Part 5: ORAL MEDICATIONS
Four types of oral medicatiopns: hormonal, antibiotics, retinoids and probiotics
Due to the systemic (every system or all throughout the body) nature of oral hormones, antibiotics and retinoids, these oral medications not only have beneficial effects on the skin but can also have potential side effects, sometimes very dangerous or serious side effects. Therefore the oral hormones, antibiotics and retinoids should be reserved for more serious cases or after other therapies have been tried.
The least controversial are the hormonal therapies for acne. The hormonal therapies breakdown into three main groups: hormonal contraceptives, androgen blockers and corticosteroids. Hormonal contraceptives, also known as ‘birth control pills,’ are for female clients only. Hormonal contraceptives come in many different combinations and can have unpredictable effects on acne but at times can be very helpful. Androgen blockers interrupt the effects of male hormones (testosterone and others) throughout the body. Androgen blockers, like spironolactone and finasteride, again are for women only. The androgen blockers can significantly help some women with elevated testosterone levels. Corticosteroids are potent anti-inflammatory drugs. Corticosteroids are rarely used orally for acne but instead can be injected directly into large cystic or nodular lesions.
Much like topical antibiotics can be used to lower the numbers of Propionibacterium acnes (abbreviated P.acnes) on the skin, oral antibiotics can also be used. The use of oral antibiotics, instead of topical antibiotics, may be beneficial when the acne is wide spread or in difficult to reach places, like the back. Unfortunately oral antibiotics not only kill specific bacteria in the skin but harm or kill bacteria throughout the body; more about that later (see pre- and pro-biotics).
Finally, the elephant in the living room, oral isotretinoin is the most potent treatment for the reduction of sebum production and hyperkeratinosis. Oral isotretinoin is also known by its brand names as Accutane (no longer on the market), Sortret, Claravis and Amnesteem. In adolescents and young adults, eighty-five percent are clear after 16 weeks and another 13% clear after 5-6 months. Mature adults have similar clearance rates typically with lower doses. That’s the upside, very effective; now the downside.
The original isotretinoin, brand name Accutane, was pulled from the market not only because its patent was running out but also its maker, Hoffmann-La Roche was involved in over 1000 lawsuits related to side effects. Isotretinoin is a proven teratogen, meaning it causes birth defects, miscarriages and stillbirths. It has serious drug interactions with commonly prescribed medications. Oral isotretinoin taken with oral tetracycline can cause brain swelling. Isotretinoin also has many other side effects like dry skin (perhaps intended), dry or chapped lips, dry hair, nose bleeds, elevated cholesterol, depression, and rarely hepatitis and ulcerative colitis.
Recent research shows a role for prebiotics and probiotics in the control of acne. Probiotics are bacteria that have been shown to improve gut health, for example following a course of oral antibiotics. Probiotics can be found in cultured or fermented dairy products or as a separate supplement. Prebiotics are indigestable (by humans) carbohydrates which feed the bacteria living in the large intestine. Prebiotics are a little bit harder to come by but are found in chicory root, Jerusalem artichokes, raw dandelion greens, raw garlic and raw and cooked onion. Also potato starch and chilled cooked rice are good sources of resistant starch, a type of prebiotic. Therefore, following a diet with a low-glycemic index but high in fiber, along with occasional live fermented foods, may be the treatment of acne in the future. I’ll keep you posted.
Thank you for time and attention,
Robert Zieber, MD
De Luz Medical Aesthetics
Next: Acne types and recommended treatment protocols