Jul
2
Acne: Blue Light Photodynamic Therapy
July 2, 2009 | Leave a Comment
Blue Light Photodynamic Therapy nxkcirqv7h
The latest thing in acne treatment is the Dusa Blue Light. The FDA initially approved this therapy for treating precancerous skin lesions called actinic keratoses. The approach utilizes a special photosensitizing chemical, aminolevulinic acid (Levu-
*** Dusa Blue Light
For people with precancerous skin lesions or severe acne, the Blue Light may be a valuable tool. The skin may took worse for a few days, but within a week or two the acne should clear up significantly. Results may last several months.
This photodynamic therapy requires a two-step process: First a photosensitizing chemical.(Levulan Kerastick) is applied to the skin and then removed. Then the skin is exposed to the special light.
Side effects: Crusting, stinging, and redness
Downside: Cannot be used if you have active cold sores (herpes simplex) or warts, if you’ve recently had chemotherapy, or if you are pregnant. People who have used isotretinoin within the last year may not be able to undergo Blue Light therapy. Stay out of the sun and avoid fluorescent light exposure for a couple of days after treatment.
Cost: Varies according to the practitioner. Some plastic surgeons charge $500 to $1,000 for a series of treatments.
Ian Kerastick), that is applied to the skin for 30 to 40 minutes. It is then rinsed off and the patient sits in front of the Dusa Blue Light for 8 to 12 minutes. This special fluorescent tube emits a narrow band of blue light (417-nanometer wavelength). It is not a laser. It looks like an ordinary fluorescent light.
This photodynamic therapy reverses precancerous damage to the skin and also seems to undo some of the effects of long-term sun exposure. In addition, this treatment appears to change the hair follicle and make the environment inhospitable for acne-causing bacteria. Dermatologists who adopted the Blue Light early on seem quite enthusiastic about its use for hard-to-treat acne. There is also a hint that it may help “rejuvenate” skin by reducing wrinkles and improving skin texture.
Jul
2
Isotretinoin in Acne Treatment
July 2, 2009 | Leave a Comment
Isotretinoin
Dermatologists have one last big gun, a powerful medicine to use in desperate cases when nothing else has worked. Isotretinoin has stirred a lot of emotions—from excitement to fear—because it is so effective but also has some extremely serious side effects. This drug is approved for severe cystic acne, and it really should be reserved for acne that is not responding to other treatments.
From the time of its introduction, the maker of Accutane strove to get across the point that this drug can cause birth defects. Women who take this medication must. not get pregnant while they are on the drug or for several months after stopping it. (The compound stays in the body for a while.) Nonetheless, the manufacturer’s warnings have not been enough. Every year some women on isotretinoin do conceive, despite all the precautions. As a result, the FDA and the manufacturer have limited the access to this medicine. To prescribe it, a dermatologist must have enrolled in the iPLEDGE program, which educates physicians about the drug. Patients are also required to enroll in the iPLEDGE program and view the educational DVD before taking the first dose. The program uses telephone- and computer-based tracking to verify that female patients are get-** Isotretinoin (Accutane, Amnesteem, Cla r a v i s, S o t r e t.
Isotretinoin is chemically related to vitamin A, so it controls cell division. Four to 5 months of treatment usually results in significant clearing of acne, sometimes lasting years.
Common side effects: Dry lips and mouth; dry, crusty skin; upset stomach; hair loss; nosebleed; sun sensitivity; elevated cholesterol; and reduced night vision
Serious side effects: Birth defects; depression, potentially leading to suicidal thoughts or behaviors; inflammation of the pancreas; pressure on the brain (pseudotumor cerebri) causing severe headache
Downside: Despite efforts to keep this drug away from pregnant women, each year some babies are exposed in utero and born with birth defects. Women must use two different and effective means of contraception throughout the time they are taking Isotretinoin.
Cost: Varies widely from about $100 to $400 for 1 month of treatment
ting regular pregnancy tests to ensure that they do not take this medication during pregnancy. Patients who do not enroll in the program cannot get their prescriptions filled. More information is available online at www.ipledgeprogram.com.
Q. I have been on Accutane to treat bad acne for almost a month. I have taken 26 tablets, but stopped taking it when I thought I might be pregnant.
I found out yesterday that I am indeed pregnant, and I am scared. I want to have this baby, but after reading about the drug causing birth defects, I am not sure. What should I do?
