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Acne Medications

Acne NYC Treatment Center

Prescription Medications for Treating Acne

A variety of prescription medications are used today to clear acne. Topical (applied to the skin) medications may be prescribed for mild to severe acne. Systemic (works internally) therapy is needed to treat severe acne and may be used for moderate cases. These medications, which play an important role in acne treatment, attack the different factors that lead to acne. To achieve long-term control and resolution, dermatologists may combine therapies. The following describes the prescription medications used in the United States to treat acne:

Intralesional Corticosteroid Injection
When an acne cyst becomes severely inflamed, there is a good chance that it will rupture and scarring may result. To treat these severely inflamed cysts and prevent scarring, dermatologists may inject such cysts with a much-diluted corticosteroid. This lessens the inflammation and promotes healing. An interlesional corticosteroid injection works by "melting" the cyst over a period of 3 to 5 days.

Isotretinoin
Isotretinoin is a potent oral retinoid that is reserved for treatment of very severe cystic acne and severe acne that has proven itself resistant to other medications. For more information about isotretinoin, see Treating Severe Acne.

Oral Antibiotics
For patients with moderate to severe and persistent acne, oral antibiotics have been a mainstay of therapy for years. Like topical antimicrobials, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation. Treatment with oral antibiotics usually begins with a higher dosage, which is reduced as acne resolves. Generally, antibiotics are prescribed for six months or less.

Over time, the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When resistance occurs, acne is no longer controlled. Another antibiotic or alternative treatment can be prescribed. Numerous studies support the effectiveness of the following oral broad-spectrum antibiotics, which are used to treat acne in the United States:

Erythromycin. It is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.
 

Tetracycline and derivatives. Tetracyclines reduce the papules and pustules (inflammatory lesions) of acne. These medications should not be taken by children younger than 8 years of age because they can affect growth and stain teeth. They should also not be taken by a woman who is pregnant or breast feeding. During pregnancy and breastfeeding, tetracyclines can affect the development of the child’s bones and teeth, leading to skeletal defects.

A typical tetracycline regimen for treating moderate to severe acne starts with a dose of 500 to 1000 milligrams a day, which is decreased as improvement occurs. Long-term, low-dose tetracycline therapy may be continued for many months to suppress acne. Higher doses may be prescribed for very severe acne.

Two synthetic derivatives of tetracycline used to treat acne are doxycycline and minocycline. Doxycycline proves especially effective in treating inflammatory acne. It can cause sun sensitivity in some patients. Minocyline has a long history of use in treating acne. It is often effective in treating acne that has not responded to other oral antibiotics. Minocycline also seems to produce fewer incidents of antibiotic resistance.

Oral Contraceptives
Oral contraceptives have been shown to effectively clear acne in women by suppressing the overactive sebaceous glands and can be used as long-term acne therapy. However, oral contraceptives should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynecologist.

Topical Antimicrobials
Topical antimicrobials work to inhibit the P. acnes populations and are used to treat patients with mild to moderately severe inflammatory acne. They may be used alone or combined with a medication that works on another factor that leads to acne aside from P. acnes. A dermatologist can determine whether a topical antimicrobial is appropriate for a patient and if so which topical antimicrobial should be prescribed. Prescription topical antimicrobials used to treat acne vulgaris in the United States include:

Azelaic acid. Naturally occurring in the skin, azelaic acid is used to treat mild to moderate inflammatory and non-inflammatory acne. It is believed that azelaic acid clears acne by reducing the populations of P. acnes, decreasing the abnormal shedding of skin cells and reducing inflammation. This medication has also proven effective in treating the dark spots that develop in some acne patients with skin of color. Azaleic acid is well tolerated by most people and can be safely used for years. Side effects may include skin dryness and lightening of the skin where applied.
 

Benzoyl peroxide. Benzoyl peroxide works by killing P. acnes. However, it does not have anti-inflammatory abilities. It is available in a wide range of strengths and can be found as a gel, lotion, cleanser, cream and wash. Many acne preparations include benzoyl peroxide because research shows that benzoyl peroxide increases the effectiveness of some medicines, such as erythromycin and clindamycin. When used in combination with antibiotics, benzoyl peroxide also reduces the likelihood of a patient developing resistance to the antibiotic. The most common side effects are skin irritation, the potential to bleach hair and fabrics as well as possible allergic reaction.
 

Clindamycin. A semi-synthetic antibiotic, topical clindamycin has a long history of successfully treating acne. It works by reducing P. acnes and decreasing inflammation. In topical form, clindamycin has proven safe and is well tolerated. Skin dryness and irritation are possible side effects. It is important to use as directed to decrease bacterial resistance that can occur with antibiotic use.
 

