Your Dermatology Prescription: A Guide to Acne Treatments

Medication concerns??

Hello Dr.
Jiang,
Recently, I've been experiencing a lot of pus-filled pimples on my forehead.
I visited a dermatologist who said it wasn't serious and that I just needed to take medication and apply topical treatments, which would help me recover quickly.
I have been taking the medication and applying the topical treatments as instructed, but my condition seems to have worsened (with even more breakouts).
After two follow-up visits, I decided to switch to another dermatologist with a good reputation.
I provided the previous doctor's prescription for reference, but the new doctor didn't say much about it, and even the instructions for the medications were somewhat vague.

Could you please explain the purpose of these medications? The first doctor's prescription included:
1.
Dermalean gel
2.
Doxycycline
3.
Erythromycin + Iso10
The second doctor's prescription included:
1.
Amoxicillin 500 mg
2.
Prelon 5 mg
3.
Benzoyl Peroxide
4.
Gentasone 5g (Hydrophilic ointment)
I vaguely remember the second doctor saying that medications 1 and 2 are oral medications, and he suggested taking them for three days before starting to apply medication 4, and once there is some improvement, to start applying medication 3.
Is this the correct order of steps? (I feel like the medication regimen is quite strange!) What symptoms of the skin are these medications intended to treat? Also, could you let me know if any of these medications are similar to retinoids, which require sun protection after application?
Thank you for your response!

Xiao He, 20~29 year old female. Ask Date: 2005/08/14

Dr. Jiang Zheen reply Dermatology

The average treatment duration for acne is 3 to 4 months.
To evaluate the effectiveness of the medication, it should be used continuously for about 3 to 4 weeks before assessing its efficacy.
If ineffective, second-line treatments may include oral retinoids or oral hormones.
Topical medications for treating comedones include topical retinoids, azelaic acid, and alpha hydroxy acids.
For inflammatory acne, options include benzoyl peroxide, erythromycin, clindamycin, and azelaic acid, among others.
There are three main categories of oral medications: the first is antibiotics, which are first-line treatments, such as doxycycline, minocycline, and ampicillin.
The second-line medications are oral female hormones.
The third category includes oral retinoids.
Physicians should tailor treatments based on the type of lesions and the patient's response to medications.
I still recommend ongoing treatment at a dermatology clinic for the best results.
Wishing you peace; Jesus loves you.

Reply Date: 2005/08/14

More Info

When it comes to understanding your dermatology prescription for acne treatment, it's essential to grasp the purpose and function of each medication prescribed by your dermatologist. Let's break down the medications you've received from both doctors and clarify their roles in treating acne.

First Doctor's Prescription:
1. Dermalean Gel: This gel typically contains ingredients that help reduce inflammation and promote skin healing. It may also have components that help unclog pores, making it effective for treating acne.

2. Doxycycline: This is an oral antibiotic that belongs to the tetracycline class. It works by inhibiting bacterial growth, particularly *Propionibacterium acnes*, which is often implicated in acne development. Doxycycline also has anti-inflammatory properties, making it beneficial for reducing the redness and swelling associated with acne.

3. Erythromycin + Iso10: Erythromycin is another antibiotic that can be used topically or orally to combat acne-causing bacteria. The "Iso10" likely refers to isotretinoin, a potent retinoid that helps in reducing oil production and promoting cell turnover. However, it is essential to clarify this with your doctor, as isotretinoin is usually prescribed for more severe cases of acne.

Second Doctor's Prescription:
1. Amoxicillin 500 mg: Similar to doxycycline, amoxicillin is an oral antibiotic that helps fight bacterial infections, including those that contribute to acne.

2. Prelon 5 mg: This medication is less commonly known in the context of acne treatment, and it would be best to consult your doctor for its specific role in your treatment plan.

3. Benzoyl Peroxide: This is a topical treatment that helps kill bacteria on the skin and reduces oiliness. It is often used in conjunction with other treatments to enhance effectiveness. Benzoyl peroxide can cause dryness and irritation, so it's crucial to start with a lower concentration and gradually increase as tolerated.

4. Gentasone 5g (Hydrocortisone): This is a topical corticosteroid that can help reduce inflammation and itching. It may be used to calm irritated skin, but it should be used cautiously, as prolonged use can lead to skin thinning and other side effects.

Treatment Steps:
The second doctor’s suggested regimen of starting with oral medications (Amoxicillin and Prelon) for three days before introducing Benzoyl Peroxide seems reasonable. This approach allows your body to begin combating the bacteria before applying topical treatments that may cause irritation. After some improvement, incorporating Gentasone can help manage any inflammation or irritation caused by the other treatments.

Sun Exposure and Precautions:
Regarding your concern about sun exposure, both Doxycycline and Benzoyl Peroxide can increase your skin's sensitivity to sunlight. It is advisable to use sunscreen daily and avoid excessive sun exposure while on these medications. Isotretinoin (if included in your treatment) also has significant photosensitivity risks, so sun protection is crucial.

Conclusion:
In summary, your treatment plan involves a combination of antibiotics to reduce bacterial load and inflammation, topical agents to manage oil production and promote skin healing, and possibly corticosteroids to alleviate irritation. It’s essential to follow your dermatologist's instructions carefully and communicate any concerns or side effects you experience. If you feel uncertain about the treatment steps or the medications prescribed, don’t hesitate to ask your dermatologist for clarification. Open communication is key to effective acne management.

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