Fighting Acne with Treasure Valley Family Medicine

Fighting Acne with Treasure Valley Family Medicine

July 26, 2019

Acne is one of the most common and distressing conditions encountered in primary care. By the time they see a healthcare provider, most patients have tried multiple, occasionally expensive, over-the-counter treatments and programs with varying degrees of effectiveness. The clinical team at Treasure Valley Family Medicine is uniquely qualified to treat even the most severe cases of acne.

Diet has a limited effect on acne. Foods that increase IGF-1 hormone levels can promote inflammation, oily skin and acne. Examples include high glycemic index (starchy/processed) foods and lactose sugar from milk. Greasy foods have not been proven to cause acne. Genetics also play a role as studies of identical twins suggest a higher risk of acne when it runs in your family.

Four main components directly contribute to the formation of acne pimples and blackheads: oil production, skin shedding, surface bacteria, and immune response. Over-the-counter (OTC) agents are usually first line. This group includes products with active ingredients such as:

  • salicylic acid (exfoliates dead skin cells),
  • adapalene/Differin gel 0.1% (prevents inflammation, limits skin shedding)
  • benzoyl peroxide 5% (reduces bacteria, skin cells, and oil production).

These same very basic agents are present in the cheapest generic cream or the most expensive commercial multi-step program. Prescription topicals are generally more effective and contain such medications as:

  • clindamycin (antibiotic)
  • azelaic acid (antibiotic, limits inflammation)
  • retinoids (prevent inflammation, limits skin shedding)

More severe cases of acne are treated with short course of oral antibiotics such as minocycline and sulfamethoxazole/trimethoprim (Bactrim). Long-term antibiotic therapy is not necessarily more effective and can cause significant complications such as antibiotic resistance. Several of the antibiotics used to treat acne are also used to treat other conditions such as pneumonia and urinary tract infections.

The most powerful and effective treatment for severe, scarring, or nodular acne is a natural derivative of Vitamin A known as isotretinoin or Accutane. While Accutane, also sold under the names Absorica, Claravis, Myorisan, and Zenatane, is by far the most effective treatment for acne, it is not without risk. The clinicians at Treasure Valley Family Medicine take these risks seriously but also want to improve access to this remarkable medication by offering it to appropriate candidates with severe acne. Using a national risk management system – iPledge – we can help ensure isotretinoin is used safely.

Of note, women may have acne driven by hormonal changes. During the premenstrual time of cycle, pregnancy or middle age, deep tender nodules can develop. If using higher androgenic progesterone birth control pills that contain norethindrone or levonorgestrel and which drive up sebum (oil) production, we recommend you consider a lower androgenic alternative progesterone such as drospirenone, desogestrel, or norgestimate. The reason to switch is that lowering androgen hormones will reduce oil production. Spironolactone (Aldactone) is another prescription pill that lowers androgens and reduces hormonal acne.

Why see a primary care provider for your acne? Who else is more accessible and knowledgeable about all aspects of your health? Who better to provide comprehensive care including contraception (required for females on Isotretinoin/Accutane) and managing the side effects of treatment (which in uncommon circumstances includes changes to mental health). Our clinicians are trained and experienced in prescribing all forms of acne treatment including Isotretinoin/Accutane.