Exciting brand-new treatments for really severe acne?

May 8, 2006 3:04 AM

Tell me about brand-new, even experimental, promising treatments for severe acne.

My dermatologist is a really nice, very trustworthy older gentleman. He says there's nothing more that can be done for my acne, but I don't want to accept "Here, have this therapist's phone number and learn to live with it."

I have severe acne on my face, jawline, neck (front, back, and sides), shoulders, back (down to waist), chest, breasts, and in my groin. I've been this way for about 10 years and it keeps spreading and getting worse (and the scars are another thread entirely). Obviously, it impacts my life a ton. Living with it is not something I really want to do.

Although the dermatologist is very nice and I like him a lot, I'm afraid that he has been more concerned with keeping up with research in other areas (e.g. skin cancer) and may not know about new acne treatments. It makes sense, as acne isn't lifethreatening, but I really don't want to give up now.

For my next appointment, I'd love to go in with a list of some treatments I've checked out and would like to discuss with him.

Things I have tried, just so nobody tries to recommend them:
Retin-A; no effect
all max strength strains of oral antibiotics approved for acne; only side effects
prescription-level strengths of benzoyl peroxide (topical); some improvement/lightening, this is all I'm on now
all lines of OTC treatment available in the US; no effect
Proactiv; no effect
tea tree oil; no effect
acne.org regimen; basically what I'm on now
other bizarre regimens, memorably one involving ice cubes; no effect

Things I can't try, no really, even if it worked for you:
Accutane
Birth control

What I'm doing now:
Non-soap cleanser (Purpose) morning and night
Benzaclin (1% clindamycin + 5% benzoyl peroxide) night
Zoderm (8.5% benzoyl peroxide + urea) night
Retin-A (0.1% retinoic acid) 3x a week
Cetaphil (moisturizer) as needed -- in practice, hardly ever

Other conditions:
Everything I use is nonacnegenic/noncomedogenic
My acne is genetic, not affected by my diet
Change pillowcases/sheets/washcloths/towels daily
Nothing (e.g. phones, hands, etc.) touches my face

My skin doesn't even notice most treatments. I've given them all a fair try, 6 months minimum, so I could see any effects -- but my skin doesn't budge. It never even dries out (and I'm not overwashing). The benzoyl peroxide I'm using now has a slight lightening/bleaching effect, which is why I'm still on it (that and I don't want to feel like I'm doing nothing).

Partly I'm looking for info on stuff like maybe light therapy or laser therapy. But I'm really not sure about any other options. I would even be willing to participate in clinical trials for new meds. I'll do anything as long as the results seem promising. (And if you cite PubMed, please summarize...I don't have access.)

This question is anonymous because I really don't want to have you look at my username and think "zits on her tits" from now on. Thank you!

posted by anonymous to health (28 comments total)

Offhand, if you can't use birth control, perhaps you could take an anti-androgen (like spironolactone) instead, which may help. (Androgens contribute to acne.) Obviously that's something to discuss with your GP or GYN or whatnot, since there are risks.

The only other thing I know of that you haven't mentioned is a series of (professional-strength) facial peels.
posted by needs more cowbell at 4:49 AM on May 8, 2006

My thoughts:

1. I understand how scary the side effects of accutane are. It seems worth mentioning again that if you can possibly ever deal with the reasons you don't want to be on accutane, you should try it, because it is far more likely to be effective than anything else you can do.

2. This has been discussed in other AskMe threads, but: Just because acne is not caused by diet does not mean it is not affected by diet. To varying degrees in different people, the inflammatory component of acne can be greatly affected by the insulin response and its effects on downstream mediators of inflammation.

2a. Try a ketogenic (low-carb) diet. Try it for 30 days and see if that helps. Results should be visible fairly quickly. Cut out all foods high in arachidonic acid, a precursor of inflammatory mediators. This means absolutely no peanuts or organ meats. Eat a minimal amount of eggs and animal skin.

2b. Try dietary supplements that interrupt the insulin->inflammation response. These 2, taken individually or together, have shown tremendous results for me: Pantethine (aka pantetheine, coenzyme A disulfide) 300 mg, 2-3 times daily; and Sesamin (lignin from sesame oil), 500 mg, 2-3 times daily.

3. Zinc gluconate, 15 mg daily, has shown some good results, but I wouldn't recommend it due to side effects (headache and nausea mainly).

4. 8.5% benzoyl peroxide + urea is probably doing more damage to your skin by increasing inflammation. I would stop using that product.

