Milia are very common, benign, keratin-filled cysts. Primary milia are typically seen in infants but also may occur in children and adults. Secondary milia are observed in a number of blistering disorders and following dermabrasion. Milia en plaque and multiple eruptive milia are distinct entities.
The eMedicine Pediatrics article Milia may be of interest, as may the Medscape Dermatologic Surgery Resource Center.
Pathophysiology: Milia are tiny epidermoid cysts. The cysts may be derived from the pilosebaceous follicle. Primary milia arise on facial skin bearing vellus hair follicles. Secondary milia result from damage to the pilosebaceous unit.
Frequency in the United States:
Primary milia in newborns are so common that they can be considered normal (occurring in approximately half of all infants). Multiple eruptive milia and milia en plaque are rare entities.
Race : No racial predilection is recognized.
Sex : Sexual prevalence is equal for primary and secondary milia. Eruptive milia and milia en plaque occur more frequently in women.
Age : Milia occur in persons of all ages but are typically found in infants.
Milia are asymptomatic. In children and adults, they usually arise around the eye. Eruptive milia, as the name suggests, have a rapid onset, often within a few weeks.
* Skin lesions
o Milia are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter.
o In milia en plaque, multiple milia arise on an erythematous plaque.
* Skin distribution
o Primary milia, in term infants, occur on the face, especially the nose. They also may be found on the mucosa (Epstein pearls) and palate (Bohn nodules).
o Primary milia in older children and adults develop on the face, particularly around the eyes.
o Milia have been observed to occur in a transverse, linear distribution along the nasal groove in some children.
o Secondary milia are found anywhere on the body at the sites affected by the predisposing condition.
o Eruptive milia occur on the head, neck, and upper body.
o Milia en plaque manifests as distinct plaques on the head and neck. Plaques have been described in the postauricular area, unilaterally or bilaterally, the cheeks, the submandibular plaques, and on the pinna.
* Primary milia are believed to arise in sebaceous glands that are not fully developed, explaining the high prevalence in newborn infants.
* Secondary lesions arise following blistering or trauma due to disruption of the sweat ducts. Milia have been described in association with many disorders, including bullous pemphigoid, inherited and acquired epidermolysis bullosa, bullous lichen planus, porphyria cutanea tarda, and burns. Skin trauma from dermabrasion or radiotherapy can result in milia formation.
* Secondary milia have arisen from a bullous contact dermatitis and a photocontact allergy to sunscreen.
They have also arisen following treatment of cutaneous leishmaniasis and after topical nitrogen mustard ointment for plaque stage mycosis fungoides.
* Secondary milia have been described following potent topical corticosteroid use.
* Milia are a feature of a number of very rare genodermatoses (eg, Bazex-Dupré -Christol syndrome). Both primary milia and multiple eruptive milia have been reported as familial disorders with autosomal dominant inheritance.
* The etiology of milia en plaque is unknown.
No topical or systemic medications are effective on primary and secondary milia. Single case reports have demonstrated the success of topical isotretinoin, oral etretinate and minocycline in treating patients with milia en plaque.
Milia can be safely left alone, but if the patient requests treatment, then incision with a cutting-edge needle and manual expression of the contents are effective. This can be performed without local anesthetic. A paper clip has been successfully used to express the contents of the cyst. Milia en plaque has been treated effectively with electrodesiccation, carbon dioxide laser, dermabrasion, and cryosurgery.
Milia, also known as milk spots or oil seeds, are benign, keratin-filled cysts that can appear just under the epidermis or on the roof of the mouth. They are commonly associated with newborn babies but can appear on people of all ages. They are usually found around the nose and eyes, and sometimes on the genitalia, often mistaken by those infected as warts or other STDs.
In children milia often disappears within two to four weeks. In adults it may require removal by a physician or an esthetician. Milia can sometimes be a result of harsh face washes or from repeated heat stress from hot showering on people with sensitive skins. Milia can be confused with stubborn whiteheads.