Erythromycin. This topical antibiotic is active against a broad spectrum of bacteria, including P. acnes. Topical erythromycin, which is an antimicrobial and anti-inflammatory, is used primarily to treat acne. When topical erthyromycin is combined with benzoyl peroxide, the combination proves to be quite effective as the patient gets the effects of two antimicrobial agents. Like topical clindamycin, erythromycin may cause skin dryness and possible irritation. It is important to use as directed to decrease bacterial resistance that can occur with antibiotic use.
 

Sodium sulfacetamide. A topical antibiotic that inhibits P. acnes and opens clogged pores, sodium sulfacetamide is effective in treating inflammatory acne. Many products containing sodium sulfacetamide include sulfur. Some patients do not like the smell of the sulfur or its grittiness. Usually, the newer products that contain sulfur do not have these problems.

Topical Retinoids
Prescribed to treat acne ranging from mild to moderately severe, topical retinoids are a derivative of vitamin A and considered a cornerstone in acne treatment. Retinoids work to unclog pores and prevent whiteheads and blackheads from forming. Topical retinoids can irritate the skin and increase sun sensitivity so it is important to use sun protection and follow the dermatologist’s directions to maximize effectiveness. An added benefit in using topical retinoids is that they may help diminish the signs of aging, such as fine lines and wrinkles. Topical retinoids currently prescribed for acne treatment in the United States include:

Adapalene. A synthetic retinoid applied as a gel or cream, adapalene unclogs pores and possesses moderate to potent anti-inflammatory abilities. Improvement is usually seen in 8 to 12 weeks. Side effects include minor skin irritation and dryness.
 

Tazarotene. A synthetic retinoid available as a gel or cream, it works to keep the skin’s pores clear and has proven effective in treating acne. This medication should not be used by women who are pregnant, and effective contraception is needed while taking tazarotene because the medication has produced birth defects in animals. Skin irritation is a possible side effect.
 

Tretinoin. The first retinoid developed for topical use, tretinoin is a natural retinoid. It works to gradually unclog pores and keep them unplugged. In the past, many patients found tretinoin too harsh for their skin; however, the newer forms are proving less irritating. Side effects include redness, scaling, dryness, itching and burning. If these occur, talk with the dermatologist who prescribed tretinoin as these side effects can be managed by adjusting the amount applied and when it is applied.

Dear Friends
 
Our goal at NYC Dermatology is to be the Tiffanys of Skin
Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified DermatologistMy goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results and the best dermatologist. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
 
Best Regards,
 
Dr. Rothfeld
 

  
 
 

 Dr. Gary Rothfeld possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding  Dermatologist in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist, Dr. Rothfeld  in Manhattan treats the most difficult cases until the problem clears.  Dr. Rothfeld, a Board Certified Dermatologist at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem is cleared.  Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give up until the condition resolves.  Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment industry.

NYC Dermatology is under the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist. 
To enhance every aspect of your skin care, Dr. Rothfeld has personally created a superb line of cosmetic procedures..

NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld  is a board certified NYC  Dermatologist with a  New York City office in Manhattan, New York  providing expert skin care, dermatology, and cosmetic dermatology services.

A board certified dermatologist in NYC specializing in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld  is known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and laser resurfacing. NYC dermatology  specializes in chemical peels, vein injections, laser, restylane, Perlane, Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
 
As an expert in the field of dermatology and cosmetic dermatologic surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high profile national magazines.
Our goal at the manhattan office of Board Certified  Derrmatologist , Dr. Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology and Cosmetic Surgery Center in Manhattan, New York.  Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board Certified  Dermatologist at NYC Dermatology who has treated many patients in the  entertainment industry.
   Schedule an appointment at our office which provides top of the line  expert skin care, dermatology, cosmetic dermatology services, and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media  office and   including different offers and many more. We offer a variety of services from Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for a consultation.   Beauty Is Forever!  and Dr. Rothfeld  at NYC Dermatologist has over 20 years of experience with his beauty tips.  
.

