Adult Acne and Acne Medication: Why Not Meds?

In last week's post, I discussed a few of the various types of medications that are sometimes prescribed for acne.

As an Virtual Skincare Coach specializing in acne conditions in adults 30+, I've noticed for years that many people who come to me for help have been disappointed by prescriptions that either simply didn't work or actually appeared to make things worse.  I have indeed seen skin clearance with medications as well - after all, prescriptions are not given based on nothing. They do sometimes help.

So why do medications disappoint so much of the time?



Let's discuss each of the types like we did last week:

Hormone Therapy
In my professional opinion, when a full hormone panel hasn't found any severe imbalances (or wasn't done at all), birth control really shouldn't be a go-to for adult acne.  It can really mess things up.  In fact, I have a theory that it can cause sensitivity in the body, even more so when there are several changes in prescription.  

As discussed last week, oil can be over-produced in the skin when the testosterone/estrogen ratio tips toward more testosterone.  There are a few problems with oral contraceptives for acne.

• The "low dose" pills, which are lower in estrogen than other oral contraceptives, don't help control oil when there is too high a level of testosterone for any reason.  This means the last thing someone suffering from adult acne needs is something with only a small amount of estrogen.  

• Some OCs have larger amounts of progestin, which aggravates acne terribly, unless someone has PCOS, which needs this.  

• The best birth OCs for acne, when there is an original, existing medical imbalance, are the "combo" types like Yaz or Yasmin, which have a higher amount of estrogen plus the oil controlling drug Spironolactone, but of course they can have side effects.  

Either way, birth control really should only be prescribed for clearing adult acne when an actual hormonal imbalance is actually found, which can be indicated also by other symptoms, such as irregular periods, excess hair growth in odd places, mood swings and other issues.

Antibiotic

As was discussed last week, killing bacteria gives an infected pore a reprieve from the highly inflammatory fatty acids that bacteria produce as waste material, allowing the pore to heal after the infection inside has gone.  But there are also a few problems with oral and topical antibiotics.

• There is a tendency for many doctors to be quick in prescribing antibiotics when really what is needed is a good skin care routine.  They basically think "bacteria" with every breakout, but bacterial proliferation is not always what's involved.  If backup of oil and dead skin cells are the main problem and/or other things are causing inflammation inside pores, antibiotic won't solve the problem at all.  Since acne bacteria are killed by oxygen, as long as irritation and clogging do not become severe enough to squeeze pores shut, oxygen will still get inside, and bacteria won't be an issue.

• Too often the antibiotic in question doesn't even reach the bottom of pores where the main bacteria involved in acne live.  As a colleague of mine laments, "It take 10 days to kill a sinus infection, yet clients end up on antibiotics for months with no relief - something's wrong with this picture."

• Many antibiotics do reduce inflammation somewhat, which is why they appear to work for a while.  But if bacteria do not cause the initial problem and something else is causing inflammation in pores, the minute the medicine in stopped the problem comes right back.

Tretinoin 
(aka Retin-A®)
I believe this is very much overprescribed, especially when acne is quite mild.  The idea behind prescribing it is that since the start of all acne is an accumulation of a mixture of oil and sticky dead skin cells creating microscopic blackheads, exfoliate the heck out of the skin, dry it out to control the oil, and be left with beautiful, clear skin.  Sadly, there are some problems with Retin-A® as well.

• The generic cream is actually pore clogging which means after stopping it you can end up with a horrible breakout!  I know, crazy, huh? Of course if it's in gel form, this problem doesn't happen.

• If the prescription is given with nothing but the instruction sheet inside the box, the skin will get severely irritated unnecessarily.  The massive exfoliation that is the method of clearing here requires quite a bit of hand holding, where the medicine is introduced to the skin gradually over time.  The effect will still be beneficial without causing any short or long term damage.  Very few dermatologists have the time, and in many cases even the knowledge, to provide this guidance.

• Since inflammation can be more involved with breakouts than anything else, prolonged use of tretinoin in the wrong doses for the wrong periods of time can make acne worse, or at least lead to increased chance for breakouts later on.

• Another consideration for long term use is that premature aging is linked to prolonged inflammation. Used improperly this can be a serious problem.  There are doctors who believe in using it indefinitely, but hopefully they are aware of the proper use of the drug and have educated their patients on how to use it effectively without over-irritating.

So, what can WE do about your Adult Acne that doesn't necessarily include prescription medications?  I don't think all meds are bad, especially OTC meds, some of which I carry myself.  With proper instruction and some hand-holding, Benzoyl Peroxide and Salicylic Acid can be the greatest things since sliced bread.  We especially need to start with identifying what type of acne you actually have, and what may be aggravating the problem in the first place.

Let's get your skin clear together.  Visit my web site for Adult Acne, or ask me questions in the comments below and let's see how we can get to the bottom of your acne issues.

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