraceptive pill for the 1st month, so patients should discuss this with their doctor if they are currently taking the pill. Usually, physical methods of contraception need to be used for the first month of use. There are also some antibiotics that must not be taken with food or milk, or an hour before a meal.

It is not unusual to experience some mild degree of stomach upsets when taking antibiotics, especially the tetracyclines. This is caused by the destruction of the normal 'good' bacteria which, flourishes in the bowel. This can sometimes be reduced by taking pro-biotic supplements, such as lacto bacillus or acidophilus (available from health food shops).

The usual recommended dosage of oxytetracycline is 1 gram a day. This will usually mean taking up to four tablets a day. Sometimes, it will be given in two 500mg doses. If minocycline is being used, the normal dose is 100mg twice a day, and vibramycin is 100 mg daily. This initial high dose of antibiotics should be continued for at least two months or until a good response has been seen and then the dosage can be tailed down over a six month period.

Lymecycline is similar to minocycline, in that it need only be taken once a day and is not affected by food or milk.
Tetracycline antibiotics are not suitable for children under 12 or in pregnant women as they can cause staining of the teeth and bone development problems.

Erythromycin is an effective treatment for inflammatory acne, but possibly less so now because of p.acnes resistance.

Trimethoprim is less commonly prescribed, but can be very successful. It is usually prescribed at doses of between 400 - 600 mg a day.

Clindamycin is a very strong antibiotic, but it can be very useful for treating acne.

Contraceptive Pills (POM)

Combination contraceptive pills contain both oestrogen and progesterone. The female hormone oestrogen tends to have an anti-testosterone effect. Progesterone is metabolised into testosterone-like products by the body. The 'mini-pill' is progesterone only and may make your acne worse.

The contraceptive pill should not be used as a first line treatment for acne, but in those patients who require adequate forms of contraception, the combination contraceptive pill, Dianette® can be used. The benefit or otherwise of other pills is uncertain.

For some women, there may be a noticeable increase in acne spots around the time of the menstrual cycle. This is due to the body's high concentration of androgens. If your acne has been persistent and hard to treat, we suggest you read through our leaflet on Polycystic Ovarian Syndrome (PCOS) for further information.

Dianette® (POM)

Dianette® is a contraceptive pill that contains a medium dose of oestrogen, but also a drug called cyproterone acetate that combats the effects of androgens in the body.

Dianette® is often prescribed for women who have not responded to high doses of oral antibiotics. It should be given for a minimum of 6 months, but can be continued for up to 24 months or as directed by your doctor.

It is not uncommon to see a flare-up of acne in the early stages of taking this treatment. However, it may take a little longer to work than the recommendation of giving a product two months trial, so it might be worth sticking at it, to give it a chance to really work. Many people report it can take up to nine months to see the full effect.

This can be combined with topical therapy. You will need to be seen regularly by the family planning team at your G.P. surgery or family planning clinic for regular checks.

Tip - If you are seeking contraception at the same time, you should state this to your doctor, who will be able to prescribe it free on the NHS under the category of contraception.

CONTINUED IN PART 7