cystic acne treatment

"How to treat cystic acne"

Cystic acne is one of the most difficult types of acne to treat. Though it is most likely caused by the same bacteria (p. acnes) as regular acne, cystic acne lesions are far more painful and have more risk of scarring compared to mild or moderate acne.
 
acne-vulgaris
cystic acne

So suffering from cystic acne is not something that can be taken lightly. It’s a severe, debilitating condition that makes it painful to look in the mirror and sometimes impossible to enjoy life.

Recommended Best Acne Treatment

 Recommended Best Acne Treatment

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 Check Reviews for  Best Acne Treatment for 2015

Makeup and Skin Care for Acne

We put a lot of time, effort, and money into looking beautiful (or handsome, depending on your gender). Americans fork over nearly $9 billion annually for creams, scrubs, concealers, and a drawer-full of other cosmetics that claim to keep our skin looking clean, clear, and more youthful.
Ironically, the very same products you rely on to keep your skin looking its best could be doing your pores a big disservice. Using the wrong makeup or cream could actually accentuate the pimples you're trying so hard to hide.
Caring for "acne-prone skin" requires some careful cosmetic sleuthing -- reading labels to find products that won't clog your pores and lead to more breakouts
 

When to See Your Doctor About Acne

Many of us turn to drugstore products to combat breakouts, which is a great first line of defense. However, no two pimples are alike, and a dermatologist is able to provide customized advice and treatment options for acne sufferers. Not sure if your bump in the skin care road warrants a doctor’s appointment? Answering yes to any of these three questions may be the best indicator that it’s time to see a dermatologist.
 

Have over-the-counter creams, gels, and cleansers stopped working ?

Mild to moderate acne will often go away in four to six weeks with the use of drugstore creams, gels, and cleansers that contain benzoyl peroxide and/or salicylic acid, says Paradi Mirmirani, MD, a dermatologist in Vallejo, Calif. But stubborn, more severe cases of acne may require the expertise of a dermatologist.

Acne Treatment for Adult Men

Why Adult Men Get Acne

Adult men can take solace in knowing that they are not alone in their quest to find the best acne treatment products. Adult women often deal with the same acne treatment issues as they do. However, men may be disappointed to hear that they are more likely to have severe, long-lasting acne.
The same things that cause acne in teenagers may cause clogged pores and pimples in adults. Whiteheads, blackheads, and other forms of acne often develop as a result of excess oil that's released into the hair follicles and mixed with skin cells, subsequently clogging the skin pores and trapping bacteria. When the immune system tries to treat acne causing bacteria, it can also cause redness and inflammation near the affected area.

How to cure acne vulgaris

Akne-jugend
Acne vulgaris
Acne vulgaris (cystic acne or simply acne) is a common human skin disease, characterized by areas of skin with seborrhea (scaly red skin), comedones (blackheads and whiteheads), papules (pinheads), pustules (pimples), nodules (large papules) and possibly scarring. Acne affects mostly skin with the densest population of sebaceous follicles; these areas include the face, the upper part of the chest, and the back. Severe acne is inflammatory, but acne can also manifest in noninflammatory forms.The lesions are caused by changes in pilosebaceous units, skin structures consisting of a hair follicle and its associated sebaceous gland, changes that require androgen stimulation.

best skin care products-Diet and Acne

Does What You Eat Affect How You Look?

One of the biggest skin care myths is that fried foods and chocolate cause acne. You’ve heard it before and maybe you believe it because when you eat a lot of junk foods, you may see the results show up on your skin in the form of pimples. While it is still a myth and there is no research that shows these foods directly cause acne, it is factual that eating nutritiously has a positive effect on the skin. Here we will discuss how a healthy diet including some very important nutrients, will keep your skin healthy, prevent breakouts and speed the healing process of existing pimples.

5 Minutes to Beautiful Skin by Morning

Don't have the time to have a time-consuming skin care routine in the morning? Take some time before you go to bed. All you need is 5 minutes! There are things you can do before you go to sleep that will make big improvements in your skin, no matter if you want to work on acne, fine lines, dull or dry skin.
Many people just grab a facial cleansing cloth before bed (me!) but by taking a little time to invest in your skin instead of just wiping away the makeup, benefits will build over time and you'll see what little it takes to see big changes.

Clean Face Tips : How to Clean Your Face Properly

Clean Face Tips : How to Clean Your Face Properly

There's nothing worse than getting out of the shower and feeling like you're face never was fully cleaned despite using your face wash. Or getting ready to put on your foundation and noticing that your pores looked clogged and dirty.
We wish it was as simple as grabbing the face cleanser and taking 30 seconds to slosh it around your face, but it's not always that simple. Here are some clean face tips to make sure you're getting the most out of your facial cleanser and some extra steps you might want to consider doing for the best outcome

Trisan Antibacterial Cleanser



0.25% Triclosan
Trisan Antibacterial Cleanser

Trisan contains the antibacterial Triclosan, an effective agent against a wide range of
Gram-positive and Gram-negative bacteria, yeasts and molds. Its mild foaming action removes oil, dirt and make-up without drying skin. Moisturizes and leaves skin feeling soft, supple and clean. Oil-free, soap-free, perfume-free and alcohol-free.

