Antiacne drugs

Definition

Antiacne drugs are medicines that help clear up pimples, blackheads, whiteheads, and more severe forms of acne.

Purpose

Different types of antiacne drugs are used for different purposes. For example, lotions, soaps, gels, and creams containing benzoyl peroxide or tretinoin may be used to clear up mild to moderately severe acne. Isotretinoin (Accutane) is prescribed only for very severe, disfiguring acne.

Acne is a skin condition that occurs when pores or hair follicles become blocked. This blockage allows a waxy material called sebum to collect inside the pores or follicles. Normally, sebum flows out onto the skin and hair to form a protective coating, but when it cannot get out, small swellings develop on the skin surface. Bacteria and dead skin cells can also collect that can cause inflammation. Swellings that are small and not inflamed are whiteheads or blackheads. When they become inflamed, they turn into pimples. Pimples that fill with pus are called pustules.

The severity of acne is often influenced by seasonal changes; it is typically less severe in summer than in winter. In addition, acne in girls is often affected by the menstrual cycle.

Acne cannot be cured, but acne drugs can help clear the skin. Benzoyl peroxide and tretinoin work by mildly irritating the skin. This encourages skin cells to slough off, which helps open blocked pores. Benzoyl peroxide also kills bacteria, which helps prevent whiteheads and blackheads from turning into pimples. Isotretinoin shrinks the glands that produce sebum.

Description

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Clear By Design, 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. Tretinoin (Retin-A) is available only with a physician's prescription and 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 who have experience in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.

Some newer antiacne preparations combine benzoyl peroxide with antibiotics. One combination of benzoyl peroxide with clindamycin is sold under the trade name BenzaClin.

Many antiacne preparations contain compounds derived from plants that have anti-inflammatory properties. One group of researchers listed thirty-eight different plants that are beneficial in treating acne and other inflammatory skin conditions.

Recommended dosage

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. Patients who have questions about how to use the medicine should check with a 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.

Precautions

Isotretinoin

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Women 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 they are 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. Women who are able to bear children and who want to use this medicine should discuss this information with their health care 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.

Do 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, do not drive or do anything else that could be dangerous until vision returns to normal. 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, check with the physician who prescribed the medicine.

Benzoyl peroxide and tretinoin

When applying antiacne drugs to the skin, be careful not to get the medicine in the eyes, mouth, or inside of the nose. Do not put the medicine on skin that is wind burned, sunburned, or irritated, and do not apply it to open wounds.

Because such antiacne drugs as benzoyl peroxide and tretinoin irritate the skin slightly, avoid doing anything that might cause further irritation. Wash the face with mild soap and water only two or three times a day, unless the physician says to wash it more often. 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, check with a physician. Using the medicine less often or using a weaker strength may be necessary.

Tretinoin may increase sensitivity to sunlight. While being treated with this medicine, avoid exposure to the sun and do not use tanning beds, tanning booths, or sunlamps. If it is not possible to avoid being in the sun, use a sunscreen with a skin protection factor (SPF) of at least 15 or wear protective clothing over the treated areas. The skin may also become more sensitive to cold and wind. People who use this medicine should protect their skin from cold and wind until they know how the medicine affects them.

Benzoyl peroxide may discolor hair or colored fabrics.

Special conditions

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, be sure to let the physician know about any of these conditions:

ALLERGIES

Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let his or her physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY

Women 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.

BREASTFEEDING

No problems have been reported in nursing babies whose mothers used tretinoin or benzoyl peroxide. Women who are breastfeeding babies should not take isotretinoin, however, as it may cause problems in nursing babies.

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, people with any of these medical problems should make sure their physicians are aware of their conditions:

• alcoholism or heavy drinking, now or in the past
• diabetes (or family history of diabetes). Isotretinoin may also change blood sugar levels.
• family history of high triglyceride levels in the blood
• severe weight problems.

USE OF CERTAIN MEDICINES

Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Side effects

Isotretinoin

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 physicians attention. These include:

• burning, redness, or itching of the eyes
• nosebleeds
• 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

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.

Interactions

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.

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 he or she is taking and should ask whether the possible interactions can interfere with drug therapy. Among the drugs that may interact with isotretinoin are:

• 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.

