Acne Part 4
This is the final of my four part article on acne. I discuss more on prescription treatment options.
Topical antibiotics reduce bacteria that infect plugged hair follicles. Topical antibiotics come as lotions or gels and applied once or twice a day. A six to eight-week course is usually recommended. After this, treatment is usually stopped as there is a risk that facial bacteria could become resistance to antibiotics. This could make symptoms worse and cause additional infections. Side effects such as minor irritation, redness, burning and peeling are uncommon.
Oral antibiotics are usually used in combination with a topical treatment for moderate to severe acne. In most cases, a class of antibiotics called tetracyclines is used. Pregnant or breastfeeding women can be prescribed an antibiotic called erythromycin as it is safer in pregnancy and breastfeeding. It takes six weeks to notice significant improvement. Treatment is usually stopped after six months to reduce risk of antibiotic resistance.
Side effects of tetracyclines include nausea, vomiting, and diarrhoea. Tetracyclines can make skin sensitive to sunlight. The most common side effects of erythromycin are nausea and mild stomach pain. All oral antibiotics can make the oral contraceptive pill less effective during the first few weeks of treatment so an alternative method of contraception is needed temporarily.
Women with acne who require contraception can take an oral contraceptive called co-cyprindiol. Acne improvement is one of the beneficial side effects of co-cyprindiol. Two to six months’ usage is usually needed before significant improvement in acne is seen.
Isotretinoin works like topical retinoids but has a much stronger effect. Due to safety concerns and precautions, isotretinoin must be prescribed by a dermatologist and not by a GP. Isotretinoin is used with caution with people who suffer from depression as it can exacerbate the condition. A four to six-month course is a usual course. Acne may get worse during the first seven to days’ days of treatment. This is normal and is caused by the medication pushing out bacteria present in deeper layers of the skin.
Isotretinoin carries a very high risk of causing serious birth defects. Women of childbearing age can only be prescribed isotretinoin following a negative pregnancy test. This is repeated throughout treatment.
Common side effects of isotretinoin:
- Inflammation, dryness and cracking of the skin and lips. This may be relieved by applying moisturising cream and lip balm.
- Dryness inside the nose leading to mild nosebleeds. Applying a thin layer of petroleum jelly to the inside of your nose can prevent and ease.
- Skin rash and peeling.
- Inflammation of your eyelids (blepharitis).
- Inflammation and irritation of your eyes.
- Back, muscle and joint pain.
- Blood in urine.
Despite initial concerns, there is no medical evidence isotretinoin increases suicide risk.
Thank you to Kayleigh Ready, skincare consultant at Whelehans Pharmacy and the HSE and NHS for their input