(July 17, 2009 - Insidermedicine) In this video, Dr. Amy Taub MD, Associate Professor of Clinical Dermatology at Northwestern University's Medical School, discusses what she would do if she were a young female with acne. Dr. Taub is the founder/medical director of Advanced Dermatology, as well as the founder/medical director of both Skinfo and SkinQRI.
At the American Academy of Dermatology’s annual meeting in San Francisco, we had a chance to speak with Dr. Amy Taub, assistant professor of clinical dermatology at Northwestern University’s Feinberg School of Medicine. Dr. Taub is the founder and medical director of Advanced Dermatology as well as the founder and medical director of Skinfo and SKINQRI.
If I were a young woman and had acne...
Dr. Taub: If you’re a young woman and you have acne, obviously, the person to see is a dermatologist; they are the experts in diagnosing and treating the skin. In terms of urgency, it really depends. If there is scarring potential of your acne, then obviously you want to get in as soon as possible because we don’t want the skin to scar. Obviously, everyone wants to see somebody to help them immediately and sometimes that can be difficult to get in to see a dermatologist.
There are four main ways that you can treat acne:
Dr. Taub: One is the traditional way which is to treat it with oral and topical antibacterials and topical retinoids which kill the bacteria and keep the pore from secreting so much oil since these are the two things that cause acne. The great thing about those is that there are minimal side effects and they’re very effective but they don’t cure the acne, so if you are in your twenties, the chance that you are going to grow out of your acne is much less than if you were in your teens, so you might be looking for something that is a little more permanent.
- Another thing to look at if you’re female is a hormonal treatment of acne. A lot of times it is the male hormone that the female has that causes secretion of the oil from the oil gland and so sometimes being on a simple birth control pill will help.
In addition, there are some new treatments for acne - procedural treatments such as photodynamic therapy which works extremely well, and then there’s also some other devices that work well for acne.
Finally, there is something called Accutane which is a brand name for Isotretinoin which is a medication that has been around for more than twenty years that we use for refractory or severe cases of acne that don’t respond to anything else, or sometimes I use it even for moderate cases of acne when you are in your twenties because it is the only known cure for acne, and you take it for approximately 5 months, and 3 out of 4 people are actually cured of their acne.
What will the dermatologist ask me?
Dr. Taub: You want to write down or bring in everything that you have ever used for acne. You want to really think about your history and whether or not you’ve used anything, whether it has been effective, whether you’ve had any side effects and also what allergies to any medications that you have or if you’re taking any current medications. The other thing that would be important to tell the dermatologist obviously is if you have any other medical conditions that might interfere with your taking certain medications and any family history of any kind of medical conditions. Also, you want to think about what kind of skin you have and what kind of things you like (Do you like gels? Do you like creams?). All of those things factor in to what is going to be chosen; if you speak up saying “I really hate putting creams on my face, I really prefer a liquid of a gel”, then that might go in to influencing the dermatologist’s choice of what to give you.
What should be monitored before, during and after treatment?
Dr. Taub: Generally speaking, unless you choose to do the isotretinoin route, there usually is no monitoring for the treatments of acne. With Isotretinoin, we do monitor pregnancy tests, we do monitor blood lipids, called triglycerides (like cholesterol but different), because those can increase during the treatment. We usually also monitor complete blood count during the treatment. There are some potential side effects from Accutane that are different from other medications and so we monitor the liver function test as well, and what we expect is to see no pregnancy and normal tests, and we expect that before, during and after. If there is any abnormality, for instance of the triglycerides or the liver function test, we may choose to decrease the dose of the medication, or we may even choose to discontinue it, if we feel that there is any risk to the person.
Dr. Taub: If I were a young woman and I developed acne, it does depend a little bit on the type of acne. I personally would choose for myself either one of the longer-lasting treatments (like Isotretinoin), the main reason being that you don’t want to spend the next ten years fighting acne, if you can it would be great to just get rid of it in one fell swoop. The other thing that I would consider is the procedural treatments for acne. The main drawback of the procedural treatments for acne is that they are not covered by insurance, and that’s very unfortunate because they really bring a lot to the table in terms of not only treating the acne, but actually making the skin look better, reducing the oil gland secretion, it really changes the skin and reduces the post-inflamatory changes (the red and the brown from the acne) so it can normalize the skin well.
The thing that we really try to prevent while you are on Accutane is a pregnancy. This is not a medication that you would take if you’re about to attempt to become pregnant. However, if you do it for the 5 or 6 months, and you wait a month for the medication to be completely out of your system, you will have no problem having a normal pregnancy in the future. It has to be in your blood stream while you are actually pregnant. And so most women in their early twenties are building their lives, and so it is not a typical time to become pregnant, but obviously if you’ve just got married and you’re thinking about getting pregnant, Accutane is off the table, in which case I would recommend either making do with some prescription items that are alright to take when you’re pregnant, or considering the procedural treatments for acne which really are alright during pregnancy.