5. If you're already using Benzaclin, I'd highly recommend switching to Duac, which is the same active ingredients, but the formulation includes an emmolient and a humectant (i.e. it doesn't make your face get irritated and peel; in fact, it is quite moisturizing). This higher tolerability vs. Benzaclin has been demonstrated in a peer-reviewed study.

I can go into greater depth about this stuff, just let me know
posted by rxrfrx at 4:57 AM on May 8, 2006 [3 favorites]

I would even be willing to participate in clinical trials for new meds.

That's risky, as a recent news story emphasizes. Better "zits on her tits" than the elephant woman. The dead elephant woman. Be careful.

On the other hand, I would not spend much time or money on natural/wholistic/alternative/whatever remedies that have not been studied properly. Most such remedies are as harmless as tea, of course, and may even be tea, or they wouldn't be able to sell them over the counter, but no matter how desperate you may be, don't throw your money away.

If I were looking for a new treatment, I might try something to control the bacteria involved. This, for example:

A British scientists [sic] believes he can develop a new gel which will eradicate acne and leave no undesirable side effects. He said the bacteria which commonly causes acne can be destroyed by a virus found on the skin.

The scientist is Keith Holland at the University of Leeds.
posted by pracowity at 5:22 AM on May 8, 2006

Wow, I feel your pain. As a man who was there, whose teenage mugshot is in some medical journal, I can tell you how it is no picnic.

Alas, Accutane was a truly, utterly life-changing wonder drug for me, well worth any side effects, but you say that that isn't for you *
I can tell you a few other things that seemed to have helped me.

If you're so mentally miserable that you are on meds, I can tell you that according to my dermatologist, many meds can make acne worse in susceptible people. This is mostly with lithium and the older anti-depressants, but it may be something to rule out as a cause.

Stay away from Iodine (obviously not to the point where you get goiter!). Your can still eat fish but all your salt should be non-iodized, you'll get enough from food and the iodized salt they put in breads et al.
Fish oils.

Proactiv actually made my acne worse!

Glad you don't overwash your skin, you should wash it no more than 2x daily.

If you wear a backpack, stop immediately, your back acne will get noticeably better.

As you like know acne is an abnormal response of your skin to normal levels of Di-hydro testosterone, the same male hormone that causes male pattern baldness. This not only increases sebum production, but narrows the pore and increases skin shedding so your pores are more likely to clog. The flavor of DHT that is excreted from your adrenals seems to be the culprit, hence why some women have acne tied to their menstrual cycles.

Generally a diet acne connection is a load of crap, BUT, a French dermatologist, intrigued by why there is no acne in traditional cultures hypothesizes that refined carbs sets up a spike in insulin, no radical stuff there, but he hypothesizes that in sensitive people (like us) the DHT reaction from the adrenal glands that causes acne is enhanced by insulin spikes. Intriguing enough that I tried getting rid of refined carbs, and I can attest, especially since I thought it would be a load of crap, a mild difference.

Sun is good for acne, but heat is bad, ergo, if you live in a hot humid climate, staying in the sun will actually exacerbate your acne. I've noticed that people who live in cold humid climates seem to be bothered by acne the least, so you could always move to Seattle, or Ireland ;-)

The Wikipedia article on acne has a section on a new kind of phototherapy.Might still be experimental but I've heard good results.

The same kind of baby aspirin that they give to oldsters for their heart also seems to have a good effect on acne to get rid of inflammation, of course if you can't take aspirin don't, but if you can, get the baby aspirin.

* I understand that you don't want to hear about Acutane, and I assume you have good reasons, and I respect that, but if, only if, you are wary because of the bad press, I invite you to e-mail me at the address in my profile for another perspective. Actually if you want to e-mail me about acne in general, and what works, what doesn't and how to cope, feel free to e-mail me.
posted by xetere at 5:29 AM on May 8, 2006

Unfortunately everyone's acne treatments differ. What works for you, may not work for me, and vice versa.

There are two things I would like to suggest:
1) The natural approach. This employs a combination of tea-tree oil and moisturiser, which can cancel each other out if misused. The tea-tree oil is available readily in Australian supermarkets, so I am unsure of American markets, try a health food store or pharmacy.
Tea-tree oil is incredibly powerful, so it is best to dab a cotton bud with water first, before adding a drop straight to the bud, or dipping it in a small puddle of drops. You will notice the drying effect within hours.
This is a treatment best for MANAGING acne when it has formed properly, including those large annoying under-the-skin heads.
The moisturiser is used to settle the surface layer of skin because you will flake or scale a bit.

