First, find out what's worked before. No point in trying
erythromycin or tetracycline if it failed before.
Also, make sure it's acne and not Rosacea. Two good screens: Retin-A
and/or sunlight usually make acne vulgaris better while they often make
Rosacea worse. Does your acne get better or worse in the summer or
winter ? Sometimes rosacea looks a whole lot like acne. some of the cases of
it all the time which have been misdiagnosed. The therapy is very different
Metrogen for Months, possibly plus sulfacet and / or tetracyclines.
First line treatment for acne vulgaris is Retin-A plus an antibiotic. The
patent on Retin-A has expired, but so far, there are no generics, so it's a
little expensive. You can use the antibiotic alone. Erythromycin is prefered, particularly in combination with benzolyl
peroxide (which does work alone). It's cheap and it usually works at
least for a while. Also, when the patient gets tolerant to it after a year
or so, you can rotate them onto another antibiotic until that one does not
work. Then when you put them back on erythromycin, it often works again.
Oral or topical: In mild acne start with topical treatment.
In cystic acne or in acne that does not respond to topical treatment (most
does), usually you will be given oral erythromycin.
An oral teracycline can be used the same way. These tend to mess up the
GI flora more, use them if erythromycin fails.
If oral erythromycin don't work, use a brief course of
Cipro. It ain't a published indication, but
a lot of doctors use it. It does work, and often fairly quickly..
If all else fails for Cystic Acne and very rarely for other types of
acne, use Accutane. This is a real pain. It takes several months and
can cause a lot of discomfort.
Again, all of this is in combination with Retin-A, except for the
accutane. Further, a treatment response may take 2-3 months.
sometimes patients on Retin-A will have a flair of their acne at 3-6 weeks.
Wash the skin
Avoid oily substances
Shampoo the hair daily
Don`t "pop" pimples
Exercise regularly
Don't stop the acne medicine
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