Friday, April 4, 2008

Acne Treatments: Old vs. New

Experts compare the latest acne treatments to time-tested remedies.

WebMD Feature

Reviewed by Louise Chang, MD

From occasional breakouts in the teenage years to chronic, ongoing battles that last clear into adulthood, acne is one of the most common -- if not the most frustrating -- of all skin conditions.
And while there have always been a variety of treatment options available, more recently some have been a cause for concern.

Indeed, the popular treatment Accutane was always linked to an increased risk of birth defects. And it has also received media attention when researchers began debating whether it might also increase the risk of suicide in young users.

Antibiotics and Topicals
Long-term oral antibiotic treatments -- once a mainstay of acne care -- also hit the headlines, implicated in everything from encouraging drug resistance to escalating the risk of breast cancer to increasing respiratory infections in teens.

Topicals had their share of problems, as patients continued to report that otherwise effective treatments like Retin A (retinoic acid) were causing skin inflammation, in many instances as bad or worse than the acne itself. And while certain oral contraceptives helped many women clear their skin, some became concerned about side effects, including an increased risk of blood clots, particularly in smokers.

"The treatments that we had, worked. And most worked well. But many patients began looking for options that were either safer or more convenient to use," says David Goldberg, MD, director of Skin and Laser Surgery Specialists of New York and New Jersey. He is also director of the Laser Research and Mohs Surgery Center at The Mount Sinai School of Medicine in New York City.

Fortunately, some new options have come on board. But are they any better -- or any safer -- than what we had in the past? WebMD asked experts to help us investigate.
What Causes Acne

According to the American Academy of Dermatology, acne develops when hormonal shifts (like the kind that occur during puberty, and in women, before a menstrual cycle and sometimes prior to menopause) cause an overproduction of oil and cells inside a skin follicle. Together, they form a kind of biological traffic jam that plugs the opening of the pore and causes the follicle beneath to swell.

This allows for the overgrowth of bacteria found normally on skin -- Propionibacterium acnes (P. acnes) -- producing irritating chemical substances, which further fuel the inflammation. The end result is acne.

"It can be characterized by anything from whiteheads and blackheads, to tiny hard pimples you barely see, to pus-filled nodules, even fluid-filled cysts with roots deep in the skin," says Sumayah Jamal, MD, PhD, an assistant professor of dermatology and microbiology at the NYU Medical Center in New York City.

'Gold Standard' vs. New Treatments
For decades, doctors have said the "gold standard" for treating mild to moderate acne has been a combination of a deep pore cleanser like benzoyl peroxide (it attacks excess oil) and a topical antibiotic or sulphur drug to combat the bacteria. For some patients, treatment also included the topical prescription medication Retin A to help speed clearing. And it's a combination that is still in use today.

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