skin disorders
Acne
Treatment of Acne
For whiteheads and blackheads,tretinoincream and/orbenzoyl peroxide For mild acne, skin treatment withtretinoincream, sometimes withbenzoyl peroxideor an antibiotic applied to the skin, or both For moderate acne, antibiotics by mouth in combination with skin treatment as for mild acne For severe acne,isotretinoinby mouth For cystic acne, injected corticosteroids General care of acne is very simple. Affected areas should be gently washed once or twice a day with a mild soap. Antibacterial or abrasive soaps, alcohol pads, and heavy frequent scrubbing provide no added benefit and may further irritate the skin. Cosmetics should be water-based because very oily products can worsen acne. A healthy, balanced diet should be followed (see under Nutritional Requirements ). A diet that is low in simple or processed carbohydrates and sugars (a Vigorous washing and scrubbing may irritate the skin and can make acne worse. Some acne treatments are useful for specific people. For example, oral contraceptives may be given to women who have acne. This treatment takes more than 6 months to produce results.Spironolactone(a drug that blocks the action of the hormone aldosterone) also may help some women.Clascoteroneis another drug that blocks the effects of certain hormones, and it can be used to treat acne in people 12 years of age and older. Various therapies that use light have helped people who have inflammation (with pimples or pustules). Acne treatment depends on the severity of the condition. Mild acne requires the simplest treatment that poses the fewest risks of side effects. More severe acne or acne that does not respond to preliminary treatment requires additional treatment. A treatment plan should always include education, support, and the most practical option for the person. People may need to see a specialist. Drugs used to treat mild acne are applied to the skin (topical drugs). They work by either killing bacteria (antibiotics) or drying up or unclogging the pores (comedolytics). Older nonprescription creams that containsalicylic acid, resorcinol, or sulfur may help by drying out the pimples and causing slight peeling. The most common prescription topical drug for blackheads and whiteheads istretinoin.Tretinoinis very effective but is irritating to the skin and makes it more sensitive to sunlight. Doctors therefore use this drug cautiously, starting with infrequent applications and low concentrations, which can both be gradually increased. People who cannot toleratetretinoinare given topicaladapalene,azelaic acid, and glycolic orsalicylic acid. People who also have inflammation (with pimples or pustules) are giventretinoincombined withbenzoyl peroxide, a topical antibiotic, or both. The two most commonly prescribed topical antibiotics areclindamycinanderythromycin.Minocyclinefoam anddapsoneare other topical antibiotics. Topical antibiotics should not be used except when taken in combination with a retinoid, such astretinoin, orbenzoyl peroxide.Benzoyl peroxideis available with or without a prescription. Glycolic acid may be used instead of or in addition totretinoinbut is no longer commonly used. Blackheads and whiteheads can be removed (called extraction) by a doctor, using instruments called comedone extractors and sterile needles. Antibiotics taken by mouth (such asdoxycycline,minocycline,tetracycline, anderythromycin) can be given to people who have more extensive acne than is manageable with topical drugs alone. Moderate acne is usually treated with antibiotics given by mouth (orally). Typical antibiotics includedoxycycline,minocycline,tetracycline, andsarecycline.Azithromycin,erythromycin, andtrimethoprim/sulfamethoxazole are other options. People often use a topical treatment as for mild acne and an oral antibiotic. People may need to take antibiotics for about 12 weeks to achieve the maximum benefits. If possible, oral antibiotics are stopped and topical treatments alone are used to maintain control. Because acne can recur after short-term treatment, therapy may need to be continued for months to years. Women who take antibiotics for a long time sometimes develop vaginal yeast infections that may require treatment. Women who are not helped by oral antibiotics may be given oral contraceptives,spironolactone, or both. For the most severe acne, when antibiotics do not work, oralisotretinoinis the best treatment.Isotretinoin, which is related to the topical drugtretinoin, is the only drug that can potentially cure acne. However,isotretinoincan have very serious side effects.Isotretinoincan harm a developing fetus, and women taking it must use at least two forms of contraception before, during, and after treatment so they do not become pregnant.Other, less serious side effects may occur as well. Therapy typically continues for 16 to 20 weeks but sometimes more. Doctors give people with acne conglobata oral antibiotics. If antibiotics do not help, doctors give oralisotretinoinand corticosteroids. Doctors give people with acne fulminans oral corticosteroids and antibiotics. Doctors give people with pyoderma faciale oral corticosteroids andisotretinoin. Doctors sometimes treat people with large, inflamed nodules or abscesses by injecting corticosteroids into them. Occasionally, a doctor cuts open a nodule or abscess to drain it. Treatment of severe acne scars depends on their shape, depth, and location. Multiple, small, shallow scars may be treated with chemical peels, Using Lasers to Treat Skin Problems , dermabrasion, and/or a newer treatment called microneedling. In microneedling, small needles are used to prick the skin, causing changes in the skin's collagen. Dermabrasion is a procedure in which the skin surface is rubbed with an abrasive metal instrument to remove the top layer. Individual shallow or deep scars may be cut out and the skin sewn back together. Wide, indented scars can be improved cosmetically in a procedure called subcision, in which small cuts are made under the skin to release the scar tissue. This procedure often allows the skin to resume its normal contours. Sometimes scars are injected with various substances such as collagen, fat, or a variety of synthetic materials. These substances may raise the scarred area to make it level with the rest of the skin. Fillers such as collagen, hyaluronic acid, and polymethylmethacrylate injections are temporary and must be repeated periodically. Some of the other injections are permanent. 