A. We were shocked to learn that you have become pregnant while taking Accutane. This acne medicine can cause very serious birth defects in a fetus.
That is why the manufacturer recommends every woman have a pregnancy test before she starts on this drug and use effective contraception throughout therapy. Every time a pill is removed from its packaging, a symbol reminds the patient not to take this drug during pregnancy.
Please discuss this serious matter with your physician and your partner. The drug company can provide further information about your odds of having a baby with severe health problems.
Jul
2
Acne: Hormone Treatment
July 2, 2009 | Leave a Comment
Hormone Treatment
Because hormones, especially androgens like testosterone, play a role in acne, changing the balance of these natural compounds in the body can be helpful in some cases. Many young women benefit from taking birth control pills for their acne. This treatment stops the hormone surges and also probably reduces the amount of testosterone that is available to stimulate oil-producing hair follicles and make mischief. Keep in mind, though, that young women who take oral contraceptives for an extended period may have a lowered libido for quite a long time after discontinuing the treatment. 18 (Parents of teenagers may not consider this a negative factor, but it can be very troublesome for a woman in her twenties or thirties.)
Q. You had a question about a teenage girl with acne. Nothing the dermatologist prescribed had worked, and her mother refused to consider birth control pills for her.
My heart goes out to her. I too have suffered with acne my whole life, starting when I was 10 years old. I am now 35.
My parents took me to dermatologists who prescribed pills and creams; we changed my diet; we tried sun exposure and no sun exposure. They kept trying because they knew my self-esteem was suffering. Acne makes you feel ugly.
At the age of 161 saw a gynecologist who suggested birth control pills. I was raised a strict Irish-Catholic, but Mom was open to anything that might help me. Within 2 months of starting birth control pills, my skin was considerably better!
I am one of those people whose body loves the pills. As soon as I stop taking them, my skin starts to break out. I hope my experience will help convince that mother that birth control pills could be the magic she wants for her daughter.
A. When all else fails, birth control pills can be helpful. The hormones counteract testosterone. Yes, young women make this male hormone too. Not every woman tolerates oral contraceptives as well as you do, but doctors frequently prescribe them for hard-to-treat acne.
A dermatologist may also prescribe a very old-fashioned blood pressure drug called spironolactone by itself or in combination with birth control pills. This is an “off label” use of spironolactone, but one with quite a long history. Spironolactone seems to help reduce the action of testosterone or other androgen hormones. That may explain why it is also used to treat women who have excessive facial hair (hirsutism). The dose that dermatologists use for acne is usually one-fourth that used for hirsutism.
Spironolactone is a potassium-preserving diuretic and must not be combined with potassium supplements or other potassium-preserving medications. In addition, spironolactone carries a black-box warning in its. prescribing information that tells doctors in the strongest way possible that this drug causes cancer in animal studies. Generally, therefore, physicians prescribe it only for a limited time. Women are urged not to become pregnant while on this medicine. When it is used in combination with oral contraceptives, that shouldn’t be as much of a concern.
Jul
2
Prescription Pills for Acne
July 2, 2009 | Leave a Comment
Prescription Pills for Acne
When topical antibiotics don’t do the job, dermatologists may prescribe oral medication to get the antibiotic into the bloodstream rather than just on the surface of the skin. Tetracycline and clindamycin have been widely prescribed, but some acne-causing bacteria have developed resistance to them. Now, dermatologists may be more likely to prescribe minocycline. Although this antibiotic works against acne, it is not clear that it is either more effective than other oral antibiotics or less likely to cause undesirable reactions.
Anyone who is prescribed oral antibiotics needs to know This topical treatment has been flying under the radar for years. Some dermatologists tell us that it should have anti-inflammatory action and may be better tolerated than benzoyl peroxide.
Side effects: Redness, dryness, and burning
Downside: Hard to find, although it is available from many online pharmacies. May take several weeks to work. Physicians and pharmacists seem unaware of its effectiveness, and studies are few.
Cost: Approximately $30 for a 30-gram tube
when to take them and whether they should delay taking other treatments, such as supplements or antacids. Patients should discuss all the pros and cons of oral (systemic) antibiotic therapy with the doctor prescribing it. Certain drugs may cause rare but potentially serious side effects, such as the pseudomembranous colitis that is sometimes seen with clindamycin.