Top 3 Acne Treatment Kits In 2013

 I’ll admit it: there was a time during my teens where my acne held me back from being truly happy. When I younger I didn’t have the options that teenagers have available to them today. In fact, I kind of hate you guys for having so many ways of treating your acne.
Okay I don’t hate you but I am a little jealous!
Here’s what you should be looking for in an acne treatment:

Top 8 Acne Treatment Mistakes

Common ways people go wrong in treating their acne
It's easy to make mistakes treating acne or even make it worse, despite the best intentions.
Here, experts list the most common mistakes people make while treating acne. In most cases, a dermatologist can help undo the damage.

Mistake No. 1: Not trying an acne treatment long enough
Skin reacts slowly to treatment. Even if the acne came on fast, it still requires time to heal. That usually takes between two to six weeks, says Barbara R. Reed, MD, a dermatology professor at the University of Colorado Hospital in Denver.
“It's not an infection, it's an inflammation. It can even get worse before it gets better

5 Tips for Reducing Acne Scars

1: Professional Help
You may resort to professional help to reduce severe acne scars or if you've tried less aggressive methods without success. Certain treatments require a licensed health professional like a dermatologist or plastic surgeon, and others may be performed by a trained professional like an aesthetician.
Collagen or fatty tissue injections make acne scars less visible. This procedure is a temporary fix, so you'll have to get it redone every so often. Certain types of acne scars respond well to massage
Dermabrasion is usually reserved for more severe acne scars [source: Mayo]. It involves using a special brush to polish the affected areas. Dermabrasion removes most surface scars, and reduces scars below. A newer and less intense version of skin resurfacing, microdermabrasion involves a small device that blows crystals onto the skin, dusting off cells on the top layer of the skin, then using suction to vacuum up the sanded off particles.
Laser and light-based therapies zap certain areas and layers of skin tissue. When these wounds heal, the new skin appears minus the acne scars [source: Mayo]. Laser treatments require the patient to the office for repeated treatments.

The Use of Spironolactone To Treat Acne

Spironolactone: (Aldactone 50-200mg)
This drug is used as a diuretic and has weak anti-androgen effects, it may be of value if your patient combines it with a birth control pill and uses it for one week before their period to minimize a premenstrual flare of acne.

Uses for which this drug have been found to be effective, but which have not been recognized by government regulatory agencies:
  • Acne
  • Androgenetic alopecia
  • Hirsutism
  • Hidradenitis
  • Suppurativa
Side Effects:
  • Menstrual irregularity
Patients Should Not Use This Drug If They:
  • Are pregnant
  • Have renal insufficiency
  • Have abnormal menstrual bleeding
Your patient should avoid ACE inhibitors – because this increases the risk of hyperkalemia (high potassium). Or if they have a personal or family history of the following:
  • Ovarian cancer
  • Breast cancer
  • Uterine cancer

Acne Treatment: Birth Control Pills And Other Hormone Therapy

Oral contraceptives (OCs) have been available since 1960, and have been modified since then to reduce their risk of side effects. They are the favoured method of contraception by most young couples. Oral contraceptives prevent ovulation and make conditions difficult for a fertilized egg to implant on the uterus wall.
Oral contraceptives can either be made up of progestin alone (called the minipill), or of a combination of synthetic estrogen and progestin. The combination pill has estrogen, which is usually in the form of ethinyl estradiol, or mestranol (only occasionally).
The vast majority of contraceptive pills use ethinyl etradiol as the estrogen, which acts to lower levels of luteinizing hormone (LH) and increase the sex hormone binding globulin (SHBG). This in turn lowers testosterone, thus reducing the drive of the oil glands that are responsible for acne to produce excess oil.
The level of testosterone in women with acne is within the normal range, but the level is lowered in those on OC’s. Some experts believe that the normal range of testosterone for women that is set by laboratories is higher than it should be. If this is true, it could mask the results for some people whose level, although considered to be within the normal range, is actually high for them individually. In such women, their acne improves when their testosterone is lowered by taking the OC pill.
A number of different forms of progestins are used depending on the brand. The progestins can be used at a constant dose throughout the cycle (monophasic), or the daily dose can vary (biphasic or triphasic). Progestins are hormones that have a differing influence on your body, depending on their molecular structure.
Some progestins have effects that can be androgenic (acting like male hormones), while others are anti-androgenic (blocking the production of androgens or blocking androgen receptors, which allow your body to absorb and use the androgen), and some are even estrogenic (estrogen-like). These different actions certainly can influence the side effects as well as the effect on your patient's skin and acne. For treating acne, those pills that produce little or no androgens, or even those that block androgen production (anti-androgens) are best.

By reducing the effect of the androgen hormones on the sebaceous glands, OC's can reduce the amount of oil glands produce, which means that pores are less likely to get blocked. Recent studies have shown that some contraceptives are also effective for treating acne.
Many women who have minimal to mild acne and who are also looking to use some form of contraception would find this very useful. As well, women who have moderate to severe acne can consider this as the primary treatment along with topical therapy. It is also considered to be one of two preferred methods of contraception for women, using oral isotretinoin (Accutane®) for treating severe acne. Mini pills may not offer adequate protection for this purpose.
Acne Approved Hormone Therapy:
Alesse® - 0.020mg EE + 0.10mg levonorgestrel
This has been shown to have a superior anti-acne effect when compared to placebo. It has a lower estrogen dose (0.020mg) than most other oral contraceptives, which may reduce the potential cardiovascular side effects of estrogen. Furthermore, trials show that weight gain does not appear to be a side effect with this pill.
Two placebo controlled parallel double blind randomized trials involving 700 women in the reproductive age group treated for 6 months, showed a 46% reduction of inflammatory lesions when compared to 29.3% for the placebo group.
In: Gynecological Endocrinology 24:RT61 (2000).
Ortho-Tricyclen® - 0.035mg EE + norgestimate
This is a combination of ethinyl estradiol (0.035mg) and norgestimate in increasing doses of 0.180mg, 0.215mg, and 0.250mg. Two clinical studies, involving 507 women with moderate acne, showed that this medication provided significant improvement of their acne after 6 months of therapy compared to those using a placebo. Orhto-tricyclens are approved in the USA and Canada for acne.
In another study, 256 women with moderate acne were given Ortho-Tricyclen® or placebo for 6 months, among the women taking Ortho-Tricyclen®, 53.1% had their acne completely cleared up compared to 26.8% of those using the placebo.