This has worked wonder for me

2) Chemically My family and friends have seen reasonable results off "Pregnycolone" or something similar, "the pill" or a birth control pill in other words. Of course creams and such only work for certain people, and certain levels of acne.



Personally, I use facial washes, creams, tea-tree oil. The whole lot. I am a squeezer, I maintain a mo-hawk with hard gel. It's entirely my own fault, I admit that, but when I stop these treatments it is noticeable.

I also like to change and alter treatments, my skin tends to improve greatly when I do. It's not psychological, I have compared levels, but it might just be timing and breakout waves.

Ha ha, good luck "zits on her tits" :P
posted by taita_cakes at 5:36 AM on May 8, 2006

If you're on the acne.org regimen, maybe you've read about the neosporin treatment. It involves a lot of neosporin in cream form. Haven't tried it myself.

My acne calmed down significantly when I just left it alone. I've used a lot of the products you listed and some others you didn't, but when I pared the regimen down to a gentle wash and the occasional spot treatment, my skin became much less angry with me. It still really sucks, but it's not quite so violent.

Unfortunately, I can completely empathize with the scar situation. If you'd like more graphic details, drop me a line.
posted by defreckled at 6:51 AM on May 8, 2006

You listed that you weren't interested in birth control, but, as someone else noted, some other hormone-based therapy might work for you. My wife had adult acne problems for a long time and tried everything you listed. This included Jessica Simpson's ProActive, which, according to the ingredients, looked to essentially be Clearasil repackaged and sold for $50.

Of course, none of these regimens, the results of multiple trips to various dermatologists, ever worked. This was very hard for her psychologically.

Her GP finally suggested she go on birth control. The acne - all of it - was gone in about four days and has never returned. This will be a problem if we ever decide to have kids...

Anyhoo - while I understand why somone might not want to mess with their hormones, and I really don't have the scientific understanding that some other posters have, I'd posit that you might be ruling out the one treatment that actually works.
posted by M.C. Lo-Carb! at 7:41 AM on May 8, 2006

Have you tried homeopathy? If its a placebo (which I don't rule out as a possibility) I am still very happy to have found it. You can email me if you want some guidance on finding a decent one as they are incredibly expensive in the US (assuming that's where you are). My problem wasn't acne but I know people who have had good to perfect results. Similarly I know people who have had some but not total luck with herbalists (and with herbalists there are similarly complicated issues in finding a good one).
posted by anglophiliated at 7:43 AM on May 8, 2006

I started using a bar of sulfur soap, which is basically what my derm recommended for me - except the stuff he prescribed me was about $60, and this bar of soap was $3.50 with shipping. The other key thing I learned was to moisturize, otherwise the soap is too drying.

If you haven't tried any sulfur preparations, AND you're not allergic to sulfa/sulphides/sulfur drugs, you could always give that a shot. For what it costs, it's cheaper than everything but the ice cubes.
posted by cobaltnine at 7:45 AM on May 8, 2006

Homeopathy is a scam. It is sugar pills, or plain water. You might as well pray to your favorite deity and save the 10 bucks.
posted by rxrfrx at 7:49 AM on May 8, 2006

People ought not to recommend Accutane and birth control to someone who specifically, emphatically says that she's not interested in hearing about them, perhaps (oh, just a wild guess) because she wants to have a baby and because Accutane causes birth defects.

As for rubbing tea and other stuff on your skin, a study called "Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials" states:

Perhaps the most striking result of this review is the extreme paucity of controlled clinical trials testing herbal antibiotics. In light of the long history and present popularity of their use, it is surprising that so few trials have tested the efficacy of herbal antibiotics. One obvious reason is the lack of patent rights on herbal medicines. Another reason could be that traditionally, herbal medicine has been hesitant to embrace modern methods for efficacy testing.

I'd guess the problem is caused by both suggested reasons: there's no patent money in researching commonly used stuff, but also the dealers in natural remedies can only lose money by subjecting their products to close scrutiny.

Regardless of the cause, the research in this area is weak. Be careful not to throw your money away on something that is great according to hearsay but not so much in controlled experiments. See a real doctor. Demand real evidence.
posted by pracowity at 8:06 AM on May 8, 2006

People ought not to recommend Accutane and birth control to someone who specifically, emphatically says that she's not interested in hearing about them, perhaps (oh, just a wild guess) because she wants to have a baby and because Accutane causes birth defects.

Well, yeah. That's a good reason not to recommend them to her, but I don't think that means we can't talk about our own experiences. (Or maybe it does, I don't know.)

