Tretinoin for acne

Vitamin A acid or tretinoin, available in cream, gel or liquid form, can help acne patients but it may be difficult to tolerate because of its irritating effect.

"Like benzoyl peroxide, vitami
A acid is an aggressive irritant the benefits of which are not readily noticeable. In fact, during the first few weeks of therapy, the rapidly drying, peeling, itching pimples may actually appear worse than ever. The skin will be rough, red and flaky and a decidedly unattractive crop of lesions will bloom quite prolifically for a while," said Dr. Frederic Haberman, a dermatologist at the Albert Einstein College of Medicine in New York, in Your Skin; A Dermatologist’s Guide to A Lifetime of Beauty and Health.

While this may be enough reason to discontinue using the drug, Consumer Guide's Prescription Drugs said you should go on with the treatment since this is a normal side effect of teitinoin.

"The acne may seem worse after several weeks of treatment but this is because the drying and peeling action of the acid has uncovered hidden comedos (blackheads). Two or three months may be required, after which dramatic improvement can be expected," explained Kurt Butler and Dr. Lynn Rayner of the John A. Burns School of Medicine, University of Hawaii, in The Best Medicine.

As for side effects, inform your doctor about blistering, crusting, severe redness and burning, swelling, or marked darkening or lightening of the skin. The safe use of this drug in pregnancy has not been established.

To lessen irritation, the use of a sunscreen is advised since tretinoin increases one's susceptibility to sunbu
and possibly skin cancer. Other studies, however, say otherwise.

"The problem with tretinoin is that it often causes irritation and redness. It doesn't have great patient acceptability because of that. What's funny is that chronic use of tretinoin is also said to reduce the incidence of skin cancer so it's like a twin-edged sword. But I would say that the use of tretinoin has decreased dramatically over the last 10 years. The type of acne that seems to respond well to it is the one mainly with blackheads and whiteheads$ not inflammatory acne which is characterized by big red pimples," said Dr. Peter W. Gould, former president of the New Zealand Dermatological Society.

Tetracycline, an oral antibiotic, which is used to treat a wide variety of bacterial infections, is also prescribed for moderate forms of acne. This prescription drug inhibits the growth of bacteria which are sometimes responsible for the development of acne lesions.

"Tetracycline (one gram) daily is usually required and has to be continued for at least six months for maximum benefit. Up to 70 percent of patients may be expected to respond with useful reduction of inflammation. However, complete clearance of lesions cannot be expected and improvement is delayed for about a month after treatment begins,"explained Dr. John Wishart of the Department of Dermatology, Auckland Hospital in New Zealand.

One drawback is that tetracycline does not work as fast as topical antibiotics and other peeling agents we discussed earlier. Because of this, the patient must continue taking them for extended periods of time and is more likely to experience their side effects.

"In general, we move to topical stuff because a lot of people may have to take oral antibiotics for two years and they should be cautious about their side effects. Some people can't take them at all. With tetracycline, they might become sensitive to the sun or suffer from gastric irritation or vaginal thrush," according to Gould. (Next: Side effects of oral antibiotics.)

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