One study found that people using antibiotics (oral or topical) to treat their acne were about twice as likely to come down with an upper respiratory tract infection. Colds, flus, and similar upper respiratory tract infections are usually self-limited and rarely a serious threat to health, but it makes sense to evaluate whether the acne is in fact affecting your life so much that you’d be willing to trade it for a cold. It might not make sense to take an antibiotic for mild acne that is not too bothersome.
After completing a course of antibiotic treatment, acne patients may be able to keep their skin clear by using tretinoin gel or a similar product.” Adapalene or tazarotene gel may also be useful.” Using such a topical medicine as follow-up therapy can reduce the amount of antibiotic exposure.
Jul
2
Acne: Prescription Lotions and Gels
July 2, 2009 | Leave a Comment
Prescription Lotions and Gels for Acne Treatment
If treatment with benzoyl peroxide doesn’t get your pimples under control within a couple of months, check with a physician. Dermatologists often prescribe topical antibiotic gels or lotions in addition to or instead of benzoyl peroxide. Erythromycin and clindamycin are old standbys. Because they have been so widely used however, bacteria have begun to develop resistance to them. As a result, dermatologists have been restricting their use and instead turning to other approaches.
One other medication that is being prescribed is azelaic acid (Azelex, Finevin). Like benzoyl peroxide, this topical treatment seems to keep pores from clogging and to discour-age the multiplication and spread of bacteria. It too may result in burning, stinging, redness, or dryness of the skin. In rare instances, dark skin exposed to azelaic acid may develop lighter patches. If you have a cold sore or fever blister that gets worse while you are using an azelaic acid product, notify the prescribing physician immediately.
Tretinoin or a similar compound in the vitamin A family can be very effective in treating acne and reducing the inflammation associated with severe acne. Using topical vitamin A–like compounds (retinoids) early in the course of acne lessens the likelihood of scarring, a complication of the condition. Some doctors prescribe tretinoin together with benzoyl peroxide or with an oral antibiotic such as doxycycline to clear the skin faster. Because it works on the deeper cellular layers of the skin and speeds up cell turnover, it can also
**** Clindamycin Gel (Cleocin T, Clinda-Derm, Evoclin Topical Foam)
Clindamycin is an antibiotic that can be applied to the skin to fight acne-causing bacteria. It may take 2 months to see significant improvement, but generally this treatment is effective. Other topical antibiotics such as erythromycin gel are also effective.
Some prescription products combine an antibiotic with benzoyl peroxide for greater effectiveness. These include BenzaClin and Duac Gel (clindamycin plus benzoyl peroxide) and Benzamycin (erythromycin plus benzoyl peroxide). These are effective but expensive because no generic equivalents are available.
Side effects: Itching, burning, dryness, and peeling. A rare but very serious and dangerous side effect of clindamycin that is extremely unlikely to occur but still possible with the topical form is pseudomembranous colitis. Notify your doctor immediately if you develop persistent or bloody diarrhea.
Downside: Skin bacteria (P. aches) are beginning to develop resistance to topical clindamycin.
Cost: Approximately $50 for a 60-gram tube Tretinoin Gel (Retin-A)
Retin-A speeds up cell turnover and normalizes the lower levels of the skin. With 6 weeks or more of treatment, it is frequently very helpful against acne.
Side effects: Stinging, dryness, redness, flaking, and irritation
Downside: Retin-A makes skin more sensitive to sunburn and sun damage, so stay out of the sun and use effective protection against ultraviolet rays.
Cost: $35 to $50 for 15 grams
bring pimples to the surface more quickly. This means that acne may seem to be getting worse at first rather than better, but with patience the condition should clear up. Tretinoin is also used to smooth out wrinkles due to sun damage.
There is another prescription gel or cream that is based on a vitamin. Nicomide-T gel or cream contains nicotinamide, a form of niacin. Like Retin-A, it is topical but not an antibiotic, so theoretically bacteria should not develop resistance to it. A preliminary study showed that Nicomide-T gel is as effective as clindamycin gel in reducing blemishes.” Other research confirmed that it can protect the skin and is less likely to dry it than a number of other acne treatments. 11, 13 It is not clear whether Nicomide-T is as effective as Retin-A, though some studies conducted by the manufacturer, Sirius Laboratories, suggest that adding it to other treatments boosts the effectiveness of both.
Jul
2
Acne: Over-the-Counter Treatment
Benzoyl peroxide is the primary ingredient in most OTC acne treatments. This compound has antimicrobial activity and is usually quite effective for mild acne.