Being married/pregnant/nursing kept me from using Accutane for years... but then my baby grew up, my circumstances changed, and I have since used Accutane and have loved the results.

So even if it's not an option right now, I think it's worth mentioning based on the possibility of use in the future.

Other than that, I had acne for 10 years that didn't respond well to anything. The only thing that seemed to help even a little bit before I did the Accutane was a topical clindamycin solution. (Not Benzaclin, that didn't work and the benzoyl peroxide dried my skin out and made it irritated).

So, if you can't try Accutane or birth control right now, don't give up hope for the future. In the meantime, you've probably already tried the clear liquid clindamycin, but if you haven't, it's worth a thought.
posted by eleyna at 8:44 AM on May 8, 2006

As to the Accutane issue, while it is linked to birth defects it is only for woman who take it while pregnant. There is no long-term risk to taking it. In fact during the regimen one is now required to be on a birth-control pill. That could be the poster's actual concern with Accutane in the first place. There are some odd side effects though, like hair loss.
posted by Helix80 at 8:49 AM on May 8, 2006

If she won't take birth control or Accutane, she could have a history of blood clots that would rule out taking BC (and Accutane also, since doctors insist on prescribing them together). Stop recommending things to her that she said not to for christ's sake.

Anyway, I really wish I had a solution for you, but the one tip I can offer is for the chest/back acne. Stridex pads (or clearasil or any other brand) actually really work for this purpose. They did fucking NOTHING for my face, but for some reason they do a shockingly good job of getting rid of body zits. I do it twice a day and within a week it's cleared up.

Also, for the groin, make sure that you wear 100% cotton panties so that you can breathe down there. Anything else will trap moisture and make things worse.
posted by gatorae at 9:43 AM on May 8, 2006

I would recommend you find a new dermatologist. Your current doctor does not sound like a good match given your condition. I would do some research and find a dermatologist specializing in acne and/or related research. He/she will probably be more aggressive in his/her treatment.Also, if I were in your position, I would also not limit myself geographically. I don't know where you live, but I would definitely look into doctors in the nearest major city. Good luck!
posted by anonymous78 at 10:14 AM on May 8, 2006

There are new treatments involving lasers and/or blue wavelengths of intense pulsed light. My doctor was recently telling me about this, and apparently he performs this procedure quite a bit (not on me, however).

The intense pulsed light may sound a bit hokey at first, but is actually very effective for sun damage/rosacea/hair removal/etc. so I imagine it would be similarly effective for acne treatment. Wish I knew more about it, but there's plenty of info on the Interwebs.

Look for a cosmetic/aesthetic physician, someone who does Botox, laser resurfacing and the like. S/he needn't be a cosmetic surgeon. And good luck.
posted by CMichaelCook at 10:33 AM on May 8, 2006

There is a growing body of literature supporting phototherapy for acne. It can be expensive and time-consuming but it may well work. The blue light kills the bacteria and the red light reduces inflammation.
posted by rxrfrx at 10:48 AM on May 8, 2006

Be skeptical of laser treatment, too. Ask to see evidence that the particular variety offered has been shown in clinical trials to be effective enough to be worth the cost, and don't believe anecdotal evidence, even if it's a doctor's anecdotes. Doctors invest a lot in training and equipment for new treatments, they work hard to build up a steady clientele for such treatments, and they come to depend on the income from such treatments, so they hate to give it all up just because new research shows that their stuff isn't quite up to snuff.

Laser therapy is an appealing treatment for acne: no messy creams, no drugs and minimal risk of side effects.

Unfortunately, there also appears to be no benefit, at least with one type of laser treatment called pulsed dye laser therapy, according to new research from the University of Michigan Health System. The study, which appears in the June 16 issue of the Journal of the American Medical Association, found pulsed dye laser therapy was not effective in treating acne. [...]

"In our study, we saw some patients' skin getting better, and we saw other patients' skin worsening. However, the changes were the same for both the treated and untreated sides of the face. It is easy to see how, without the split-face design, some changes could be interpreted as a treatment-related improvement," says Orringer, director of the Cosmetic Dermatology and Laser Center at UMHS. [...]