Diane-35® - 0.035mg ethinyl estradiol (EE) + 2.0mg cyproterone acetate (CPA)
Cyproterone acetate acts as an anti-androgen, multiple clinical studies have shown that this medication is effective for the treatment of acne. Diane-35® is approved in Canada, and has been approved for two decades in Europe (Note: This product is not approved by Health Canada for the indication of oral contraception).
Results have shown, that Diane-35® is as effective as oral tetracycline or minocycline after 6 months of use. The largest study to date (on 1,161 patients) showed that 192 patients had 100% improvement after 18 months.

Skin Cleansers For Different Skin Types

Oily Skin:
The selection of cleansers for oily skin should involve using products that rinse off well, both bar soaps and liquid cleansers have been formulated for this purpose. Many of the soap gels and stronger liquid cleansers are helpful for oily skin. Because the skin on the face, chest and back is oilier than the rest of the body, it may be necessary to use one product on these areas, and a more moisturizing product on the arms, legs, hands and feet. Many of the cleansers which are appropriate for acne-prone skin, would be suitable for oily skin.
Dry Skin:
The use of hard-milled face soaps and gentle synthetic detergents are very appropriate for dry skin. It may be necessary to only use cleansers on the face and body folds, when the ambient humidity is low for example, in the winter or in the south-western United States. There are many liquid cleansers formulated by cosmetic houses as well as products like Cetaphil or Aquanil which are very useful. There are some new products, which incorporate a liquid cleanser in a cleansing sheet, these act to leave on a modicum of petrolatum after the final rinse and have been demonstrated to be effective.
Normal Skin:
Most people can cleanse with bar soap daily. The synthetic detergent soaps react better with hard water. Liquid cleansers and soap gels are popular at this time, the advantages, being cleaner dispensers in the bathroom. The cleansing sheets may be used for normal skin as well, the petrolatum is suspended in the water by crystals that dissolve in the last rinse leaving the skin feeling smooth and moist. People with normal skin may enjoy using a loofah-type sponge to clean themselves, these have been sold with some liquid cleansers.
Sensitive Skin:
People with sensitive skin can react easily to fragrance and preservatives, and should avoid mechanical cleansers such as cleansing grains, brushes and loofahs. Most synthetic detergents have the pH balanced favorably for the skin and are well tolerated by sensitive persons. A few liquid cleansers are not irritating, but many interact with the skin because of their additional surfactants. Two non-irritating cleansers are Cetaphil and Aquanil lotions, many of the hard-milled soaps are well tolerated also.
Antibacterial Cleansers:
These products were introduced in the 1960' s and have been used by many people since. They initially contained photosensitizers, which have since been removed. Triclosan is currently the most common active ingredient. For persons in occupations, which demand extra precautions, these products have been helpful. However, for many dermatologists, these products are very drying to the skin and they often contribute to hand and body eczema. Various antibacterial cleansers are available that are of benefit to acne patients, such as Tersaseptic.

Acne Cleansers

Acne cleansers are generally used to remove accumulated oil, make-up, sweat, and dirt on the surface of your skin. In doing so, these products generally make it easier for topical acne treatments to be absorbed. However, excessive use of acne cleansers can also lead to irritated dry skin. Most acne patients will only need to cleanse with such products once to twice daily.
Examples Of These Cleansers Include:
Salicylic acid cleansers:

These break down keratin in the blackheads, and can be used for mild acne.
  • PANOXYL® CLEAR ACNE CLEANSING GEL (Stiefel)
  • SALAC® (Medicis)
  • CLEARASIL® (Procter & Gamble)
  • FOSTEX® (Bristol-Myers Squibb)
  • NOXZEMA® (Procter & Gamble)
  • AVEENO® BAR (SC Johnson)
Benzoyl peroxide cleansers:
Breaks down keratin in blackheads, and has antibacterial effects.
  • PANOXYL® BAR, PANOXYL® CREAMY WASH, PANOXYL® WASH - (Stiefel)
  • BENZAC-W® wash - (Galderma)
  • CLEARASIL® - (Procter & Gamble)
  • CLEAN & CLEAR® - (Johnson & Johnson)
Antibacterial cleansers:
  • TRISAN© (Dermtek)
  • TERSASEPTIC® (Stiefel)

Topical Combination Products for Acne Treatment

Combination therapy can offer a strategy for preventing resistance to the antibiotic. Its synergistic effect can prevent more resistant bacteria, as well as other susceptible acne causing bacteria, from growing during treatment. Often when a combination topical product is used, less antibiotic is needed to prevent the growth of resistant bacteria compared to the amount needed when the antibiotic is used alone. Combination products are all effective for treating inflammatory acne and include:

Topical Combination Products
Combination therapy can offer a strategy for preventing resistance to the antibiotic. Its synergistic effect can prevent more resistant bacteria, as well as other susceptible acne causing bacteria, from growing during treatment. Often when a combination topical product is used, less antibiotic is needed to prevent the growth of resistant bacteria compared to the amount needed when the antibiotic is used alone. Combination products are all effective for treating inflammatory acne and include:

1) Topical retinoid (tretinoin) plus erythromycin (Stievamycin® by Stiefel)
  • It should be applied to the affected areas once/day before bedtime after the skin has been thoroughly washed, rinsed and patted dry.
2) Topical benzoyl peroxide plus erythromycin (Benzamycin® by Dermik)
  • A thin layer should be applied to the affected areas 1 to 2 times/day after the skin has been thoroughly washed, rinsed and patted dry. This product must be refrigerated and may bleach clothing.
3) Topical benzoyl peroxide plus clindamycin (Benzaclin® by Dermik, Clindoxyl® by Stiefel in Canada)
  • It should be applied to skin that has been washed, rinsed and patted dry. This product does not need to be refrigerated.

Aggravating Factors to Avoid

The points below are well documented factors that cause or aggravate existing acne. While there is great individual variability, these are factors that have been well documented in acne studies. While complete avoidance is not a reasonable possibility all the time, minimizing them can help you reduce the chance of flare-ups.
  • Over-cleansing
  • Greasy cosmetics, especially moisturizers
  • Sweating
  • Drugs such as anabolic steroids that increase
  • Squeezing pimples
Possible factors that may aggravate acne
The points below have been not been established as aggravating factors in controlled medical studies, but there is an abundance of anecdotal evidence that supports possible connections. These may be minor factors. As acne is a complex process with a lot of individual variability, it can be difficult to establish causal relationships in a controlled study, as there are many factors to take into consideration. Small sample size is also a big hurdle for factors that only affect a small percentage of the population. Our suggestion is to not be paranoid, but if you know that these factors do affect you negatively, it would be wise to avoid them as much as possible.
  • Certain types of foods (individual dependent)
  • Chronic stress
  • Certain sunscreens and moisturizers
Myths that have no basis in reality
The points below are myths that have absolutely no basis in reality. Unfortunately, these misconceptions can not only be misleading, but harmful in many ways.
  • Sexual activity
  • Dirty skin/poor hygiene
  • Acne is only a teenage boy's problem
  • Acne is a trivial problem

A Look At Topical Treatment Options For Acne

The most commonly used topical acne treatments include benzoyl peroxide, retinoids, topical acne antibiotics, azelaic acid, and combination topical products.
1) Benzoyl Peroxide:
Benzoyl peroxide can improve acne by killing the acne bacteria and by unblocking oil gland pores. There are many different benzoyl peroxide products available to you. The lower concentrations can be obtained over the counter (OTC), while higher strengths require a prescription.
2) Retinoids:
These products are the most effective type of medications for unblocking the pores of oil glands. They are generally considered to be the first choice of treatment for whiteheads and blackheads (comedones). Although there are a variety of topical retinoids, your physician can choose the one that is best suited to your needs.
  • Tretinoin
  • Adapalene
  • Tazarotene
  • Isotretinoin
3) Topical Acne Antibiotics - Antibacterial/Anti-Inflammatory:
  • Clindamycin
  • Erythromycin
  • Sulfacetamide
4) Azelaic Acid - Antibacterial/Anti-Inflammatory:
5) Combination Topical Products:
  • Topical benzoyl peroxide with clindamycin (BenzaClin® by Dermik)
  • Topical benzoyl peroxide with erythromycin (Benzamycin® by Dermik)
  • Topical retinoid with erythromycin (Stievamycin® by Stiefel) - Available only in Canada
  • Topical benzoyl peroxide with clindamycin (CLINDOXYL® by Stiefel in Canada, Duac® by Stiefel in the USA)

8 Cheap Acne Scar Remedies

If you are like most people, you are trying to figure out ways of spending your money more wisely than ever before. Well, this is not always an option when it comes to skin care treatments, especially when acne or scarring is involved. However, today you are in luck because we have provided a list of eight of the cheapest treatments for acne scars ever found. And best of all, they really work!
1. Lemon Juice Massage   
The juice of a fresh lemon or lime applied on your face where scarring is visible will help cleanse the skin and allow for healing to occur. Plus, it will lighten the appearance of the scars.

 1. Lemon Juice Massage
2. Olive Oil Massage
Pure extra virgin olive oil will help moisturize the skin and it also has anti-inflammatory properties that will help your skin begin to heal on its own as the levels of these properties increase within your skin. Best part, it won’t clog your pores!

 2. Olive Oil Massage


3. Ice Massage  
Applying ice to the scars will lessen the swelling and trigger your body’s responses to that area, often times lessening the appearance of scars on most parts of your body.

Ice Massage



4. Cucumber Facial
A cucumber paste face mask will lessen the appearance of scarring, taking away most of the dark coloring and helping to moisturize the skin around the scar. The plumper the skin around the scar, the less noticeable the scar will be.