G. My teenage son has a mild case of acne, but to him it is huge. He washes with strong cleansers and uses a variety of acne medicines. Can you recommend something that will clear up his skin so he doesn’t scrub so much? His face is bright red after all the washing, and I don’t think that is good.
A. You’re right! Acne is not caused by dirt, so vigorous washing won’t help. It may even make things worse.
OTC benzoyl peroxide (Benzac, Clearasil Acne Treatment, Oxy 5, etc.) should do the job. If not, your son should see a dermatologist. Retin-A (tretinoin) and/or antibiotics can work wonders.
Benzoyl peroxide is found in a number of different products, from cleansing bars and liquid cleansers to lotions and even shaving creams. Read the instructions on the label and follow them; the procedure varies a little for the different forms. Benzoyl peroxide can dry the skin and cause irritation. If that happens, use it a little less frequently or look for a product with a lower concentration of the ingredient. Some Benzoyl Peroxide
Benzoyl peroxide unplugs pores and discourages thegrowth of skin bacteria. It is not, however, an antibiotic, and skin bacteria don’t seem to develop resistance to it.. Follow the instructions on the product label for application and use.
Side effects: Skin irritation, dryness, redness, scaling, and rash
Downside: Acne may worsen initially before improving. Use the product for 6 weeks to 2 months to evaluate its effectiveness..
Cost: Varies, depending on - the product; approximately $20 to $30 for a month’s worth of gel .
individuals are allergic to benzoyl peroxide and break out in hives or swelling, so try it out on your forearm first to make sure you will not react badly. If you do, you will have to forgo benzoyl peroxide treatment and look for another way to manage your acne.
A few nonprescription acne products contain active ingredients other than benzoyl peroxide. Resorcinol is generally used in combination with sulfur (Clearasil Adult Care contains them both). Salicylic acid is also found in some OTC acne products. None of these should be used in combination with benzoyl peroxide. All may irritate and dry the skin, and they should not be combined with other products that might irritate the skin.
Jul
2
Acne Home Remedies.
July 2, 2009 | Leave a Comment
Home Remedies
People have devised a number of potions to put on their faces as home treatments for blemishes. There’s really no good evidence that any of them work, but they might be worth a try. We heard from a man who had tried washing his face with milk every day as a teenager and found it helpful. He wasn’t able to convince his daughter to try the same approach, though. We haven’t seen any evidence that a milk face wash is effective, but it seems like a low-risk adventure. In India, milk is mixed with ground nutmeg and applied to blemishes as a treatment.
Another approach is the clay mask. Versions of this are sold in drugstores and at cosmetics counters. We don’t know why it would work, but it has been popular for a long time.
Q. I taught pottery at a vocational program in the Dominican Republic some years ago. My teenage students often smeared liquid local clay from our workshop on their faces as a cure for acne. The treatment worked.
A. We’ve never seen a scientifically solid study of clay for treating acne. But clearly, clay masks have been used as a complexion aid for centuries. We don’t know if American teenagers would be willing to embrace such a treatment, but stranger things have become popular.
Clay is not the only traditional “poultice” that has been applied to blemishes. We’ve heard of one home remedy that calls for mixing a teaspoon of powdered nutmeg with a teaspoon of honey and putting it on the zit for 20 minutes.’ Then it is rinsed off, just as the nutmeg-milk mixture or milk alone would be. Still another variant is to apply a paste of ground cinnamon and honey to the blemishes and leave it on overnight. Whether any of these will actually clear up pimples is a mystery to us. They have not been put to the rigors of scientific study.
One natural product that has been studied is tea tree oil in a 5 percent gel. An Australian study compared a gel composed of an extract of the Australian tree Melaleuca alternifolia to a standard over-the-counter (OTC) acne treatment, benzoyl peroxide.’ The scientists who conducted the 124-patient study wanted to see if the antimicrobial activity of the tea tree product would be useful. They found that although the initial response was slower, the benefits were comparable for non-inflamed lesions after 3 months of treatment. Benzoyl peroxide was significantly better at reducing inflamed lesions, but it also produced significantly more undesirable side effects, such as skin dryness, stinging, itching, burning, and redness. If you can’t find a water-based tea tree oil gel, look for a cleanser with tea tree oil, which should be readily available. Some people are allergic to tea tree oil, so try a bit on the inside of your forearm first to make sure you don’t have a reaction. Watch for redness, itching, or irritation.