Zithromax

Zithromax Basics:

Zithromax has to be one of the most convenient antibiotics that you can take and you may have taken a five day Zithromax Z-PAK yourself a time or two. The fact that you can also take just a three or one day course of Zithromax makes it particularly popular with parents of children who don't like to take medicine.

What Zithromax Is Used For:

In children, Zithromax can be used to treat acute otitis media (ear infections), community acquired pneumonia, and pharyngitis or tonsillitis caused by Streptococcus pyogenes (strep throat). Keep in mind that Zithromax is not usually considered to be a first line antibiotic though. For example, penicillin should usually be used for strep throat, and Zithromax is used only if a child is allergic to penicillin. And the AAP recommends Amoxil as the first line drug for ear infections

Zithromax Facts:

Zithromax is often used off-label for many other mild to moderate Pediatric infections that are caused by susceptible bacteria, including sinus infections (sinusitis), Cat Scratch Disease, chronic bronchitis with a secondary bacterial infection, walking pneumonia, and pertussis.

Other facts about Amoxil:

• the trade name for Zithromax is azithromycin
• Zithromax is a type of macrolide antibiotic
• Zithromax is a good choice for children who are allergic to penicillin
• Zithromax can be taken either with or without food
• although the suspension is not generic yet, it is actually a little less expensive than many other brand name antibiotics and usually retails for just under $40

Forms Of Zithromax:

• Zithromax for oral suspension, which when treating ear infections, can be given as a large one time dose (30mg/kg), once a day for three days (10mg/kg/day), or once a day for 5 days
• Zithromax Z-Pak 250mg tablets (5 day course)
• Zithromax Tri-Pak 500mg tablets (3 day course)

Zithromax Side Effects:

For children taking a 5 day course of Zithromax, the most common side effects include diarrhea and loose stools, abdominal pain, vomiting, nausea, and rash. When children take the larger one time dose, side effects were the same, but the incidence of vomiting and diarrhea were higher. Like other antibiotics, zithromax can also rarely cause allergic reactions. See the full prescribing information sheet for a list of all known side effects.

Who Should Not Take Zithromax:

Children with a known hypersensitivity or allergy to Zithromax, erythromycin or any other macrolide antibiotic should not take Zithromax.

What You Need To Know:

Although approved for use in children, the 'safety and effectiveness in the treatment of pediatric patients' ... 'under 6 months of age have not been established' for Zithromax.

Other important information:

• talk to your Pediatrician and pharmacist about possible drug interactions if your child is taking other medications
• although very convenient if your child can take it, the very big downside of the one time dose of Zithromax is that if your child vomits right away, you will likely need to get a new prescription
• multiple generic versions of azithromycin 250mg, 500mg, and 600mg tablets were recently approved by the FDA

References:

• Zithromax Prescribing Information Sheet. January 2004.
• American Academy of Pediatrics Clinical Practice Guideline - Diagnosis and Management of Acute Otitis Media. PEDIATRICS Vol. 113 No. 5 May 2004, pp. 1451-1465.

Peyronie’s Disease

Peyronie’s disease, a condition of uncertain cause, is characterized by a plaque, or hard lump, that forms on the penis. The plaque develops on the upper or lower side of the penis in layers containing erectile tissue. It begins as a localized inflammation and can develop into a hardened scar.

Cases of Peyronie’s disease range from mild to severe. Symptoms may develop slowly or appear overnight. In severe cases, the hardened plaque reduces flexibility, causing pain and forcing the penis to bend or arc during erection. In many cases, the pain decreases over time, but the bend in the penis may remain a problem, making sexual intercourse difficult. The sexual problems that result can disrupt a couple’s physical and emotional relationship and lead to lowered self-esteem in the man. In a small percentage of patients with the milder form of the disease, inflammation may resolve without causing significant pain or permanent bending.
The plaque itself is benign, or noncancerous. A plaque on the top of the shaft (most common) causes the penis to bend upward; a plaque on the underside causes it to bend downward. In some cases, the plaque develops on both top and bottom, leading to indentation and shortening of the penis. At times, pain, bending, and emotional distress prohibit sexual intercourse.