Cucumber-Facial



5. Rubbing Tomato On Face
Tomato slices placed all over the face, avoiding the eye area, will help increase the moisture levels in the skin, and will help aid in the healing process of the skin due to the anti-inflammatory properties that tomatoes contain.
Rubbing-Tomato-On-Face

6. Honey Mask 
Applying a honey mask daily will help reduce the appearance of any scarring on your face and will also leave you with a healthy, radiant glow. Honey has many natural anti-inflammatory properties as well as a deep moisturizing ingredient naturally found within it, to leave you with more youthful and healthy skin.
Honey Mask

 7. Lavender Oil
Lavender oil used twice daily as a moisturizer is a great way to reduce noticeable scars on the skin and will leave your skin with a sweet scent. Plus, if you put it on right before bed, you will get the relaxation effects of the lavender to help put you to sleep...

Lavender Oil

  8. Egg White Mask 
Egg whites used as a mask on the face will help reduce the appearance of any scarring, remove blackheads, and allow your skin to become tighter and more firm than it was before.


Egg-White-Mask

Scar Free Life  
If you use these easy and inexpensive methods to reduce the appearance of scars, remember to keep taking care of your skin when you are done with this type of treatment. The last thing you want to do is go through all of this for a clean and healthy complexion only to start getting more acne as soon as it’s over because of forgetting to take care of your precious skin!

 Scar Free Life




Cold Sores: why and when to treat them

There are several reasons to treat cold sores including:
  • to treat the symptoms to reduce the pain and speed healing
  • to prevent transmission to other parts of the body and to others
  • to prevent or treat recurrences
Cold sores can be uncomfortable, unsightly and embarrassing for sufferers and they also carry the risk of spreading the herpes virus to other parts of the body or to other people. The virus can be spread by the fingers or items such as cutlery, glasses/cups, water bottles, towels, lipstick, or razors.

Direct contact with the colds sore can spread the virus to others especially through kissing or sexual contact. Even, cuddling and kissing your own children can spread the virus.

Playing sports is another way to spread the virus onto the cheek, other parts of the body or to other players, especially if equipment or showers are shared and if there are cuts or trauma to the skin. This type of herpes is called herpes galaditorium
Sexual contact can transmit or spread the herpes virus to the lips, eyes or genital skin. People who have eczema need to be extra cautious with cold sores as the herpes virus can infect their damaged eczema skin making their condition worse. This is called eczema herpeticum.
There are a number of things to consider in the treatment of cold sores. The most important thing is to treat the cold sore at the very first sign or symptom (tingle, itching, redness, small blister) of a cold sore.
It is not too late to treat them after the blisters have formed but the treatment may not be as effective. Treatment should include some practical steps as well as medication (either non-prescription or prescription).

How can the cold sore diagnosis be confirmed ?

The diagnosis is usually made by the history from the patient combined with the examination of the skin. At times it is difficult to be certain of the diagnosis.

Lab tests can be used to confirm the diagnosis if necessary.
Viral culture is the classical way of making or confirming the diagnosis but this may take 3-7 days, at which point your outbreak is over. Culturing or growing the virus is not easy and sometimes the tests will be negative even when virus is present. Generally a positive result means you have HSV-1.

Newer tests examine the virus under a microscope and give fast reliable results often within an hour of the sample reaching the lab. Cell scrapings from the blister will provide enough of a sample in which the virus can be detected. This test also is able to distinguish between herpes type 1 and 2

The use of serology which measures the antibodies to the herpes virus present in the blood is a way of knowing if the infection is new or a recurrence of the virus.

Cold sores - What are the risks?

What are the risks to me?
Proper hygiene is important at any time but especially during a cold sore outbreak. It is possible to transfer the virus from the cold sore around the mouth to other areas of the body causing an infection and sore in those places.

The virus may be spread to other locations such as:
  • the eye (herpetic keratitis)
  • skin that has eczema causing widespread involvement of the skin (eczema herpeticum).
Other risks include:
  • the development of rare condition called Erythema multiforme (a short-term inflammatory skin reaction can be minor or severe) that can develop with each outbreak of herpes
  • secondary infections with bacteria such as Staphylococcus aureus.

What are the risks to others?
It is just as easy to transfer the virus from person to person. This is a much greater risk when the cold sore is actively present on the skin but it is also possible to transfer the virus even when the skin looks normal.
How can I reduce the risk of spreading the virus to others?
  1. Avoid kissing or pecking others when the cold sore is present. The lesion is infectious until it becomes completely dry and the crust has fallen off.
  2. Avoid performing oral sex
  3. Discourage children who have a cold sore from sucking their thumb or fingers
  4. Do not share cutlery, cups, glasses, water bottles, towels, razors
  5. Wash your hands with hot soapy water after touching your cold sore

What triggers cold sores?

Most of the time the outbreaks seem to have a life of their own and there is no one factor that appears to have initiated or caused the outbreak. There are a number of factors that are known to cause an outbreak of herpes labialis including:
  1. Emotional and physical stress may alter or lower the immune system allowing the virus to awaken or reactivate.
  2. Colds or other upper respiratory tract infection may also reactivate the virus. These cold sores are often called fever blisters.
  3. Sun (including tanning beds)or wind exposure without protection, especially on the lips, may reduce the immune activity in the skin leading to a recurrence of cold sores.
  4. Hormone changes such as those seen during menstruation
  5. Local trauma or injury to the skin around the lips including dry cracked lips and injury to the skin following cosmetic surgery, chemical peels or laser therapy

How do I know that I have a cold sore?

