Acne: Prevention better than treatment
Dear Dr Donya,
I read your article about acne on The Jakarta Post's website. I am 30 years old but is still suffering from acne problems, especially the scars it leaves behind.
I would like to know how to remove or reduce acne scars. I had exfoliated my face eight times about five years ago, but it did not work. I have heard about laser treatment to reduce/remove scars. Is it an effective method, and are there any side effects of this treatment in the short and long term? I would appreciate your comments and suggestions.
-- Lolita
Dear Lolita,
For acne scaring, prevention is the best. When you have inflamed acne, you should treat it immediately to prevent scaring.
Treating acne scars using laser would depend on your skin type. There are six skin types. Type I is white like an albino's, type III is like Chinese people's skin, type IV is a little dark and easily tanned like the skin of most Asians, and type VI is black.
Skin type I to III can be treated with laser Erbium, which is presently the best. If you have skin types IV to VI, you should apply retin A daily and do an AHA facial and use an AHA home use application.
There are noninvasive methods to remove/reduce scars such as iontophoresis with retin A gel, and invasive methods such as subcision scar, which cuts the fibrous tissue beneath the scar, or punch surgery or punch surgery and graft.
But laser treatment is not recommended for skin type IV to VI since its side effect -- post inflammatory hyperpigmentation -- darkens your skin and can last for a year before getting better, or sometimes even worse. Another side effect is erythema (redness of the skin) or bacterial infection of the treated area. Please check your skin type with your dermatologist and the treatment he recommends.
-- Dr. Donya
Hello Dr. Donya,
I have acne problems and I am presently using a retin A to treat it. However, my doctor recommends that I take Accutane pills if I want to get rid of my acne once and for all.
I'm tempted to do so, but I'm afraid of its side effects. I hear the drug may cause itching and hair problems. Since my doctor is not very open about this, I need your professional opinion on this. Here are my questions:
1. What are the possible side effects of this pill?
2. When should I start taking them and how long will it be effective?
-- Onnie
Dear Onnie,
Isotretionin is used in the treatment of severe cystic acne -- inflammatory nodules with a diameter of five millimeters or more. The term "severe" is defined by many nodules. Isotretinoin has usually been associated with continued improvement and prolonged remission after discontinuance of therapy in patients with severe nodular acne.
To answer your questions:
1. The other possible side effects include dry lips and mouth, minor swelling of the eyelids and lips, crusty skin, nosebleeds, indigestion, eye irritation or redness, headache or thinning of the hair. Serious side effects, which are rare, include mood swings, changes in vision, stomach ache, rectal bleeding, severe diarrhea, tingling sensation of the skin, sun sensitivity, bone aches, stiffness of the joints, lethargy or even hepatitis.
Acne may get worse during the first few days of therapy. If you experience any side effects listed or not listed above, contact your doctor. If you have an allergic reaction such as rash, itching, swelling, dizziness or breathing problems, stop the drug right away and contact your doctor.
Before starting on the drug, you should tell your doctor your medical history, such as do you have diabetes, a family history of high blood lipids, psychiatric disorders or allergies.
If you take this drug, you should not donate blood for at least a month after you have stopped taking it. Avoid exposure to the sun and sunlamps. Use sunscreen and protective clothes. Be cautious when driving at night or operating machines in the dark. If you miss a dose, skip it. Do not double dose.
2. The dose will hinge on the severity of the problem and your weight because acne is a multifactor skin disorder that depends on the individual's hair follicle structure and the bacteria that has infected the follicles. That's why it is sometimes quite difficult to treat.
The doctor may change the dosage after two or more weeks, depending on your tolerance and response. The doctor will want to find the lowest possible effective dosage. Normally, about a month after treatment, you will be able to tell if the drug is working. The treatment will last about 15 to 20 weeks but it can be discontinued sooner if the cysts have reduced by more than 70 percent. The relapse percentage of acne is 5 percent. The main problem of using Accutane is some patients cannot tolerate its side effects, and moreover the drug is expensive.
-- Dr. Donya