("Pulsed dye laser therapy does not improve acne")

That's from almost two years ago. Someone with better access to research reports could tell you the latest on that and other forms of laser treatment.
posted by pracowity at 1:42 PM on May 8, 2006

Keep in mind that laser treatment and red/blue phototherapy (using plain ol' LEDs) are two different things.
posted by rxrfrx at 4:14 PM on May 8, 2006

It's hard to tell from your list if you've tried a strong salicylic acid (beta hydroxy). I don't use it on my face, but Paula's Choice 2% BHA body treatment has been really great for my body acne issues.
posted by ch1x0r at 4:36 PM on May 8, 2006

This sounds utterly kooky but I know several people who swear by it, including one friend who used it to clear up his long standing adult acne: wash your face and other affected areas once a day with Head and Shoulders brand shampoo. It has to be the name brand.
posted by fshgrl at 6:01 PM on May 8, 2006

Topical erythromycin basically solved my acne problems. Mine were not as severe as yours, but nonetheless erythromycin has given me a new lease on life.
posted by anjamu at 6:40 PM on May 8, 2006

Whenever my acne used to flare up, I would go get myself a good sunburn, and my skin would be clear after that for months.

I will probably get skin cancer because of this, so it's not exactly something I can recommend. It worked for me.

The other thing that helped me was discontinuing all the drying agents, astringents, antibiotics, and so on, and changing over to using neutrogena fragrance free original formula soap twice a day. I also started washing my face towels in unscented laundry soap.

I'm nothing like an expert on this, though; the above is an anecdotal case report.
posted by ikkyu2 at 8:45 PM on May 8, 2006

Two things:
1) I will forever seethe at just reading the word "accutane". AFAIK, there are still many long-term side effects to it that are unknown. In my case it caused very mild but permanent depression (though there have been a few reports of serious bipolar depression brought on, evidently, by the drug) and an additional skin disorder - one that has prompted many a dermatologist to look stuff up in large leather-bound books, and then take a biopsy in the hopes of winning Dermatologist of the Year. This is, of course, in addition to the rather embarassing other side effects that most people think of when they think of Accutane, such as chapped lips and hair loss (both of which I also experienced but consider less worrisome than the depression.) I guess what I'm trying to say is not for the OP, but for the recommenders: Any embarassment caused by the acne, for me at least, is dwarfed by the embarassment caused by the Accutane.
2) I second the erythromyacin. I had mine perscribed orally, at $60 or so, but with no refills. It had noticable effect in the time I had it. Should have gone back to the Doctor, come to think of it.

It's been 15 years now, and I guess I'm just getting used to it; I don't get angry when I see people with nice skin any more, and I'm starting to consider my scars just part of my face. The answer here isn't an answer per se, just a note to let you know that there are more people than you think in that boat with you.
posted by hoborg at 9:27 PM on May 8, 2006

I swear by Queen Helene Mint Julep cream for calming it down from the outside. It's the only topical that has ever seemed to have an effect on my cystic acne.

I have been able to single out foods which break me out -- not the usual culprits like chocolate and pizza, but apples and olives, of all things.

Like you I am unwilling to take birth control or Accutane. I do take a daily antibiotic along with vitamin E, pro-biotics, and fish oil. I exclude caffeine and refined sugar from my diet. I eat two eggs every morning for breakfast and a salad for lunch.

Of course I still break out but things are better than they were. I also swear by Laura Mercier's concealer cream. It's the best on the market.

Best wishes and don't give up hope.
posted by macinchik at 11:20 PM on May 8, 2006

You say "Everything I use is nonacnegenic/noncomedogenic." It's important to know that these terms don't really mean anything--they can be applied by any manufacturer to any product. Also, individual ingredients' effects can vary from person to person--just because something doesn't cause pimples or clog pores in 10 people doesn't mean it won't cause problems for you.

I'm basing this on stuff by the Cosmetics Cop lady, Paula Begoun, and also my own experiences. She also mentions something called Photodynamic Therapy (link to AAD's page on that; also some info here.).
posted by needs more cowbell at 5:44 AM on May 9, 2006

Way late here, but I must second the recommendation of spironolactone or a similar anti-androgen. I also am unable to take Accutane, and I find topical treatments to be totally worthless, but spironolactone worked miracles for me.

It reportedly can disrupt the menstrual cycle, and is a class C pregnancy drug, if those are issues for you, but I cannot recommend it highly enough.

Oh, and this may be specific to my case, but I also find that all the fancy-pants facial cleansers I've ever tried do more harm than good. The only thing that's allowed to touch my face now is plain antibacterial white Dial bar soap. Harsh, I know, but if I use anything else, even for a day or two, I can feel my face clogging up. Yuck.
posted by miagaille at 7:53 AM on May 9, 2006

I will bet anyone here $500,000 that homeopathy doresn't work beyond the placebo effect. Don't waste your money.
posted by Optimus Chyme at 6:44 AM on May 11, 2006