A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart”) is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age. In fact they are sometimes humorously referred to as the “barnacles of old age”.
They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across. They can resemble warts, though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well. Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.
Seborrheic keratoses may be divided into the following types:
* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)
Reticulated seborrheic keratosis (also known as “Adenoid seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with keratin cysts seen histologically.
* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic
keratosis) Stucco keratosis (also known as “Digitate seborrheic keratosis,” “Hyperkeratotic seborrheic keratosis,” “Serrated seborrheic keratosis,” and “Verrucous seborrheic keratosis”) is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with church-spire-like projections of epidermal cells around collagen seen histologically.
* Clonal seborrheic keratosis
Clonal seborrheic keratosis is a common benign cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.
* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)
* Seborrheic keratosis with squamous atypia
Seborrheic keratosis with squamous atypia is a less common cutaneous condition characterized by a skin lesion with a dull or lackluster surface, and with round, loosely packed nests of cells seen histologically.
* Melanoacanthoma (Pigmented seborrheic keratosis)
Melanoacanthoma (also known as “Pigmented seborrheic keratosis”) is a common, benign, darkly pigmented cutaneous condition characterized by a skin lesion with a dull or lackluster surface.
* Dermatosis papulosa nigra
Dermatosis papulosa nigra (DPN) is a condition of many small, benign skin lesions on that face that closely simulate seborrheic keratoses, a condition generally presenting on dark-skinned individuals.
They should not be confused for Leser-Trélat sign, a sudden explosion of lesions due to a growing tumor.
* The sign of Leser-Trélat
The Leser-Trélat sign is the explosive onset of multiple seborrheic keratoses (many pigmented skin lesions), often with an inflammatory base. This can be an ominous sign of internal malignancy as part of a paraneoplastic syndrome. In addition to the development of new lesions, preexisting ones frequently increase in size and become symptomatic. It is named for Edmund Leser and Ulysse Trélat.
Although most associated neoplasms are gastrointestinal adenocarcinomas (stomach, liver, colorectal and pancreas), breast, lung, and urinary tract cancers, as well as lymphoid malignancies are associated with this impressive rash. It is likely that various cytokines and other growth factors produced by the neoplasm are responsible for the abrupt appearance of the seborrheic keratoses. In some cases, paraneoplastic acanthosis nigricans accompanies the sign of Leser-Trélat.
Variances of Seborrheic Keratosis:
Dermatosis Papulosis Nigra: Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.
Stucco Keratosis: Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.
Diagnosis: Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy.
Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.
When correctly diagnosed, no treatment is necessary. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.
Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.
The cause of seborrheic keratosis is unclear. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light
may play a role, as may genetics. A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.
The term “seborrheic keratosis” combines the adjective form of seborrhea, keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.
You can possibly prevent acne from affecting your skin or at the very least, moderate the outbreaks. Science has not yet discovered a fool-proof method that will work for everyone with an acne problem, but there are many things you can do to control it. Treating your acne outbreaks properly is something that must be done, especially if you are prone to suffer from severe cases.
Acne is a very common skin condition which produces whiteheads and blackheads on the face and upper torso. It affects people differently, being mild for some and quite debilitating for others. Acne untreated or treated improperly can cause permanent scarring which requires extensive time and expense to effectuate any level of cure.
Acne is mainly caused by bacteria that get into the pores on your skin, and the first and most important thing you need to do is to prevent this from becoming a problem. Bacteria are everywhere, and while there is no way to keep them from getting on the skin of your face or other areas, you can remove them before they cause a problem. There are many good cleansing products on the market today that contain anti-bacterial elements to help you get rid of bacteria on your skin. No matter how thoroughly you think you are washing, in all likelihood bacteria still remain.
A second step you should take to prevent acne is to use an exfoliating product on your skin. The dead skin cells that are always present on your skin can often contribute to acne formation. They do this by blocking your pores. This leads to oil becoming blocked in the pores, also known as follicles, which is one of the major causes of acne. The dead cells are also used as a food source by the bacteria which furthers their breeding. Using an exfoliating product does a good job in removing these dead skin cells.
