Daniel K. McKenzie, M.D.
Skin Diseases, Skin Cancer, Dermatological Surgery Acne (pimples, zits, etc.) is an inflammatory disorder involving the sebaceous glands of the skin. It is exceedingly common among teenagers and frequently continues into adulthood. There are many factors involved in the development of acne, including oil glands, bacteria, hormones, stress, and a hereditary predisposition. Factors that aggravate or promote acne in many people include: 1. Nervous stress 2. Infections, including viral infections 3. Excessive sweating for prolonged periods of time (e.g., while exercising) 4. Physical pressure such as constant touching of the face, resting the chin or sides of the face on your hands, football pads, and helmets (acne mechanica). Picking lesions won’t help and may cause them to last longer and worsen any scarring. 5. Hormonal influences (not necessarily abnormal hormone levels) 6. Oil based creams, lotions, or makeup (acne cosmetica) 7. Drugs, including certain birth control pills, iodides, bromides, or fluorides 8. Certain chemicals, particularly machine oils and other industrial compounds 9. Sunshine is not always beneficial, and in some cases aggravates acne. The obvious disadvantage of sun exposure is premature aging of the skin and an increased incidence of skin cancers. 10. Diet is not thought to be a major factor in the majority of acne patients, but if you notice any dietary items making your acne worse, avoid those foods. Frequently patients are doing ―all the right things‖ – none of the factors listed above apply – and yet they still have acne. This is not uncommon. The propensity to form scars varies from patient to patient, and the redness and color changes after acne lesion resolution may take months to fade. ACNE MEDICATIONS

Many internal and topical medications are used to treat acne. All of them work in different ways. Also,
what works well in one person doesn’t always work in another and what causes side effects in one
person may not cause them in another.

Antibiotics such as Tetracycline, Erythromycin, and Minocin are frequently used, especially in
inflammatory acne (pimples). It usually takes several weeks before you see any benefit from them. In
addition, there are potential side effects of using antibiotics. Headaches and vaginal yeast infections in
women can occur and are indications to stop the medicine immediately.
Often merely stopping the medication will clear the yeast infection. If id doesn’t clear, or if it worsens, your physician can prescribe something to help. Antibiotics are also suspected of decreasing the effectiveness of birth control pils. Although this is controversial, it might be best to use an alternative form of birth control while taking oral antibiotics. Tetracycline — Tetracycline must be taken on an empty stomach with a full glass of water (i.e. an hour before you eat, or two hours after you eat). Upset stomach and sun sensitivity are common side effects. It should not be taken if you are pregnant or are trying to get pregnant. Erythromycin — Generic Erythromycin must be taken on an empty stomach as well. However, certain brands, such as ERYC®, E-Mycin®, and P.C.E.®, may be taken directly before or after meals. Some people experience diarrhea or bloating with Erythromycin, but most tolerate it very well. Minocin — Minocin can be taken on an empty or full stomach. Occasionally patients may experience light-headedness. If this happens, break your morning dose in half and take half with breakfast, and half with lunch. If this doesn’t help, the medication must be discontinued. Another rare side effect is a bruise-like pigmentation of the skin. This fades over a period of months after you discontinue the medication. It should not be taken if you are pregnant. Also, this mediation can be expensive – a one month’s supply can cost over $100. Accutane (Isotretinoin)
Accutane® is a very powerful drug with many side effects and is used in severe, recalcitrant, cystic acne.
Among the side effects are chapped lips, sun sensitibity, dry skin, minor muscle and joint pain, elevation
in blood triglyceride levels, birth defects, and a worsening of acne during the first two months. All of
these resolve after you finish your 20 week course. Most patients are then ―cured‖ of acne after they
stop the drug, although some may experience a minor problem with acne, and some individuals (10 –
25%) seem to experience only a temporary improvement.
Cortisone Shots
Inflamed acne cysts can be treated with injections of a mild cortisone solution directly into the lesion.
This will help make the acne cysts go away faster, but will do nothing to help other lesions or to prevent
new ones. The main side effect is an occasional dimple or depression (atrophy) at the site injection.
This usually fills in over a period of months.
Birth Control Pills
The newer birth control pills generally have the benefit of helping acne. Hormone levels are more stable
while taking some forms of birth control pills, and this may help your pre-menstrual flares. Your
gynecologist can help prescribe a type that may be suited to your needs.

Topical Antibiotics
Topical antibiotics include clindamycin (Cleocin-T®) and erythromycin (EryMax®, Erygel®, T-Stat®,
ATS®, Emgel®, and Erycette®). These are applied twice a day after washing and are more effective in
superficial inflammatory and pustular acne. Side effects are rare and include stinging (usually lasting
only 20 – 30 seconds) and mild drying of the skin.
Cleocin-T solution has been known to cause diarrhea – even when used topically. Although very rare,
this can be serious. If diarrhea develops, discontinue use immediately. If there is no improvement in a
few days, see your doctor.
Benzoyl peroxide comes in 2.5%, 5%, and 10%, and is available as a gel which you apply and leave on,
or as a wash solution. The most common side effect is dryness and irritation, especially around the
mouth, nose, and eyes. The skin usually becomes more tolerant with continued use, so it might be
helpful to use it less frequently at first (i.e. once a day or every other day), or use a milder concentration.
Another side effect can be permanent bleaching of your clothes and/or bedding; be especially careful if
you use the solution on your neck or back. A combination product called Benzaclin® (benzoyl peroxide
and clindamycin) gives the added ease of a two-in-one product.
Often it can be up to six weeks or more before you start to see a benefit from this medication.
Retin-A®, Differin®, and Tazorac® have been used for acne for years, and have recently had a lot of
publicity because of their beneficial effect on wrinkling. They are specially modified forms of vitamin
A, but are more powerful. Like benzoyl peroxide, retinoids can be quite irritating at first, but tolerance
gradually develops. It is important to apply retinoids on dry skin as this well help reduce irritation.
Retinoids can also make you very sensitive to the sun, so the use of sunscreen and a hat while in the sun
for any extended length o time is important. Like benzoyl peroxides, it may tate six or more weeks
before improvement is noted. It is acceptable to start using retinoids every other night until your face
adjusts to the medication, then increase use to every night.
Alpha Hydroxy Acid
Alpha hydorxy acid (AHA, glycolic acid, or ―fruit acid‖) is a naturally occurring break down product of
fermented fruit or sugar cane. It is used as a moisturizing lotion and is applied two times a day after
washing. Transient stinging may occur immediately after application. If persistent redness or burning
occurs, you may be allergic and you must discontinue use. It usually takes 4-6 weeks to start to see
improvement in a patient’s acne. Azelex® is a wheat-based cream which can be used as adjunctive
therapy to other topical acne medications. Irritation is uncommon, but it takes at least six weeks to see
Chemical Peel Light Acids

Chemical peel light acids can be applied to the skin to remove dead cells from the skin surface. This
procedure aids in decreasing plugged pores and acne in general, as well as improves fine lines, skin tone,
and texture. The Beta-Lift® peel is a formulation of salicylic acid (beta hydroxy acid). Skin peeling will
begin a day or two after the procedure and may vary from very mild to noticeable peeling and flaking.
Peels can be performed as frequently as every two weeks.


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