Location of the herpes outbreak
Cold sores are most frequently located on the lips at the place where the lips meet the skin and the mucosa. This is known as the vermilion border.
These herpes outbreaks can also be found occasionally on the cheek, chin and nose. In individuals who have their immune system suppressed by medications or infections such as HIV/AIDS the herpes outbreaks can also appear in the mouth and can sometimes be seen as chronic superficial ulcers.
Has it occurred in the same place before?
Herpes simplex infection is the most common cause of a rash that recurs in the same place or location on the skin. There is another condition that produces a recurring rash in the same location and this is much less common and is called a Fixed drug eruption. This is an allergic reaction that manifests or shows itself only in a small local outbreak whenever the drug is taken.
There are clues that an outbreak is about to appear.
There are symptoms that some people can recognize that indicates that a cold sore is on its way. These are called prodrome or prodromal symptoms.
Some people will experience a sense of tiredness the day before the recurrence of the cold sore. Others feel a tingling, or numbness, or just a feeling of discomfort at the site of the future outbreak. Some will feel subtle tenderness or a sense of localized fullness or swelling in the skin.
It is important to cold sore sufferers to be aware of these symptoms as they allow early intervention or treatment that could abort or shorten the duration of the outbreak.

There is usually a specific cycle of events in the life cycle of a cold sore. This will usually last for 10-14 days.
  1. Skin appears normal but there may be localized redness and swelling which is seen in response to the virus multiplying in the skin cells, this is called inflammation
  2. Small blisters appear that often seem to join together within a few hours at the site of redness or inflammation. Some of the blisters may look like small red bumps. Usually this area is now very tender.
  3. The blisters break and a moist sore can appear, this is the most painful stage.
  4. A crust or scab forms over the sore. It is important to keep the sore/scab clean because bacterial infections can occur under the scab. The scabs usually become dry and eventually fall off.
  5. The area may stay slightly red for a couple of weeks as the skin finishes healing.

Why do I have cold sores?

Cold sores are caused by a virus. Once you have been exposed to the virus and infected with the herpes virus you are infected for life. Exposure to the HSV-1 virus and infection commonly occurs in childhood.
It is quite common for a child to become infected from a parent or a sibling. In developing countries about 1/3 of children have been infected by the age of 5 years whereas in the developed western world infection is slightly lower at about 20%.
By the age of 14 more than 70% of children are infected with the HSV-1 virus.
Infection usually occurs when the virus enters through small breaks in the skin possibly at the site of injury or trauma or just small cracks in the skin. The virus then travels along the nerves to reside next to the spine in a location called the dorsal root ganglion.
For various reasons the virus which is normally 'contained' in this location starts to multiply and then travels down the sensory nerves to the skin.
Once in the cells of the skin the virus multiplies, damaging the skin cells causing the blisters that we call a cold sore to develop. This virus infection of the cells (whether a cold sore is visible or not) is always looking for new cells to infect, this process is called viral shedding. 
At this time there are large numbers of herpes particles being shed or released and as a result it is easy to expose or even infect others with the virus.
This is the time when hygiene is extremely important.
Are cold sores common?
About 20-40% of the population will experience cold sores.
The frequency of recurrence is very variable ranging from monthly to a few a year to every few years.

The Facts About Cold Sores

 Cold sores, or fever blisters, are common among Canadians.
Read the facts about cold sores and the virus that causes them
Fact: Cold sores are caused by a virus
  • Cold sores are caused by the herpes simplex virus. There are two types of this virus and cold sores are usually caused by type 1 (known as HSV-1). The other type of herpes simplex virus, HSV-2, usually causes genital herpes
  • In general, we are infected with HSV-1 when we are children; in the majority of these initial (“primary”) infections, there are no symptoms
  • Usually, the virus infects our mouths. Some children experience mouth and gum symptoms (“gingivostomatitis”) or a sore throat (“pharyngitis”).
Fact: Cold sores are the result of the virus reactivating in our bodies
  • Once HSV-1 has entered our bodies, it never leaves. The virus moves from the mouth to quietly reside (“remain latent”) in the central nervous system.
    About Cold Sores
  • In approximately one third of people, the virus can “wake up” or reactivate to cause disease
  • When reactivation occurs, the virus travels down the nerves to the skin where it may cause blisters (cold sores) around the lips, in the mouth or, in about 10% of cases, on the nose, chin, or cheeks
  • Many people who suffer from cold sores are aware in advance that a cold sore is about to break out — they have a tingling or burning feeling, redness, itching, or pain (“prodromal symptoms”) around their lips or mouth
  • Cold sore outbreaks may be influenced by stress, menstruation, sunlight, sunburn, fever, or local skin trauma.
Fact: The virus that causes cold sores is infectious
  • 30%-60% of children below 10 years of age are infected with HSV-1. They have acquired the virus from family and friends through sharing utensils or toothbrushes, and from kissing
  • The virus is transmitted from cold sores and also when there are no symptoms, as it can make copies of itself on the skin in the absence of a blister. This phenomenon is called “asymptomatic shedding”
  • By 50 years of age, 80%-90% of us harbour HSV-1 because we have caught it from someone close to us
  • HSV-1 can sometimes be transmitted to newborn babies by family members or hospital staff who have cold sores; this can cause a severe disease called neonatal herpes.
Fact: The virus from cold sores can infect other areas of the body
  • People can transfer the virus from their cold sores to other areas of the body, such as the eye, skin, or fingers; this is called “autoinoculation”
  • Eye infection, in the form of conjunctivitis or keratitis, can happen when you rub the cold sore, then rub your eyes before washing your hands
  • Finger infection (“herpetic whitlow”) can occur when a child with cold sores or primary HSV-1 infection sucks his/her fingers
  • HSV-1 can infect your genital area if you engage in oral sex with a partner with a cold sore
Fact: Early treatment can help eliminate the cold sore
  • Some products can accelerate healing if they are used at the prodromal stage of the cold sore
  • Prescription drugs include acyclovir cream or capsules (Zovirax®) and penciclovir cream (Denavir®); also, Health Canada recently approved a one day course of 2 grams valacyclovir caplets (Valtrex®) for prodromal use
  • Docosanol cream (Abreva®) can be bought without a prescription
  • Frequent hand washing minimizes the risk of transferring the virus to other areas of your body

