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Selecting the Right Acne Treatment for You

Treating ‘Hormonal’ Acne

Many cases of inflammatory acne are "hormonal" in nature -- that is, they occur in teenage girls and women, and are aggravated by hormonal fluctuations like those that occur during the menstrual cycle. For these women, dermatologists often choose to prescribe either oral contraceptive pills or another medication called spironolactone.

There are now three oral contraceptives that are specifically approved by the FDA for the treatment of acne in women: Yaz, Estrostep, and Ortho Tri-Cyclen. Only pills that combine the female hormone estrogen with the synthetic version of the male hormone progesterone, progestin, can stabilize hormonal fluctuations in a way that can treat acne.

Oral contraceptives are a very effective treatment for acne in many women, but you have to give them time to work, says Bethanee Schlosser, MD, assistant professor and director of the women’s skin health program in the department of dermatology at Northwestern University’s Feinberg School of Medicine. "I ask patients to give the pills at least three months of use before judging their impact. That’s when the studies found a notable difference between placebos and oral contraceptives. Many patients went on to get further benefit at about 6 months out. This is not an overnight process."

Some women may prefer not to use oral contraceptives, or should not take them because they are smokers or otherwise at high risk. These women, as well as those who only get partial acne relief from contraceptives, are often prescribed a drug called spironolactone.

This medication is a diuretic -- that is, a "water pill" that causes frequent urination. It also blocks receptors for male hormones, which modulates the hormonal surges that can stimulate oil production, causing acne. Spironolactone isn’t approved by the FDA to treat acne and probably won’t be, Schlosser says, because as a generic drug there’s little motivation for a manufacturer to pay for the trials needed to go through the approval process. But most dermatologists agree that it works well as an acne treatment.

Treating Severe Inflammatory or Cystic Acne

When acne does not respond to the standard one-two punch of topical retinoids and oral antibiotics, patients have two other choices: the drug isotretinoin, or one of several procedure-based treatments for acne that involve using laser or light treatment to reduce inflammation and kill acne-causing bacteria.

Isotretinoin is an extremely powerful treatment for acne, often clearing up severe, scarring breakouts that had not responded to any other treatments within a matter of a few months.

But it also carries with it a host of risks and side effects, including inflammatory bowel disease, ulcerative colitis, liver damage, bony malformations, depression, and a virtual certainty of severe birth defects for the babies of women who take isotretinoin while pregnant. 

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