Both anti-bacterial cleansers and exfoliates can be found in just about any pharmacy or super store at very reasonable prices. There are usually several brands and price ranges from which to choose, so you should be able to find products that suit you.
What To Do When More Care and Treatment Are Needed
For many people, washing their face and skin properly and using exfoliates is enough to manage the acne blemishes they have. For others, however, these two methods do not contain the acne outbreaks. These people should see a dermatologist or some kind of skin specialist. This is the person who can prescribe whatever medication that is needed to get the condition under control.
When it comes to treating and preventing acne, there are many products on the market that can help some, or maybe most, people. When you are using facial/skin cleansers, exfoliating products or topical medications, it is very important that you follow the directions given for them. Most of them should be used regularly if you are to get any benefits.
In conclusion, not everyone can have a clear complexion, but many will find relief in these products for acne prevention and treatment.
If like many others you are desperate to get your acne treated in order to regain the skin you once had then using an acne skin care treatment is essential to the process. By reading through the tips provided below you should soon be back on the road to have that beautiful skin you had before you suffered from acne.
However it is important that first of all you know what acne is and then you will be able to treat it much better. A person suffers from acne because their sebaceous glands begin to produce too much oil and when combined with dead skin cells a person’s pores will then become blocked. As the pores are blocked they are unable to breathe correctly and then bacteria sets in and so blackheads and whiteheads will begin to erupt on the person’s skin.
In order to clean your face effectively whilst treating acne of any form you should not scrub it but rather gently wash it using a mild anti-bacterial soap or lotion.
Next you need to look at what you are eating and drinking. Many people do not realize this but what they eat and drink seriously affects their acne further. Therefore you should drink lots of fresh water each day. Not only will it help to remove all those unwanted toxins (which make a person’s acne worse) from the body but it is probably the most inexpensive form of acne skin care treatment.
You should also eat vegetables which contain high amounts of Vitamin A and will normally be bright orange or yellow or green in color. By eating plenty of these vegetables such as carrots, sweet corn and broccoli, cabbage etc, it will help you achieve a much better complexion on your skin.
Besides keeping the above points in mind, you should also consult your doctor. They will be able to prescribe acne skin care treatment medications that you will not be able to find or purchase elsewhere. But as well as using the medication provided by your doctor you should look more closely at your dietary habits and make the necessary changes and do not forget to drink plenty of fresh water also.
By taking these steps in your acne skin care treatment program you should be on the road to seeing the results of your work in the mirror in a very short period of time.
A skin rash shows up as an area of inflammation or change in the texture, and/ or color of your skin. It can be caused by a number of different things including irritation, disease, or allergic/ non-allergic reactions to foods, chemicals, plants, animals, insects or other environmental factors.
So many rashes appear because the skin is an active player in the immune system. Antigens are things like viruses or proteins that we react to. These antigens need to be presented to our immune system in a very controlled way; otherwise we would react to too many things. The skin is the site at which antigen presenting cells introduce the antigens to lymphocytes. These lymphocytes are in a sense the paratroopers of our body. A complicated process of making sure that we are not overreacting takes place. All of this occurs in the skin once these lymphocytes have been activated they produce many chemicals that cause inflammation. When we become allergic to an antibiotic or other drug, the action takes place mainly in the skin as well as in the lymph glands. Viral infections also frequently produce rashes as viral particles are presented to our immune system in the epidermis. In a sense the skin is like the schoolyard which is where many of the fights occur.
Rashes can appear on your entire body or be limited to a specific area, and what it looks like and how it feels can vary depending on the cause and type of rash. Some common types of rashes include:
* eczema (also called atopic dermatitis), which is commonly seen in children. It can cause dry, chapped, bumpy areas around your elbows and knees, and can be very itchy. It can sometimes become very serious causing red, scaly and swollen skin all over your body. (Visit Eczema Guide.ca for more information)
* irritant contact dermatitis, which is caused by your skin coming into contact with something that irritates it, such as a chemical, soap or detergent. This type of rash can be red, swollen and itchy.