During your office consultation  and examination you will be provided with a detailed plan of the treatments that will benefit you most.  NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,  services including general dermatology, wrinkle fillers such as Restylane®, Captique,  Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®, Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne, rosacea, skin cancer and  surgery.  Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical hair transplants, and lasers in  the country.   Acne Photodynamic Treatment - Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser  - Cosmelan Depigmentation Treatment - Glycolic Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction -  - Surgery - Minimal Scar Technique -  Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy - Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments - Velasmooth Our cosmetic surgeon includes Dermatologist  Dr. Gary Rothfeld Board Certified Dermatologist  at NYC Dermatology.  Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan office in NYC

 

Sun Protection

 

Ultraviolet radiation is the major cause of skin cancer, including melanoma. It is important for everyone to be aware of its damaging effects and take measures to avoid overexposure.

 

Although many people enjoy the appearance of tanned skin and think it looks "healthy," tanned skin is damaged skin. The ultraviolet radiation in sunlight penetrates the deepest layers of the skin where it harms the cells. The body responds by making more pigment (melanin) to try to protect itself, but the damage has already happened and may be permanent. The more exposure you have to the sun, the more likely you are to develop skin problems later in life.

Ultraviolet Radiation

The damaging part of sunlight is called ultraviolet radiation, or UV rays. It is categorized into three types:

  • UVC rays (wavelengths = 200 nm to 290 nm) are the shortest and most powerful of the UV rays. UVC is the most likely to cause cancer if it reaches skin. Fortunately, most of it is absorbed by the ozone layer in our atmosphere. However, there is concern that a thinning of the ozone layer may be causing more UVC to reach the earth's surface.
  • UVB rays (wavelengths = 290 nm to 320 nm) are less damaging than UVC, but more of it penetrates to the earth's surface. It is the most common cause of sunburn and skin cancer. UVB is particularly strong at the equator, at high elevations, and during the summer.
  • UVA rays (wavelengths = 320 nm to 400 nm) are the least powerful of the UV rays, but they are present all year and can penetrate windows and clouds.

Sun Protection

The first and more effective way to avoid sun damage is to stay out of tthe sun as much as possible.

If you cannot avoid being exposed to sunlight, there are five basic defenses that you should keep in mind when you go outdoors:

  • Avoid peak hours of sunlight
  • Sunscreen
  • Clothing
  • Sunglasses
  • Shade

Avoid Peak Hours of Sunlight (UV Index)

In general, UV rays are the greatest between 10 a.m. and 4 p.m. It is best to avoid the outdoors during these hours without protection, particularly during summer, in tropical regions, or at altitude. During this time, you should pay close attention to the appropriate use of sunscreen, clothing, sunglasses, and shade.

You can obtain an accurate measure of the amount of UV rays in your area by looking up the Ultraviolet (UV) Index. The UV Index is like a weather forecast. It provides a report on the amount of damaging UV rays that are expected to affect a region on a particular day. The UV Index changes day to day according to time of year, cloud cover, atmospheric ozone, and other factors.

The following table is a breakdown of the UV Index. A high UV Index number means that you are at greater risk of being exposed to ultraviolet radiation. You should take special care to avoid outdoor exposure to sunlight when the UV Index is moderate or greater.

  • 0 to 2 = Minimal
  • 3 to 4 = Low
  • 5 to 6 = Moderate
  • 7 to 9 = High
  • 10 or more = Very high

The UV Index can be found on our Website or in local papers, usually in the weather section.

Sunscreen

There are several factors to consider when selecting the right sunscreen. (See the Sunscreens handout for more information.)

Sun protection actor (SPF) - Sunscreens are rated by the amount of protection they provide from UVB, measured as the "sun protection factor" or SPF. Sunscreens with higher SPF provide greater protection from the sun. It is best to use sunscreens that offer a minimum SPF of 15.

Broad-spectrum sunscreens - It is best to use a sunscreen that can protect you from both UVA and UVB rays. These are called "broad-spectrum" sunscreens. 
Most of the original sunscreens blocked only UVB, but increased awareness of the damage caused by UVA has lead to the development of ingredients that protect against UVA too. Broad-spectrum sunscreens combine ingredients to provide a product with greater protection.

Common sunscreen ingredients that  provide protection from UVB rays:

  • Cinnamates
  • Octocrylene
  • PABA (para-aminobenzoic acid)
  • Padimate O and Padimate A (Octyl Dimethyl PABA)
  • Salicylates

Common sunscreen ingredients that  provide protection from UVA rays:

  • Avobenzone (Parsol 1789)
  • Benzophenones (oxybenzone, dioxybenzone, sulisobenzone)

Sunblocks - "Physical" sunscreen ingredients lie on top of the skin and work by reflecting or scattering UV radiation. They are particularly useful for people who are sensitive to the ingredients found in other sunscreens. Sunblocks often contain one or more of these ingredients:

  • Zinc oxide
  • Titanium dioxide
  • Iron oxide

Although past formulations were unsightly (often leaving a white film on the skin), newer "microfine" formulations are invisible after being applied. Microfine titanium dioxide is effective at protecting from both UVA and UVB rays.

