What is the best way for men with light skin to treat moderate, persistent acne on the face? Acutane seems like overkill and is expensive. Pills like oracea or minocin have helped, but they have not given me clear skin, only a reduction in redness and acne. Topicals like finacea or metrogel are useless and irritating because I also have rosacea.
I have tried IPL photofacial and it worked better than anything else, but I am still wondering if there could be an equally effective solution that is less expensive. Or, should I commit to a consistent IPL treatment along with lasers? If so, are there actually any medical spas in CA that have licensed doctors who perform or visually oversee these procedures? The assistants make me too nervous and most standard dermatologists are still behind the times, as they still push useless creams, expensive pills that don’t work and do not have IPL or lasers in their offices. I know that quality treatment will cost money. Expert opinions are welcome!
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27 Feb
8:17 pm on February 27th, 2010
This is long — but you seemed to want a lot of information. I have very fair skin, which is also oily, and I also suffer from persistent acne (with which I have twenty years of battle experience), and I also have rosacea. My acne was also serious enough to warrant multiple courses of Accutane (which also helped the rosacea, by the way). If other treatments have failed, some dermatologists will prescribe a low dose (10mg) treatment of Accutane that you can take just two to three times per week — if your skin is oily; if it is dry, then this is obviously not for you.
In terms of topicals, I do use Finacea, and it is specifically for rosacea — while it was somewhat irritating initially, it did turn out to be an outstanding rosacea (and acne) treatment after about a month of therapy. It helped reduce the redness *significantly*. MetroGel is definitely a total waste of time, especially since it is an antibiotic, and recent research has demonstrated that bacteria are not the correct target for treatment in rosacea. An overabundance of certain inflammatory proteins in the skin have been identified as the appropriate target for treatment in rosacea — and Finacea does target these pretty well (see research link cited below). Not all dermatologists are terrible, though — mine here in Birmingham was president of the American Academy of Dermatology in 2004 and was the lead researcher on the comparison of Finacea vs. MetroGel study. You can find a good one, I would hope, there in California.
I have also received IPL treatments for rosacea (in a dermatologist’s office — although I live in Birmingham, Alabama), and they are effective, as well — but repeat treatment is required in order to maintain remission. It’s not a cure. I prefer the Finacea, since it also helps to control acne and oiliness.
There is a less-prescribed option, Nicomide-T, a topical treatment, which also has an oral form, Nicomide. This is actually an anti-inflammatory preparation of B-vitamins, copper, and zinc. It has been studied to be just as effective as antibiotics (without the side effects or issue antibiotic resistance), and the topical form has been demonstrated to also help reduce redness and irritation caused by other topical acne treatments. (It is also helpful to control oiliness, as well.) I would say it would definitely be worth your time to investigate Nicomide-T.
I also use Tazorac (a topical retinoid) intermittently to help control the acne and take doxycycline for rosacea. (By the way, Oracea is just a low-dose form of doxycycline, so if your dermatologist prescribed doxycycline, it would be less expensive — available as a generic — than the the Oracea, which is only available as a brand-name drug. I am assuming you have insurance.)
If your acne is not serious/severe, I would have to say that lasers are overkill since they are also not a “cure” and would be very expensive. A diode laser can shrink the oil glands (again, this is only preferable if you have oily skin) and prevent acne for a certain remission period — but no longer than Accutane does.
Finally, I would also recommend a prescription wash called Plexion — it is not irritating, and it treats *both* acne and rosacea, so it would seem like a good choice for you. It’s also available as a generic, so it would be reasonably affordable.
So, my recommendation would be to inquire about: combination therapy with Plexion cleanser, doxycycline, Finacea, and Nicomide / Nicomide-T … and possibly a retinoid like RetinA-Micro or Tazorac. Hope this information helps!
10:19 pm on February 27th, 2010
since i do not live in california you are going to have to call your local offices to ask if the docs perform these tx themselves( many do not any longer)
IPL( intense pulse light) seems to work for you …now you could ask if a nursepractitioner or physicians assistant or licensed esthetician( with yearsof experience) administers these and that should make you less nervous as these people have had proper training and are licensed. You could try a low dose of retin- a at night to help smooth out the problem as well… yes, accutane is pretty harsh (esp on your internal organs) but it might help ..I just cannot really tell you because I have not analyzed your skin in person… so my thoughts are if you are really concerned about who is offering the IPL then do NOT be afraid to ask and TO SEE a license from one of the above i mentioned.