One study found Peyronie’s disease in 1 percent of men. Although the disease occurs mostly in middle age, younger and older men can develop it. About 30 percent of men with Peyronie’s disease develop fibrosis (hardened cells) in other elastic tissues of the body, such as on the hand or foot. A common example is a condition known as Dupuytren’s contracture of the hand. In some cases, men who are related by blood tend to develop Peyronie’s disease, which suggests that genetic factors might make a man vulnerable to the disease.

Men with Peyronie’s disease usually seek medical attention because of painful erections and difficulty with intercourse. Since the cause of the disease and its development are not well understood, doctors treat the disease empirically; that is, they prescribe and continue methods that seem to help. The goal of therapy is to keep the Peyronie’s patient sexually active. Providing education about the disease and its course often is all that is required. No strong evidence shows that any treatment other than surgery is effective. Experts usually recommend surgery only in long-term cases in which the disease is stabilized and the deformity prevents intercourse.

A French surgeon, François de la Peyronie, first described Peyronie’s disease in 1743. The problem was noted in print as early as 1687. Early writers classified it as a form of impotence, now called erectile dysfunction (ED). Peyronie’s disease can be associated with ED; however, experts now recognize ED as only one factor associated with the disease—a factor that is not always present.

Course of the Disease

Many researchers believe the plaque of Peyronie’s disease develops following trauma (hitting or bending) that causes localized bleeding inside the penis. Two chambers known as the corpora cavernosa run the length of the penis. The inner-surface membrane of the chambers is a sheath of elastic fibers. A connecting tissue, called a septum, runs between the two chambers and attaches at the top and bottom.
If the penis is abnormally bumped or bent, an area where the septum attaches to the elastic fibers may stretch beyond a limit, injuring the lining of the erectile chamber and, for example, rupturing small blood vessels. As a result of aging, diminished elasticity near the point of attachment of the septum might increase the chances of injury.

The damaged area might heal slowly or abnormally for two reasons: repeated trauma and a minimal amount of blood flow in the sheath-like fibers. In cases that heal within about a year, the plaque does not advance beyond an initial inflammatory phase. In cases that persist for years, the plaque undergoes fibrosis, or formation of tough fibrous tissue, and even calcification, or formation of calcium deposits.

While trauma might explain acute cases of Peyronie’s disease, it does not explain why most cases develop slowly and with no apparent traumatic event. It also does not explain why some cases disappear quickly or why similar conditions such as Dupuytren’s contracture do not seem to result from severe trauma.

Some researchers theorize that Peyronie’s disease may be an autoimmune disorder.

Diagnosis and Evaluation

Doctors can usually diagnose Peyronie’s disease based on a physical examination. The plaque is visible and palpable whether the penis is flaccid or erect. Full evaluation, however, may require examination during erection to determine the severity of the curvature. The erection may be induced by injecting medicine into the penis or through self-stimulation. Some patients may eliminate the need to induce an erection in the doctor’s office by taking a digital or Polaroid picture in the home. The examination may include an ultrasound scan of the penis to pinpoint the location and extent of the plaque and evaluate blood flow throughout the penis.

Treatment

Because the course of Peyronie’s disease is different in each patient and because some patients experience improvement without treatment, medical experts suggest waiting 1 to 2 years or longer before attempting to correct it surgically. During that wait, patients often are willing to undergo treatments whose effectiveness has not been proven.

Experimental Treatments

Some researchers have given vitamin E orally to men with Peyronie’s disease in small-scale studies and have reported improvements. Yet, no controlled studies have established the effectiveness of vitamin E therapy. Similar inconclusive success has been attributed to oral application of para-aminobenzoate, a substance belonging to the family of B-complex molecules.

Researchers have injected chemical agents such as verapamil, collagenase, steroids, calcium channel blockers, and interferon alpha-2b directly into the plaques. These interventions are still considered unproven because studies included small numbers of patients and lacked adequate control groups. Steroids, such as cortisone, have produced unwanted side effects, such as the atrophy or death of healthy tissues. Another intervention involves iontophoresis, the use of a painless current of electricity to deliver verapamil or some other agent under the skin into the plaque.

Radiation therapy, in which high-energy rays are aimed at the plaque, has also been used. Like some of the chemical treatments, radiation appears to reduce pain, but it has no effect at all on the plaque itself and can cause unwelcome side effects. Although the variety of agents and methods used points to the lack of a proven treatment, new insights into the wound healing process may one day yield more effective therapies.