What are cold sores?

herpes Cold sores appear as a cluster of small blisters usually on the lips or around the mouth, especially the corners, and occasionally inside the nose. Approximately 20-40% of people will suffer a recurrent outbreak.
Cold sores are caused by Herpes simplex virus-1 infection (HSV-1).
There are two types of HSV infections:
  • HSV type 1 is the commonest cause of cold sores.
  • HSV type 2 is more common in the genital area but is also responsible for at least 10% of cold sores in adults
The medical term for cold sores is herpes labialis.

Cold Sores Treatment

Most cold sores will clear up on their own after 7-10 days. Most treatment options are focused on reducing the discomfort and pain associated with cold sores and reducing the length of the outbreak. Some treatment options may even help prevent cold sore blisters from forming.
Non-Prescription Treatments
Topical
  • Skin protectants
  • Analgesics/anaesthetics
  • Abreva (docosanol)
  • Lipactin (zinc, heparin)
Oral
  • Analgesics
This is non-prescription medication available at your local drug store. Abreva has been clinically proven to reduce both the symptoms (including pain and itching) and the length of the cold sore outbreak. Abreva is most effective is used at the first sign or symptom of a cold sore (prodromal stage). Abreva is applied five times a day from the time of the initial symptoms for up to 10 days.
Skin Protectants and Analgesics
  • Skin protectants and lip moisturizers with allantoin, dimethicone, cocoa butter, white petrolatum or glycerin provide moisturization to keep the cold sore moist as well as a mechanical barrier to guard the skin and lips from irritants
  • Topical analgesics/anaesthetics including benzocaine, lidocaine, benzyl alcohol, camphor, menthol and phenol help provide local pain control and may help reduce the itching.
  • Oral analgesics such as ibuprofen and acetominophen also provide temporary relief from the pain
Other Products
Other non-prescription products containing zinc and heparin (Lipactin, topical gel) are also available. This product may help shorten the duration of the cold sore if used early during the outbreak, applied 3-6 times a day for up to 14 days.
Prescription Treatments
Topical
  • Zovirax (acyclovir)
Acyclovir Cream/Ointment (Zovirax)
Zovirax has been shown to help reduce cold sore intensity and symptoms (including pain). Zovirax is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax is applied 4-6 times a day for 10 days
Oral
  • Famvir (famciclovir)
  • Valtrex (valacyclovir)
  • Zovirax (acyclovir)
 These drugs work only on the replicating virus so they are most effective if taken in the first few days of an outbreak. There are no controlled studies of these drugs been taken after the first 12 hours of symptoms.

Acylcovir (Zovirax)
Reduces pain and healing time to scab or crust formation but does not appear to affect or reduce progression, size or healing time of the cold sore. Zovirax oral is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax oral dosing is 200mg five times a day for 5 days.

Famciclovir (Famvir)
Reduces the duration, healing time and pain of a cold sore. Currently this drug is only indicated for treatment of recurrent episodes of HSV infections in HIV-infected patients although new indications for the treatment and prevention of cold sores are being explored. Currently, dosing is 500mg twice daily for 7 days.

Valacyclovir (Valtrex)
Reduces duration, healing time and pain of a cold sore. Valtrex may help prevent cold sore outbreak if taken during prodromal stage. Most effective if used at the first sign or symptom of a cold sore (prodromal stage). Valtrex dosing is 2 grams every 12 hours for two doses.

Medical Options for Treating Cold Sores

Most cold sores will clear up on their own after 7-10 days. Most treatment options are focused on reducing the discomfort and pain associated with cold sores and reducing the length of the outbreak. Some treatment options may even help prevent cold sore blisters from forming.
Non-Prescription Treatments
Topical
  • Skin protectants
  • Analgesics/anaesthetics
  • Abreva (docosanol)
  • Lipactin (zinc, heparin)
Oral
  • Analgesics