Speaking of cleansers, it is a myth that acne is caused by dirt that needs to be scoured off with a harsh or gritty cleanser. Simply washing the face gently each morning and evening with a nondrying cleanser such as Dove, Cetaphil, or CeraVe is recommended. Cosmetics and sunscreens should be noncomedogenic, which means they don’t contribute to blackheads. This information should be on the label.
Q. 1 am 39 years old and plagued with acne on my chin and neck. The dermatologist has given me topical prescription creams that haven’t done much good, and has said my only other choice would be oral antibiotics.
Recently I started applying Neosporin ointment to the affected areas of my face. The difference is miraculous! I am practically blemish free after only 2 weeks of this treatment. Any blemishes I do get are very small and disappear within a few days of applying the Neosporin. Have you heard of this? My teenager tells me that some of her friends do the same.
A. Neosporin contains the antibacterial ingredients polymyxin B, bacitracin, and neomycin. It is used for first aid to keep minor cuts from becoming infected. Your use of Neosporin is new to us. If you stop getting good results, check back with your doctor. There are a number of other prescription treatments for acne that should help. Some people develop serious skin reactions to neomycin.
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2
Acne Overview and FAQs
July 2, 2009 | Leave a Comment
ACNE
• Avoid sugar and refined Garbs and cut back on milk
*Try an over-the-counter product with benzoyl peroxide
• Ask your MD about a prescription for clindamycin gel
• Apply prescription-strength tretinoin gel
• Discuss Nicomide-T gel with your doctor ***
• Ask your doctor about isotretinoin **
• Ask your doctor about photodynamic therapy ***
Acne is usually thought of as an adolescent problem, but dermatologists have been treating adults with blemishes for years. The technical term for such outbreaks of pimples is acne vulgari& Common skin bacteria (mostly Propionibacterium acnes), the production of oils by the skin, and even the impact of hormones all seem to play a role in determining who gets acne and how severe it will be. When an oil-producing hair follicle becomes plugged up and the bacteria go to work feasting on the fatty acids trapped inside it, the body often reacts with inflammation. That’s what makes the pimple so sore and red.
Based on this scenario, there are four ways to tackle the problem of acne: discourage the bacteria, reduce the production of oil, control the hormones, or lower the level of inflammation. In practice, dermatologists mostly focus on bacteria and, oil production. But perhaps trying to lower the level of inflammation is more practical than they think.
The Anti-Acne Diet
Dietary recommendations for acne sufferers have a checkered history. Way back when, teenagers were told to lay off the cheeseburgers and french fries. If they stayed away from high-fat foods like milk shakes and chocolate, they were told, they’d have lovely, clear skin.
We don’t know how many kids with acne in the 1960s and 1970s followed that advice, but eventually dermatologists changed their minds. They did some studies and discovered that the amount of fat in the diet didn’t seem to correlate very well with the severity of blemishes. So they told their adolescent patients, “Never mind.” Diet was not considered a significant risk factor for acne.
Then a few dermatologists began to wonder if that advice was correct. An international team of investigators reported that clinical examination of 1,200 residents of Papua New Guinea (Kitavan Island) and of 115 hunter-gatherers from Paraguay did not turn up a single case of acne.’ Since 70 to 95 percent of adolescents and approximately half of people more than 26 years of age have facial acne in Westernized societies, the difference was striking. The researchers proposed that diet might play an important role. Specifically, they noted that the native peoples consume a diet composed of lowglycemic-index foods, with a minimum of refined foods, especially refined carbohydrates such as sugar and flour. (Presumably, their diets are also low in the unnatural trans fatty acids as well, since these are equally linked to processed foods. 2) Perhaps, the scientists hypothesized, this diet that minimizes insulin spikes might also benefit the skin.
Q. My 14-year-old daughter has had moderate acne for nearly 2 years. There are always 5 to 10 small pimples on her forehead, and now she has 10 to 20 pimples on her cheeks as well.
Clearasil left bleach stains on her clothes. Antibiotics the doctor prescribed didn’t help and even seemed to make matters worse. The doctor suggested birth control pills, but that is not an option we’d entertain. Are there any natural remedies that might work? What about diet?
A. The purported link between acne and diet is controversial. Teens once were told to avoid chocolate and high-fat foods. That turned out to be unhelpful.