Water resistance - Sunscreens are classified as "water-resistant" if they maintain their protection after two 20-minute immersions in water. They are classified as "waterproof" if they maintain their protection after four 20-minute immersions. You should seek a water-resistant or waterproof sunscreen if you will be participating in water sports, such as swimming or water skiing, or will be actively sweating.

However, independent testing has shown many products do not perform well in the real world. So it remains a good idea to apply sunscreen every time you leave the water, or frequently if you are actively sweating.

Using a Sunscreen

Sunscreen should be applied evenly and liberally on all sun-exposed skin within 30 minutes before going outside to give sunscreen time to take effect. (Sunblocks are effective immediately after being applied.) Sunscreens should be reapplied every two hours or following swimming or sweating. Apply sunscreen generously and reapply frequently at least every two hours.


The chemicals may lose effectiveness over time, so it is important to throw away sunscreen that is past its expiration date or is over two years old.


No sunscreen is 100% effective; take additional measures to avoid the damaging effects of the sun's rays.

Clothing

Clothing can provide excellent protection from the sun. However, not all clothing is protective. A thin, wet, white t-shirt will provide almost no protection from UV rays. When selecting clothes for sun protection, consider the following:

  • Cover your head, shoulders, arms, legs, and feet.
  • Use a hat that is broad-brimmed (brim should be at least four inches wide).
  • Wear fabrics that are thicker or with a tight weave; these allow less sunlight to penetrate the skin.
  • Wear darker-colored clothes that absorb more UV rays.
  • Wear clothing made from nylon or Dacron because it is more protective than cotton.
  • Avoid remaining in wet clothes because wet fabric may allow more UV rays to penetrate the skin.
  • Wash clothing with chemical absorbers to increase their protectiveness.
  • Some clothing comes with a UPF rating that stands for "Ultraviolet Protection Factor." This measures the ability of the fabric to block UV radiation from penetrating to the skin. A fabric with a UPF 15 allows only 1/15th (6.66%) of the UV radiation to penetrate your skin as compared to uncovered skin.

Garments fall into 3 categories:

  • Good protection: UPF = 15 to 24
  • Very good protection: UPF = 25 to 39
  • Excellent protection: UPF = 40 to 50+

Choose clothing with a UPF rating of at least 15. Keep in mind that the UPF of a garment will decrease over time as the fabric wears.

Sunglasses

Overexposure to sunlight can cause cataracts and macular degeneration, a major cause of blindness. Sunglasses can provide protection. However, not all sunglasses are of value. A darker lens itself does not guarantee protection. Look at the label to ensure that the glasses provide UV protection. Sunglasses should be large enough to shield your eyes from many angles. Look for sunglasses that are described as blocking 99% or 100% of UVA and UVB. The glasses may also be described as providing UV absorption up to 400 nm.

Shade

If possible, remain in the shade when outdoors. Keep in mind that shade does not provide full protection from the sun because UV rays can bounce off reflective surfaces, such as sand, snow, water, concrete, or even porch decks. In addition, some fabrics used as shade devices, such as parasols or umbrellas, may not provide sufficient protection. If you seek shade under a cloth, look for a fabric that is thick, tightly woven, and dark-colored.

Clear window glass provides protection from UVC and UVB, but not UVA rays. If you are frequently exposed to sunlight while driving, the plastic interleaf of your windshield (which prevents it from shattering) can help block the light, but side windows have no such protection. Non-drivers can make use of additional window shade devices. Drivers in some states may be able to use darkly-tinted glass in the side windows, but this is illegal in some states.

Summary

  • Avoid the sun when its UV rays are strongest, between 10 a.m. and 4 p.m.
  • Use a broad-spectrum sunscreen with SPF 15 or greater. Apply it 30 minutes prior to being exposed to the sun and reapply every two hours. Consider using a water-resistant sunscreen if you will be active (sweating) or in the water.
  • Use a sunblock on your lips.
  • Wear a broad-brimmed hat when outdoors.
  • Wear sunglasses.
  • Wear tightly woven, dark clothing to cover your arms, legs, and feet.
  • Stay in the shade when possible.
  • Avoid reflective surfaces, such as water or snow.
  • Avoid sunbathing.
  • Don't be fooled by cloudy days since damaging rays can penetrate clouds.

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