Acne consists of comedones (whiteheads and blackheads), papules (“pimples”), nodules (large papules), and cysts. Teenagers and many adults have persistent acne.
Mild to moderate acne can be treated with topical creams and lotions that kill bacteria, open pores, and decrease inflammation. Severe or resistant acne can be treated with oral antibiotics, in addition to topicals. Women, including those whose acne persists beyond adolescence, can also be treated with hormones and medications to suppress the effects of hormones on the skin. Sometimes, extraction of comedones (acne surgery) and chemical peels can augment the medical treatment. For the most resistant acne in teenagers and adults, the oral vitamin A derivative isotretinoin will give long-term remissions to the majority of people who use it. However, isotretinoin can cause birth defects in children born to women who are, or become, pregnant while taking this powerful medication. Isotretinoin can also cause reversible irritation of the liver, elevation of cholesterol and triglycerides, stomach upset and dryness of the skin and lips. Therefore, close monitoring, including frequent blood tests, is essential for all patients prescribed isotretinoin. Appropriate precautions to avoid pregnancy are essential for women. Registration with the FDA is required if you take this medication.