Archive for December, 2005
In a recent post here on the Everything Acne.com blog we talked about the potential link between dairy intake and acne. The authors of the cited study conlcuded that “…the association with milk may be because of the presence of hormones and bioactive molecules in milk.”
In a follow up letter, another dermatologist hypothesized that perhaps the iodine content of milk may also be playing a role in the development of acne. Prior studies have shown that iodine can worsen acne and other evidence has shown significant levels of iodine in milk. This iodine content results from the fortification of animal feed with idoine and the use of iodine containing sanitizing solutions on the cows’ udders and milking equipment.
It is hard to know for sure, but perhaps these issues will be addressed in a prospective study in the near future.
December 20th, 2005
It has long been hypothesized that stress can make acne worse. It is safe to say that many dermatologists observed this in their practices. Indeed, just in the last few weeks as final examinations have come to an end and many high school and college students are on their winter break, we have observed significant improvement in our patients’ acne.
To add some actual data to this belief, s study performed a few years ago looked at college students and evaluated the change in their acne during final exams. The participants of the study we assessed for the degree of acne and perceived degree of stress.
The study concluded that “Patients with acne may experience worsening of the disease during examinations. Furthermore, changes in acne severity correlate highly with increasing stress, suggesting that emotional stress from external sources may have a significant influence on acne.”
For the full article abstract, click here.
December 19th, 2005
This was the title of an editorial in the most recent edition of Cutis magazine. The author touched on many of the key features of the upcoming program that have been discussed in a prior post. Among the key features stressed were the fact that female patients of childbearing potential must enter into a system monthly lab results indicating a negative pregnancy test as well as listing two forms of contraception that are being used.
The author conveyed his concern that these new regulations, which to most dermatologists seem a bit extreme, may discourage physicians from prescribing this extremely valuable medication. He even sarcastically stated “I thought it might be easier for someone to construct a weapon of mass destruction than for a doctor to actually prescribe isotretinoin under the new iPLEDGE guidelines.”
We concur with the conclusion of the article that while the transition to the new program will take some work, it is important to remember the lives that have benefited and will continue to benefit from this important acne medication.
December 18th, 2005
There are ongoing myths that attempt to link certain foods and diets to acne. Among the favorite foods to blame are chocolate, french fries, and other greasy foods. Despite the tales of acne causation, there has never been proof that diet is actually linked to breakouts.
Until recently that is.
In a recent article in the Journal of the American Academy of Dermatology, there was a positive association with acne for the intake of some dairy products. The study was retrospective in nature (based on questionnaires) and looked at the association of high school dietary dairy intake with teenage acne.
The article concluded that there was a positive association with acne for intake of total milk and skim milk. In addition, there were also positive associations with instant breakfast drink, sherbet, cottage cheese, and cream cheese. The authors hypothesized that the association with milk may be because of the presence of hormones and bioactive molecules in milk.
It will be interesting to see how the dermatologic community responds…
December 17th, 2005
In dermatology, when we talk about the vehicle, we are referring to the “substance” that carries the active medication to the skin. The various vehicles include ointments, creams, gels, lotions, solutions, pads, and even foams. Choosing the right vehicle is part of the art of treating acne and can significantly improve compliance.
By far the most common vehicles used in acne are gels and creams. When choosing between these two, it seems that creams tend to be a bit more gentle on the skin while gels overall seem to penetrate more and are usually slightly more effective. When treating a large area or treating the back and/or chest, the use of medicated pads or lotions can help make treatment easier and less messy. Recently a new foam product was released that spreads very easily and can be used on the face and/or body, even hairy areas. Finally, there are also many cleansers that are available that can allow added treatment while washing the face and body.
So, if you think you may be more likely to use a treatment based on a certain vehicle, be sure and ask your doctor if an appropriate medication is available that vehicle so that you can get the most out of your acne treatment.
December 16th, 2005
We are often asked whether some of the topical acne medications require refrigeration. The main topical acne medications that we focus on for this issue are the combination medications. In the past, the original combination medication Benzamycin did (and still does) require refrigeration. This is so the two ingredients do not “come apart.” More recently, the newer combination medications which combine the effects of topical clindamycin and benzoyl peroxide (Benzaclin gel and Duac gel) do not require refrigeration. This allows for added convenience and ease of use.
When comparing the two products, Benzaclin gel is stable without refrigeration for up to 13 weeks after being mixed at the pharmacy and Duac gel is stable for 8 weeks after being mixed at the manufacturer. So, while Benzaclin is stable for longer, both will give you at least two months of use before expiring.
December 15th, 2005
For moderate to severe inflammatory acne, oral antibiotics are one of the most popular and effective choices for treatment. It is important to note however, that many of the antibiotics used for acne can cause increased sensitivity to the sun. In fact, they can cause what is know as phototoxic reactions. In other words, an exaggerated sunburn-like response. Not all oral antibiotics cause this sun sensitivity and for those that do, there are varying degrees of sensitivity that can result.
Probably the most common oral antibiotics used in acne that cause photosensitivity are the tetracyclines. Of these, doxycycline (Adoxa, Doryx) is the most photosensitizing, followed by tetracycline, and finally minocycline (Dynacin, Minocin, Myrac).
Perhaps the next most common class of oral antibiotics used in treating acne is the erythromycin family (Eryc, Eryped, EES, and others). The erythromycins are not photosensitizing and would be a good choice for people who spend a lot of time in the sun.
Finally, a less commonly used oral antibiotic, Bactrim is also photosensitizing and caution should be used when in the sun.
So, if you happen to be on one of the oral antibiotics that can cause increased sensitvity to the sun, please exercise caution when outside and add a suscreen to your topical skin regimen.
December 14th, 2005
Medicis is now offering instant pharmacy rebates on both Triaz Pads and Triaz cleanser. What this means, is that you get the rebate immediately at the pharmacy (no need for paper work or sending the rebate in) and will likely have no copay! As prices for medications are increasing this can really help cut the cost of your prescription acne regimen. So, if your doctor prescribes Triaz for you, ask for the rebate and enjoy the savings!
December 13th, 2005
In today’s world, everyone wants results right away. Unfortunately, when it comes to acne, true results usually take time. While some treatments can show results within 24 hours on individual blemishes (like the Zeno Acne Clearing Device), for more widespread acne, the way that many of the medications that are used to treat acne work can take up to 4 to 6 weeks to truly show their full benefit. Often times, we’ll see patients who say that the medications didn’t work and then later find out that they quit after a week or two.
So, be patient with your acne treatment regimen and understand that it may take even up to 6 weeks to see the true results. In the end, the wait will be worth it!
December 12th, 2005
When it comes to treating acne, the topical retinoids are a key factor in the fight against pimples. And while these medications are best at fighting comedones (blackheads and whiteheads) they have also been shown to fight inflammatory lesions as well (pimples, pustules).
Many experts recommend that a retinoid be a part of any acne regimen. There are many topical retinoids to choose from and while any of these medications can cause dryness and irritation, some seem to be more gentle than others. There are many studies that look at the tolerability of the topical retinoids, but in our experience, a few things hold true.
In general, creams tend to be less irritating than gels. Also, when it comes to the brand names as a whole, Differin seems to be the least irritating, followed by Retin-a microgel and finally Tazorac ,while perhaps the most effective topical retinoid, seems to be the most irritating. Skin type will be important in determining which topical retinoid is best.
For tricks to decrease the irritation of any topical retinoid, check out our post on Acne Treatment During the Winter Months.
December 11th, 2005
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