* allergic contact dermatitis is caused by your skin coming into contact with something you’re allergic to, such as rubber, hair dye or nickel (which is a metal that is found in some jewelry). A nickel allergy can show up as a red, scaly, crusty rash wherever the jewelry touched your skin. Urushiol, which is an oil or resin that’s found in poison ivy, oak and sumac, can also cause this kind of rash.
If you develop a rash, don’t scratch it! If you do, the rash can take longer to heal and you might develop an infection or scar. There are a wide range of over-the-counter products available to treat rashes, but it’s important to see your doctor first and determine what’s causing the rash and the most effective treatment.
* If the rash is caused by an allergy, then treatment will focus on identifying and avoiding the allergen.
* It it’s caused by eczema, your doctor may suggest special moisturizers (emollients) to help retain the water in your skin; not only will this help to keep your skin soft and smooth, it will help reduce the itching. Short, cool showers are also a good idea because hot showers and baths can dry out your skin more. Also use a mild soap (read more on Mild Cleanser.ca ) and be sure to apply more emollients after you’ve showered.
* For poison ivy, cool showers and calamine lotion often help and if the rash is severe, your doctor may prescribe an antihistamine to reduce the itching and redness.
It’s important to try to find out what’s causing the rash because the best way to prevent it is to avoid the problem food, substance, medicine or insect. If a poison plant is your problem, learn what it looks like and avoid it. It may also help to wear long sleeves and pants when you go camping or hiking. If insect bites are causing your rash, then consider applying insect repellant before going outside. For eczema, stay away from harsh soaps that may dry out your skin, and make an effort to moisturize with creams or lotions.
When applying antiacne drugs to the skin, people should be careful not to get the medicine in the eyes, mouth, or inside the nose. They should not put the medicine on skin that is wind burned, sunburned, or irritated, and not apply it to open wounds.
Because antiacne drugs such as benzoyl peroxide and tretinoin irritate the skin slightly, users should avoid doing anything that might cause further irritation. They should wash the face with mild soap and water only two or three times a day, unless the physician says to wash it more often. They should also avoid using abrasive soaps or cleansers and products that might dry the skin or make it peel, such as medicated cosmetics, cleansers that contain alcohol, or other acne products that contain resorcinol, sulfur, or salicylic acid.
If benzoyl peroxide or tretinoin make the skin too red or too dry or cause too much peeling, the user should check with a physician. Using the medicine less often or using a weaker strength may be necessary. Benzoyl peroxide can irritate the skin of people with skin of color and cause darkened spots called hyperpigmentation on the skin. Benzoyl peroxide may discolor hair or colored fabrics.
ORAL DRUGS. Oral antibiotics are taken daily for two to four months. The drugs used include tetracycline, erythromycin, minocycline (Minocin), doxycycline, clindamycin (Cleocin), and trimethoprim-sulfamethoxazole (Bactrim, Septra). Possible side effects include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.
The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. One effective treatment is topical tretinoin, used along with a topical or oral antibiotic. A combination of topical benzoyl peroxide and erythromycin is also very effective. Improvement is normally seen within four to six weeks, but treatment is maintained for at least two to four months.
People who have certain medical conditions or who are taking certain other medicines may have problems if they use antiacne drugs. Before using these products, the physician should be informed about any of the following conditions.
ALLERGIES. Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let the physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY. Teens who are pregnant or who may become pregnant should check with a physician before using tretinoin or benzoyl peroxide. Isotretinoin causes birth defects in humans and must not be used during pregnancy.
OTHER MEDICAL CONDITIONS. Before using antiacne drugs applied to the skin, people with any of these medical problems should make sure their physicians are aware of their conditions:
• Eczema. Antiacne drugs that are applied to the skin may make this condition worse.
• Sunburn or raw skin. Antiacne drugs that are applied to the skin may increase the pain and irritation of these conditions.
