Adult patients suffering from nodulocystic acne, where both nodules and adult cystic acne lesions are present, face a high risk of scarring. To combat this condition, adult cystic acne treatments generally include using oral medication together with topical treatment to control the inflammation. Oral medications consist of antiobiotics, hormonal therapy and isotretinoin (Accutane).
1) Oral Antibiotics
Antibiotics are the first line of oral treatment, and have proven effective, with good safety records over periods of more than 30 years. Antibiotics reduce the population of P.acnes, the bacteria that causes acne. Effective antibiotic therapy can reduce P.acnes by 90% or more. The most common antibiotics are tetracycline, doxycycline, minocycline, as well as erythromycin and cotrimoxazole.
Adult cystic acne generally take four to six weeks to respond to antibiotic therapy. During this initial period, the patient must take the medication regularly to avoid treatment failure. As the inflammatory acne clears, the dosage of antibiotics will be gradually reduced, and eventually stopped. Adult acne cysts usually take three to six months to clear. Once the acne lesions clear, the doctor will stop antibiotic treatment and put the patient on maintenance topical medication.
The use of broad-spectrum oral antibiotics may change the normal bacteria flora of the vagina in women, which may result in an overgrowth of the superficial fungus Candida. This causes vaginal thrush, or candidosis, presenting as an increased white vaginal discharge several days to weeks after starting therapy.
2) Hormonal Treatment
Hormonal treatment is an alternative systemic treatment available to women only. Oral contraceptives combining cyproterone acetate (an anti-androgen), ethinylestradiol (an oestrogen), and other low-dose, anti-androgen drugs such as spironolactone are the most common hormonal therapies used to treat adult acne.
Oral contraceptives and spironolactone act by reducing the effect of androgens on the sebaceous glands by blocking the androgen receptors. Women who are starting hormonal therapy must be examined to ensure that they are not pregnant. Side effects include temporary weight gain, breast soreness and irregular menstruation.
3) Oral Isotretinoin (Accutane)
Isotretinoin belongs to a class of drugs known as retinoids. Isotretinoin reduces sebaceous gland activity and is also anti-inflammatory. It prevents the formation of new comedones and indirectly reduces P.acnes populations.
Oral isotretinoin is available in 10- or 20-mg capsules. A full course treatment usually takes four to eight months. Most dermatologists prescribe the drug to patients based on body weight, and aim for a certain target cumulative dose. This method has been proven to give the best long term results.
After one to two weeks, the patient will start to notice the skin getting less oily, and after three to four weeks, the acne will show signs of clearing. In some people, the acne may seem to get worse during the first few weeks. This is temporary and will eventually improve.
Isotretinoin side effects include
- red, cracked and sore lips which can be relieved by applying a lip moisturizer
- dry irritated eyes which can be reduced by the use of eyedrops
- dry mouth and nose and sometimes nosebleeds
- dry skin which may also peel. Those suffering from eczema may be more vulnerable and require liberal use of moisturizers.
- higher doses may lead to the occurrence of headaches, joint pain or stiffness, mild hair loss (Accutane hair loss) and nausea
Precautions When Using Isotretinoin
- Pregnancy must be avoided throughout the time that the patient is on isotretinoin, and for one month after it has been stopped to prevent serious harm and deformities to unborn babies.
- Do not donate blood while taking oral isotretinoin and for at least one month after taking the medication.
- Limit exposure to sunlight with a sunscreen as isotretinoin tends to incrase sensitivity to sunlight.
- Avoid vitamin preparations containing high doses of Vitamin A or oral tetracycline antibiotics while on oral isotretinoin. This combination can cause fluid pressure within the brain to rise, leading to severe headaches, nausea and vomiting.
- Limit your intake of alcoholic drinks while on isotretinoin medication as both isotretinoin and alcohol can increase triglyceride (fats) and enzyme levels in the liver.
4) Intralesional Corticosteroids
Large acne cysts take several weeks to resolve on their own, and the ongoing inflammation may result in deep scars. To quickly reduce this inflammation and resolve the adult acne cyst, your doctor may inject a small amount of steroid solution such as triamcinolone acetonide into it.
This painless injection is done with a small needle. The adult acne cyst usually resolves within several days without scarring. Repeat treatment may be required when there is a recurrence of the adult acne cyst.
Cures for adult cystic acne work best when combined with a sensible adult acne skin care regimen and a healthy diet. Be sure to drink lots of water, eat plenty of fresh fruit and vegetables, and get enough sleep.
If you know of other cures for adult cystic acne that have worked for you, please feel free to comment.