Selecting the Right Acne Treatment for You
Treating Severe Inflammatory or Cystic Acne continued...
In 2005, the FDA established an online tracking database, called iPledge, and now requires all patients to sign onto the database to continue receiving their prescriptions. The iPledge system requires women to submit two negative pregnancy tests before they can receive an initial prescription for isotretinoin. Women must also undergo a monthly pregnancy test before each refill. Men are also tracked because of isotretinoin’s depression risk.
"Anyone taking [isotretinoin] really needs to be counseled properly about all of these risks,” Alexiades-Armenakas says. The drug also impairs wound healing, so if a patient with severe cystic acne begins taking the drug, those cysts typically resolve with scars. "It gets rid of the underlying problem, but you’re almost guaranteed to heal with scars if you’re at that level of inflammation when you start taking [isotretinoin]."
The alternative to isotretinoin for people with severe, stubborn acne, is a treatment involving laser/light therapy. The two main options are:
Photodynamic therapy. "In this technique, we apply a prescription liquid to the patient’s face, chest, or back -- wherever the acne is -- and then apply a light or laser to activate the medicine," Taub says. "Not only does the medication kill bacteria -- which is less important, because bacteria will come back -- but over a few months, it also reduces the size and activity of the oil glands."
Isolaz. This treatment combines a vacuum with a broadband light. The vacuum cleanses pores and extracts excess oil, while the light helps destroy the acne-causing bacteria as well as reducing the activity of the oil gland.
"For people with the most severe acne who’ve failed other treatments, I usually count on [isotretinoin] or laser treatment," Taub says.