Research published in the Archives of Dermatology suggests, however, that diet actually may make a difference. Populations on low-carb diets that don’t make blood sugar rise quickly may be less prone to blem-fishes. Your daughter might try avoiding foods like candy, cookies, french fries, potato chips, sugar, and white flour to see if it helps her complexion.
Not all dermatologists have welcomed this new look at the possible role of diet. The epidemiological comparison suggesting that diet might be relevant in the development of acne triggered a series of comments under titles such as “Diet and Acne Revisited” and “The Unwelcome Return of the Acne Diet., ,3,4,S
It isn’t altogether clear why this development should be so unwelcome. Nutrition science is gradually reaching a consensus that a low-glycemic diet, one with the least amount. of trans fats as well as saturated fat, is probably preferable for long-term health in many respects. Such a dietary pattern seems to lower the risk of diabetes and heart disease. Encouraging young people to adopt healthy dietary habits at a time when they would be motivated by the short-term benefit of clearer skin might be a good public health strategy. Most patients seem to think that diet is important in treating acne, and they expect dietary recommendations from their doctorS.6 In the meantime, dermatologists should be conducting research to determine if this dietary hypothesis is solid or if it is as far-out as many doctors think.
Refined carbohydrates and trans fats like margarine might not be the only dietary culprits. A different study reviewed the dietary and dermatological histories of 47,355 female nurses and concluded that the more milk these women drank in adolescence, the more likely they were to have had severe acne as teenagers.7 The Harvard scientists who conducted this research suggest that hormones and growth factors found in milk might contribute to this problem.
It appears that a good deal more research is needed before there will be a clear answer to the question of whether diet affects acne. In the meantime, motivated acne sufferers can do their own experimentation to find out if including less processed food and less milk in their diet might result in fewer blemishes.
My son recently returned from a 5-day camping trip where he didn’t have milk or any of his acne medicine. To my surprise, his face looked beautiful. Maybe there’s a connection between clear skin and no milk. The dermatologist suggested eliminating milk to see what happens.
Conclusions
Blemishes are a common part of adolescence, but they also trouble many people well into adulthood. Changes in hormone levels seem to aggravate acne. Most treatments are aimed at killing or slowing down bacteria that are commonly present on and in the skin, and this usually works well until or unless the bacteria develop resistance. Stress seems to make acne worse (which is why college students have more zits during the week of final exams), but given the fact that stress is so hard to avoid, almost no treatments focus on controlling it. There are many approaches to acne treatment; if self-care does not prove effective, a dermatologist should be able to prescribe a therapy that will help.
• Change your diet. A low-glycemic-index diet with very little sugar and other refined carbohydrates might improve skin significantly, and it will have other health benefits as well. Other things to avoid: milk and trans fatty acids, which are found in margarine and shortening. A study of dairy products and acne is currently under way.
• Facial masks of clay may remove excess oil and help clear the skin. Other topical treatments include nutmeg mixed with milk or honey to make a paste for pimples. A tea tree oil gel (5 percent) is worth trying.
• Wash morning and evening with a gentle nonsoap cleanser. Using a harsh or abrasive product may aggravate acne.
• Ask your doctor about applying a topical antibiotic such as clindamycin or erythromycin. They can be helpful, but skin bacteria are developing resistance to these drugs.
• Check with your doctor regarding a prescription for Retin-A. Be vigilant about protecting your skin from the sun or any other source of ultraviolet radiation while you are using this medicine.
Q Ask about Nicomide-T gel or cream. This vitamin-based topical medicine can reduce inflammation and may be almost as effective as some topical antibiotics.
• Oral antibiotics may work even when topical antibiotics do not. Be sure to ask your doctor about side effects and interactions, and follow the dosing instructions carefully.
• Women may benefit from birth control pills. Sometimes the diuretic spironolactone provides additional anti-acne power.
• For severe acne that has not responded to other treatments, isotretinoin (Accutane, Sotret, etc) is an option. Discuss the risks and benefits thoroughly with your dermatologist before starting on a 5-month course of these pills. Because isotretinoin causes birth defects, women are required by the manufacturer to verify before taking any of this medication that they are not pregnant, and to confirm it again each month during treatment. They must also use two effective forms of contraception during the course of treatment.
• Ask your dermatologist if Dusa Blue Light (photodynamic therapy) is appropriate for you. It should be administered by a dermatologist or plastic surgeon experienced with its use.