In people with certain medical conditions, isotretinoin may increase the amount of triglyceride (a fatty-substance) in the blood. This may lead to heart or blood vessel problems. Before using isotretinoin, adolescents with any of the following medical problems should make sure their physicians are aware of their conditions:
• alcoholism or heavy drinking, currently or in the past
• diabetes or family history of diabetes (Isotretinoin may change blood sugar levels.)
• family history of high triglyceride levels in the blood
• severe weight problems
Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.
Acne: Words to Know
A male sex hormone found in both males and females.
A drug that slows down the production of androgens.
A drug that kills bacteria.
A hard plug that develops in the pores of the skin composed of sebum and dead skin cells. The mildest form of acne.
Drugs that break up comedos and open clogged pores.
A drug that decreases sebum production and dries up acne pimples.
An oily material produced by sebaceous glands that keeps the skin moist.
A drug that increases the rate at which skin cells are formed and die.
The exact cause of acne is not known, however, several risk factors have been identified.
- Age. Because of the effect of sex hormones, teenagers are quite likely to develop acne.
- Cosmetics. Make-up and hair sprays that contain oils can make acne worse.
- Diet. Acne is not caused by diet, but some foods can make the disease more serious.
- Disease. Hormonal disorders can increase the severity of acne problems in girls.
- Drugs. Acne can develop as a result of using certain drugs, such as tranquilizers, antibiotics, oral contraceptives, and anabolic steroids. Steroids are synthetic hormones that may sometimes be abused by athletes to increase the size of their muscles.
- Environment. Acne can become worse as a result of exposure to oils, greases, and polluted air. Sweating in hot weather can also make the condition worse.
- Gender. Boys are more likely to develop acne and tend to have more serious cases than girls.
- Heredity. Acne is more common in some families than in others.
- Hormonal changes. Acne can flare up during menstruation, pregnancy, and menopause. Menopause is the period in a woman’s life when her body stops producing certain hormones.
- Personal hygiene. Strong soaps, hard scrubbing, and picking at pimples can make acne worse.
- Stress. Emotional stress can contribute to acne.
The skin has many oil (sebaceous) glands, which secrete oil that contains wax esters, triglycerides, and squalene - a hydrocarbon that is an intermediate in the formation of cholesterol. These fats (or lipids) form a film that helps keep moisture in the skin. While increased sebum production results in oily skin, the opposite is not always the case, as dry skin can also arise from an impaired skin barrier. Oil production can be affected by diet, stress, and hormones-as well as genetics. In a study of twenty pairs each of identical and nonidentical same-sex twins, identical twins had virtually identical amounts of oil production, while the nonidentical twins had significantly different amounts.
No amount of blotting and scrubbing will “remove” the skin’s oil production, and many of us unknowingly destroy the natural beauty of the skin in pursuit of clarity. The skin’s own sebum mechanism is there to regulate own moisture. Drying your skin profusely with oil-stripping, foaming cleansers, detergents and de-greasers like soap and sulfates, or alcohol-based toners that leave the skin feeling tight (always a sign it’s been stripped), will only cause the skin to “rebound” with excess oiliness and destroy its protective and anti-bacterial “matrix,” leaving it sensitized. By stripping the natural acid mantle of the skin, these deep cleaning products actually make skin more vulnerable to bacteria and inflammation. Dabbing benzoyl peroxide often destroys the beauty of the skin by causing flaking, while more aggressive treatments, such as antibiotics or Accutane can cause a cascade of side-effects.
Minor discomforts such as dry mouth or nose, dry eyes, dry skin, or itching usually go away as the body adjusts to the drug and do not require medical attention unless they continue or are bothersome.
