effective acne treatment

Factual Questions
1

Wondering if any of you out there might have any experience with effective acne treatment?

My 15-year-old daughter’s acne seems to be getting worse and worse. She seems to be dealing with it very well - much less self conscious than I would be. In fact, one thing that is kinda wierd is that she seems to be almost unconcerned about it.

Tho I was quite the pizza face in my day, hers is worse than mine was, and reaches to her back and neck. And I assume treatment options have changed in the last couple of decades.

I know no single treatment will be effective for every person. And I realize that to some extent her hygeine practices affect her condition. But she is such a beautiful girl. If she could have a clearer complexion, I would like to help her acheive that. I want to help her in whatever way I can to minimize the likelihood of significant scarring.

We have gone to dermatologist in the past, with no success, and are gearing up for another round. Hoped some of you might be able to provide some insight that will help us ask the right questions and evaluate the options.

2

Did any of the dermatologists recommend the drug Accutane?
I was prescribed accutuane for my acne which had become excessive. The drug worked well in my particular case. There are a few catches though. Very serious catches, actually. The drug is prescribed very carefully, because it has been linked to depression among it’s users. Make sure to talk to any skin doctor about this part of the treatment before making any decisions. Also, things like a pre-treatment blood test, abstinence during treatment, etc. are enacted. However, I believe that although it seems like a lot of hassle, it is worth at least asking your dermatologist about his opinions and getting some information.

3

Something tells me that dermatoligist has heard of everything you might find on a bulletinboard, times ten.
You might try to get a recommendation on a different doc, though, from someone who has it under control, if you know of anyone.
The key is to keep from making things worse by doing nothing and ending up with scars.

4

I would (very shyly) recommend the birth control called…um…umm…I forgot…Its advertised on TV. I had a GF a long time ago go on that and, although she turned into a raging, angry psycho for about 3 months, her acne cleared right up.

But you should definatly go to a dermatologist.

5

Yeah, we definitely intend to see a derm. But I guess your experience with medical professionals is somewhat different than mine. In too many cases, it seems as tho you have to do a fair bit of research yourself to even know the right questions to ask. Or to clearly understand what the specialist is telling you. I was hoping you guys might be able to provide some of that base info.

We have primarily tried lotions and cremes with her. (Pardon my spellings - I do not have records at hand.) Tretinin did not seem effective on her - tho it works well with her brother. My understanding is that it workes better for some types of acne than others.

Benzomyacin and (I believe) cleotin were not effective. Nor were hormones. At times she has had some success with ultra sensitive Stridex.

We are interested in doing what we can to address this situation intelligently. As such, we are investigating all possible sources of info. Dopers included.

I guess I should be thankful she hasn’t asked to be put on birth control. “For my acne, that’s right!” :wink:

As I said, she seems to not be bothered by it too much - but it strikes us as tho her skin is basically unhealthy in some respects. And she shouldn’t HAVE to deal with it given current medical knowledge. And it drives us nuts when we learn - the other day for example - that she wan’t even using soap to clean it, in some mistaken belief that it would irritate her skin.

I know it used to kill me when I’d have a huge honking zit on my face. Couldn’t believe anyone else couls see any part of me other than it. Kudos to my kid for apparently being more secure than her old man was.

And they have to resent the genetic crapshoot that gave them my lousy complexion instead of Ms D’s flawless skin.

6

the birth control is cyproterone acetate, which has to be taken in conjunction with an oestrogen.

i take it as dianette, but not for my skin. it’s the only progesterone that doesn’t make me very ill.

it’s not available in the US as far as i know, but you could ask about Dianette, Diane 35 and cyproterone acetate in general, just in case. it’s very safe, and has few side effects other than the normal ones for contraceptive pills.

if she were to take roaccuatane they would probably ask her to take a birth control pill anyway, as the drug is strongly teratogenic.
i know she’s only 15, but it’s standard medical practice for all women of childbearing age.
the hormonal balance that the pill gives could also help her.

tetracycline antibiotics, either topical or oral are a possibility. they are also safe, but may have some side effects like photo sensitivity, heart palpitations and skin dryness.

my sisters (age 19, and 14) are both taking medications (one takes oral tetracycline, the other topical antibiotics and dianette) for their skin, and both have seen very good results.

don’t leave your dermatologist without a prescription for something, or a VERY good reason for not having one.

7

I had bad acne when I was in high school (over a dozen years ago), and still occasionally break out, though nothing like it was back then. I had acne on my neck and back, like she did. I was put on oral tetracycline and had some dietary restrictions, though I’m not sure how much of an effect any of that had.

