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Retinoids are vitamin A derivatives which have proven very effective at unblocking pores of current acne spots and preventing new blockages from developing. They can either be applied on the skin (topically) or taken by mouth (orally) in the form of capsules.

Topical treatments 

Retinoid creams and gels are adapalene (Differin), tretinoin (Retin A, Re Trieve) and tazarotene (Zorac). There is also a 2 in 1 product (Epiduo gel) that combines adapalene and benzoyl peroxide.

Retinoid creams and gels have proven to be very effective at suppressing mild to moderate acne while waiting for the natural 'growing out' of pimples. To obtain faster acne improvement and control, retinoids are often combined with an antibiotic at the beginning of treatment.

This combination reduces levels of acne causing bacteria and directly reduces inflammation. It also helps prevent problems with irritation which can affect 10-20 per cent of people when they begin using topical retinoid treatments.

In females, hormonal treatment in the form of the oral contraceptive pill, cyproterone acetate or spironolactone can be combined with a topical retinoid to help provide better longer term acne control. Your doctor will be able to advise you. As acne may last many years, retinoid creams or gels can be continued for several years as maintenance. 

Oral isotretinoin

Isotretinoin capsules (Roaccutane, Oratane, Accure, Isohexal) are the most effective treatment for severe acne as they address all the known causes of severe cystic acne. They work by unblocking and preventing further blockage of pores, reducing sebum or oil production and soothing the redness and inflammation of acne. This treatment makes the oil gland less friendly to the bacteria that contributes to acne.

Isotretinoin capsules produce a long-term remission in up to 85 per cent of people with in severe cystic acne. Long lasting acne clearance may be obtained with just one course of oral isotretinoin treatment (typically five to six months duration). However, a small percentage of people may have a recurrence of their acne which is usually less severe than their original form and may occur after a long break from having pimples. Depending on the severity of the recurrence, a subsequent course of isotretinoin may be beneficial.

Isotretinoin is available on the Pharmaceutical Benefits Scheme (PBS) for the treatment of severe cystic acne that has not adequately responded to other treatments. It is available is a variety of doses from 5-40 mg. The newer, low dose isotretinoin provides a useful starting point for patients who are particularly concerned about the risk of  side effects.

Generally, oral isotretinoin can only be prescribed by skin specialists so a referral to a dermatologist for careful assessment and monitoring is needed.


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