Other side effects should be brought to a physician’s attention. These include:
• burning, redness, or itching of the eyes
• signs of inflammation of the lips, such as peeling, burning, redness or pain
Bowel inflammation is not a common side effect, but it may occur. If any of the following signs of bowel inflammation occur, stop taking isotretinoin immediately and check with a physician:
• pain in the abdomen
• bleeding from the rectum
• severe diarrhea
Conditions Caused By Benzoyl Peroxide and Tretinoin
The most common side effects of antiacne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Other side effects should be brought to a physician’s attention. Check with a physician as soon as possible if any of the following side effects occur:
• blistering, crusting, or swelling of the skin
• severe burning or redness of the skin>
• darkening or lightening of the skin (This effect will eventually go away after treatment with an antiacne drug ends.)
• skin rash
Other side effects are possible with any type of antiacne drug. Anyone who has unusual symptoms while using antiacne drugs should get in touch with his or her physician.
Patients using antiacne drugs on their skin should tell their physicians if they are using any other prescription or nonprescription (over-the-counter) medicine that they apply to the skin in the same area as the antiacne drug.
Isotretinoin may interact with other medicines. When this happens, the effects of one or both drugs may change or the risk of side effects may be greater. Anyone who takes isotretinoin should let the physician know about all other medicines being used and should ask whether the possible interactions can interfere with drug therapy.
Among the drugs that may interact with isotretinoin are listed below:
• Etretinate (Tegison), used to treat severe psoriasis. Using this medicine with isotretinoin increases side effects.
• Tretinoin (Retin-A, Renova). Using this medicine with isotretinoin increases side effects.
• Vitamin A or any medicine containing vitamin A. Using any vitamin A preparations with isotretinoin increases side effects. Do not take vitamin supplements containing vitamin A while taking isotretinoin.
• Tetracyclines (used to treat infections). Using these medicines with isotretinoin increases the chance of swelling of the brain. Make sure the physician knows if tetracycline is being used to treat acne or another infection.
Acne comes at a difficult time, the adolescent years. While mild acne can be treated with over-the-counter medications, more severe acne needs medical attention. Experts advise against a wait-and-see attitude. Treatment options can help control acne and avoid scarring.
Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Sexually active adolescent females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In addition, acne treatments that can dry the skin should be used with caution by people with skin of color.
Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Acne treatments that can dry the skin should be used with caution by people with skin of color.
Tretinoin (Retin-A) is available only with a physician’s prescription. It comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians experienced in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.
The recommended dosage depends on the type of antiacne drug. These drugs usually come with written directions for patients and should be used only as directed by the prescribing physician. Teens who have questions about how to use the medicine should check with their physician or pharmacist.
Patients who use isotretinoin usually take the medicine for a few months, then stop for at least two months. Their acne may continue to improve even after they stop taking the medicine. If the condition is still severe after several months of treatment and a two-month break, the physician may prescribe a second course of treatment.
Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In that case, a woman who uses this drug must have a pregnancy test two weeks before beginning treatment and each month she is taking the drug. Another pregnancy test must be done one month after treatment ends. The woman must use an effective birth control method for one month before treatment begins and must continue using it throughout treatment and for one month after treatment ends.
Females who are able to bear children and who want to use this medicine should discuss this information with their healthcare providers. Before using the medicine, they will be asked to sign a consent form stating that they understand the danger of taking isotretinoin during pregnancy and that they agree to use effective birth control.
People using this drug should not donate blood to a blood bank while taking isotretinoin or for 30 days after treatment with the drug ends. This will help reduce the chance of a pregnant woman receiving blood containing isotretinoin, which could cause birth defects.
Isotretinoin may cause a sudden decrease in night vision. If this happens, users should not drive or do anything else that could be dangerous until vision returns to normal. They should also let the physician know about the problem.
This medicine may also make the eyes, nose, and mouth dry. Ask the physician about using special eye drops to relieve eye dryness. To temporarily relieve the dry mouth, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than two weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.
Isotretinoin may increase sensitivity to sunlight. Patients being treated with this medicine should avoid exposure to the sun and should not use tanning beds, tanning booths, or sunlamps until they know how the drug affects them.
In the early stages of treatment with isotretinoin, some people’s acne seems to get worse before it starts getting better. If the condition becomes much worse or if the skin is very irritated, they should check with the physician who prescribed the medicine.