Does she wash her hair frequently enough? The oils from that might possibly be contributing to her acne where her hair touches her face and neck.

To keep my “adult acne” under control, I picked up the latest edition of Paula Begoun’s Don’t Go to the Cosmetics Counter Without Me. She’s been rating makeup and skin care for at least a decade, and has products analyzed to see if they can do what they claim. In there she outlined simple skin care regimens for different skin types. I use the combination skin one, but oily skin is probably similar - a simple version is something like twice daily washing with Cetaphil (a mild liquid soap that doesn’t clog pores - many bar soaps do), once or twice a day toner use (something as simple as hydrogen peroxide even), occasional use of milk of magnesia to remove excess oil (it has the active ingredient that those expensive clay masks do, and doesn’t clog pores), and nightly use of an effective AHA or salicylic acid (the latter penetrates blackheads better, I gather) to help keep pores from getting clogged up. Oh, and she recommends after washing, the occasional, gentle squeezing of any blackheads to try to unplug them. She warns to not overdo it to the point where you cause damage to the skin, or you’ve made a blackhead into a worse problem.

If you dry out your skin, you’ll force it to make more oil, and make the problem worse. This is probably why the product for very sensitive skin worked somewhat; most of those Stridex, etc., pads seem to have a lot of alcohol or other very drying, nasty stuff in them.

I’m not a doctor, it’s been a while since I’ve been treated for acne (or needed it), and I’m not a shill for Ms. Begoun, but I’ve checked through her books on and off for several years and she seems to know her stuff. Besides, her book is also a pretty comprehensive “Consumer Report”-type analysis of makeup and skin care products, and your daughter might enjoy looking through it for the scoop on whether those expensive cosmetics are really worth it (usually not), and what makeups really don’t clog pores so much, etc.

8

My son is on Accutane. The stuff he had to read before getting it prescribed included a loose leaf binder of materials from the dermatologist. It
requires frequent lab draws (once a month or so),
as the stuff can do liver damage (very rare). If
the patient is a female they run a pregancy test before prescribing since this stuff can do nasty things to a foetus. It can, as mentioned earlier, cause depression. The boy (age 20) has been on it for maybe four months and looks great! He had major back acne and some on his face…and it’s cleared up pretty well and he may need only one or two more months of treatement.

Accutane is also very expensive, so make sure your health insurance is up to snuff.

9

I went to a dermatologist once and was prescribed Cleocin in conjunction with Differin; they worked, but you have to use them CONSISTENTTLY, and they can also be very drying. (I also took oral antibiotics for a couple of weeks in the beginning, can’t remember which.) My skin got very dry, and I had to use a moisturizer.

After I cleared up the initial inflammation, I have been pretty much fine ever since just using a non-soap foaming cleanser on my face every morning (Neutrogena for sensitive skin), with occasional recourse to a toner before bed if it’s hot and humid, just to clear the gunk out of my pores. YMMV, but whatever your daughter does, she must be consistent about it for it to work!.

Also, years ago I had success with some nasty-smelling homeopathic sulfur-based stuff from Meraz Apothecary in Lincoln Square. It smelled foul, but it worked. If you aren’t keen on the idea of taking drugs, talk to the pharmacist at Merz. They’re very helpful. And good luck!

10

Oops…that’s Merz Apothecary.

11

I’m currently dealing with adult cystic acne. It’s delightful, let me tell you that now. But I’m being treated with a combination of benzamycin and differin. Yes, you do have to use them consistently and they do dry your skin out, make them more sensitive to sunlight and such. But my skin looks so much better than it did - I wish I’d done this a lot sooner.

Oral contraceptives might be the way to go, but I don’t know - that’s up to her doc (and it might take derm and gyno visits to determine).

Don’t stress about her not always using soap to clean her face, unless she wears a lot of makeup. I don’t always, because soap tends to make my face more dry. If you can get her to use it, a mild cleanser could help clean it without drying.

12

I think it’s important to keep in ming that everyone’s skin is different. You’ll have to experiment. For instance, in my case it is true that washing with soap tends to irritate my skin and cause more breakouts. Sun exposure leads to bad breakouts for me, but seems to dry out and improve my sister’s skin. Tetracycline has never done a damn thing for me except upset my stomach, but others report good results. Go figure.

