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Acne is one of the most pervasive skin conditions. As I mentioned last week, almost 85% of Americans are affected by acne at some point in their lives, whether during adolescence or adulthood. Because acne can be surprisingly difficult to treat, there are a variety of options available for treatment. This week, we’ll focus on oral acne treatments.
Oral contraceptives are mainly prescribed to nonsmoking women under the age of 35 when they don’t see success with other acne treatments and are also in the market for contraception. Doctors have treated acne with oral contraceptives off-label for years, but the FDA has only approved three for the treatment of acne (Ortho Tri-Cyclen, YAZ, and Estrostep) because of their combinations of hormones. Each of the three contains both estrogen and progesterone.
All acne has four components. One well-known contributor is the bacteria P. acnes, but another culprit is hormone-mediated overproduction of sebum, the oil in your pores. These combine with inflammation and a build up of dead skin cells on the surface to create all of the forms of acne. Because oral contraceptives mainly influence oil production, they’re often used in combination with other treatments. Remember that it may take several months for you to see results. Some people experience no negative side effects, but others may experience depression and mood swings, migraines, hypertension, and blood clots (which are a risk for stroke), so be sure to discuss this option carefully with your doctor.
Much like topical antibiotics discussed last week, oral antibiotics work to kill P. acnes, a bacteria that is one of the most common causes of acne. Different antibiotics work in different ways; for example, erythromycin kills bacteria to prevent breakouts, doxycycline slows the growth of bacteria, and clindamycin works to suppress formation of P. acnes proteins.
One antibiotic sometimes used off-label is Bactrim, a combination of trimethoprim and sulfamethoxazole, which is FDA-approved for treatment of urinary tract infections, shigellosis, and acute exacerbations of chronic bronchitis. Side effects for Bactrim include joint pain, rash, insomnia, and a swollen tongue. Bactrim also contains sulfur, which many people are allergic to.
All antibiotics are serious medications and should never be taken without a personal, direct prescription and ongoing supervision from your own physician.
Isotretinoin is an oral form of vitamin A approved to treat severe cystic acne. It should only used as a last resort for very severe acne or acne that is causing permanent scarring. Vitamin A derivatives help to regulate the maturation and turnover of skin cells and can be very effective in acne, but side effects have led the federal government to require that patients enroll in a program called iPledge to be monitored by their dermatologists very closely. For example, among several other risks, isotretinoin can cause severe birth defects, so all women of childbearing age must get monthly blood tests and pregnancy tests and participate in monthly counseling with the dermatologist.
Other side effects of isotretinoin include dry eyes, nose, and skin; itching; nosebleeds; sun sensitivity; muscle aches; and poor night vision. It may also increase triglyceride levels in the liver and increase cholesterol. Isotretinoin is also possibly associated with an increased risk of depression and suicide, although a causal relationship has yet to be determined. Since severe acne is also associated with these risks in teens, this issue is still being studied for clarification, but anyone who has a history of depression or psychiatric issues must be cleared by a mental health professional to be in the program.
Oral treatments can be an effective way to treat acne and are often used in conjunction with other types of treatments to ensure maximum effectiveness. Of course, not all oral treatments are best for everyone, and sometimes the side effects can outweigh the benefits, so be sure to discuss the above options with your doctor to see what would work best for you.