I’ll second (third, whatever) the vote for Accutane, though. It’s a serious drug, with potentially bad side effects, but if you keep an eye out it works wonders. I was a horrible pizza-face for four years until I took the stuff, during which time absolutely nothing else had any effect. After taking it, my acne has been reduced to moderate-to-light, and has remained so for over a decade. When I’m in the mood to keep it more under control, using Retinin-A (the same as Tretinin, I think) once every two-three days takes care of it nicely.

I don’t know about your daughter, but I didn’t deal with my acne nearly aggressively enough as a teen because I felt powerless and ugly when I thought about it. It was easier for me to say (and beleive) that it didn’t matter to me. She probably also won’t appreciate it if you are bringing it up all the time, either. Unless you really fear serious scarring, let her go her own pace. I would still recommend suggesting Accutane, though, because (a) it is powerful enough to make her feel like she’s doing something productive, and (b) she may find taking pills more pleasant than smearing icky topicals all over an area she’s already not too happy about.

My two cents, for whatever it’s worth.

mischievous

13

(1) See a dermatologist
(2) Don’t pick
(3) Get Rx from said dermatologist
(4) Don’t pick
(5) Start conservatively (antibiotics) and move toward aggressive (Accutane)
(6) Don’t pick
(7) Soap may be your enemy. Try cleaning with a cleanser and if her skin is dry, use a mild lotion (ie Moisturel)
(8) Don’t pick

:slight_smile:

14

You can find the straight dope on acne, its causes and its treatment, at the American Academy of Dermatololgy’s web site http://www.aad.org/pamphlets/acnepamp.html. Some posters might want to look at the site to see what DOESN’T work.

Quite a few treatments work very well for acne: benzoyl peroxide, tretinoin, topical clindamycin, an oral tetracycline, some birth control pills. Only a few people need to resort to isotretinoin.

But, what is not emphasized enough and is mentioned by only a few people on this board is that NOTHING WORKS IF IT’S NOT USED REGULARLY and NOTHING WORKS IMMEDIATELY.

In my experience, for every 10 people with acne severe enough that they would benefit from treatment, only 5 seek appropriate professional care and only 1 or 2 of the 5, when given appropriate therapy, will actually use it. You say that your daughter tried several products without success. Are you certain that she used them as directed for 4 - 8 weeks without any improvement? If she did, she probably should make an appointment with a someone with experience treating acne in teenagers.

15

Dinsdale,
I’ve had alot of trouble with acne, and its just now starting to clear up. First of all, I would like to point out that the skin types on the face, chest and back can vary a bit, so what works on one may not necessarly work on the other. Also, I second the recommendation to see a dermatologist. I’ve found the Mary Kay cosmetic line has some products which are very effective in dealing with acne; also, I’ve found Tazarac (prescription) to be helpful. Make sure to get her plain, unscented, soap- no lotions or anything in it. Try either the Mary Kay stuff or Neutrogena. Also, she should make sure she’s using an oil-free makeup.

16

What everyone else said.

I took oral antibiotics (minocycline) for a number of weeks, and at the same time began using Retin-A Micro (which is a potent form of Retin-A). After the course of antibiotics was finished, I began using another topical - clindamycin, which is also called Cleocin, I believe.

This is the first treatment that has ever worked for me. I’m 29 and have had fairly bad acne since I was about 10 years old. I’m pretty certain that part of the reason it’s working so well is that I’ve been consistant about using the meds.

17

I knew a couple pizza-faces in high school for whom Accutane worked wonders.

18

Accutane also worked said wonders for me. And there are all those serious physical and suspected psychological side effects to consider.

The most common problem is that it dries you out, hardcore. I had very oily skin and hair when I started the course, and progressed to having to skip washing my hair some days because it was just so dry. I second the vote for Cetaphil skin cleanser. After using it I really can’t understand why people tolerate soap on their face. They also make an effective, though not terribly pleasant-smelling moisturizing lotion. And chapstick becomes necessary.

19

Thanks a bunch for all the info, folks. Gave me a lot of pointers of where I can direct my initial research.

I know whatever treatment she was on last summer caused sun sensitivity. She used a special kind of sun block as well.

And I believe she washes her hair every morning. God knows she’s in the shower long enough!

My daughter’s comments re: past treatment is that “It seems to work for a while, and then stops being effective.” I’ll have to see if I can tactfully determine whether her use declines over time. Promises to be a tricky conversation, as any parent of a teenager can attest!

As far as makeup is concerned, she pretty adamantly refuses to wear any. Maybe a minimal bit of foundation and some lip gloss for a big dance, but that’s it.

Thanks again, folks.