This is non-prescription medication available at your local drug store. Abreva has been clinically proven to reduce both the symptoms (including pain and itching) and the length of the cold sore outbreak. Abreva is most effective is used at the first sign or symptom of a cold sore (prodromal stage). Abreva is applied five times a day from the time of the initial symptoms for up to 10 days.
Skin Protectants and Analgesics
  • Skin protectants and lip moisturizers with allantoin, dimethicone, cocoa butter, white petrolatum or glycerin provide moisturization to keep the cold sore moist as well as a mechanical barrier to guard the skin and lips from irritants
  • Topical analgesics/anaesthetics including benzocaine, lidocaine, benzyl alcohol, camphor, menthol and phenol help provide local pain control and may help reduce the itching.
  • Oral analgesics such as ibuprofen and acetominophen also provide temporary relief from the pain
Other Products
Other non-prescription products containing zinc and heparin (Lipactin, topical gel) are also available. This product may help shorten the duration of the cold sore if used early during the outbreak, applied 3-6 times a day for up to 14 days
Prescription Treatments
Topical
  • Denavir® (penciclovir cream)
  • Zovirax (acyclovir)
Penciclovir Cream 1%(Denavir®)
Denavir® is a non-greasy cream that works by penetrating the area to block the virus that causes cold sores. It is first topical anti-viral approved in Canada with the indication for cold sores. Denavir® has been found to be most effective when applied during the early signs of a cold sore although it can also be useful in later stages. It helps cold sores heal on average in four and a half days.
Acyclovir Cream/Ointment (Zovirax)
Zovirax has been shown to help reduce cold sore intensity and symptoms (including pain). Zovirax is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax is applied 4-6 times a day for 10 days
Oral
  • Famvir (famciclovir)
  • Valtrex (valacyclovir)
  • Zovirax (acyclovir)
These drugs work only on the replicating virus so they are most effective if taken in the first few days of an outbreak. There are no controlled studies of these drugs been taken after the first 12 hours of symptoms.

Acylcovir (Zovirax)
Reduces pain and healing time to scab or crust formation but does not appear to affect or reduce progression, size or healing time of the cold sore. Zovirax oral is most effective if used at the first sign or symptom of a cold sore (prodromal stage). Zovirax oral dosing is 200mg five times a day for 5 days.

Famciclovir (Famvir)
Reduces the duration, healing time and pain of a cold sore. Currently this drug is only indicated for treatment of recurrent episodes of HSV infections in HIV-infected patients although new indications for the treatment and prevention of cold sores are being explored. Currently, dosing is 500mg twice daily for 7 days.

Valacyclovir (Valtrex)
Reduces duration, healing time and pain of a cold sore. Valtrex may help prevent cold sore outbreak if taken during prodromal stage. Most effective if used at the first sign or symptom of a cold sore (prodromal stage). Valtrex dosing is 2 grams every 12 hours for two doses.

Types Of Acne Scars

Scars caused by acne are much more common than doctors once believed. Most people will have acne scars that are mild. However, some will have scars that look significant even to others. The best approach is prevention and to treat acne right away as sometimes even mild acne can cause scarring. This can minimize the risk of permanent acne scars.There are a number of different looking scars caused by acne.
They Can Be Classified As Follows:
Ice pick scars - Deep pits, that are the most common and a classic sign of acne scarring.
Boxcar scars - Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
Rolling scars - Scars that give the skin a wave-like appearance.
Hypertrophic scars - Thickened, or keloid scars.
In order to get rid of, or minimize acne scarring, a combination of treatments provides the best results for many people.
The acne scar treatment you and your patient choose should depend on the type of scars he or she has, as well as on the skin type. Most experience has been gained treating facial scars. Generally, scars on the chest and back do not respond as well.

Topical Agents Used in the Management of Hyperpigmentation

Hyperpigmentation is a common and distressing problem caused by various inflammatory skin disorders, such as eczema, allergic contact dermatitis, and irritant contact dermatitis Acne is also a frequent cause. Papulosquamous disorders in general commonly predispose a patient to postinflammatory hyperpigmentation. Melasma is a common form of noninflammatory hyperpigmentation.
Sun exposure often reverses the results of therapy, compromising the lengthy treatment process. Consequently, the first line of therapy for hyperpigmentation is a broad-spectrum sunscreen used in conjunction with a phenolic agent such as a hydroquinone, or with a nonphenolic agent such as tretinoin, azelaic acid, or kojic acid. There are hundreds of sunscreen formulations with different UV absorbing chemicals in various concentrations.1 The UVB and UVA absorbing chemicals used in the formulation of topical sunscreens include paraaminobenzoic acid-related products, salicylates, cinnamates, benzophenones, zinc oxide, and titanium oxide. Almost all sunscreen products contain a mixture of one or more UVB absorbing chemicals.1
Hydroquinone and related compounds reduce the production of melanin by their inhibition of the enzyme tyrosinase. Topical corticosteroids also inhibit tyrosinase activity and affect endoplasmic reticulum secretory function of melanocytes. Agents such as salicylic acid and glycolic acid act to remove melanin in the epidermis by their peeling action. Tretinoin, which has a mild peeling effect, acts in a similar manner. It may also inhibit tyrosinase.
Hydroquinone
Hydroquinone, which is a hydroxyphenolic chemical, has been the gold standard for treatment of hyperpigmentation for over 50 years. It acts by inhibiting the enzyme tyrosinase, thereby reducing the conversion of DOPA to melanin. Some of the other possible mechanisms of action are the destruction of melanocytes,degradation of melanosomes, and the inhibition of the synthesis of DNA and RNA.
Hydroquinone can be compounded into 5%-10% concentrations, but at these strengths, may be irritating and unstable. The 2% concentrations of hydroquinone available over the counter in the US and Canada are not as efficacious as the 3% and 4% prescription formulations, as their onset of action is later than with the higher concentrations. Antioxidants, such as vitamin C and retinoids, as well as alpha-hydroxy acids may be used as additives to increase penetration and enhance efficacy. Exogenous ochronosis with the use of hydroquinone has been reported in dark-skinned patients, in particular South African women who frequently use very high concentrations of hydroquinone over large surface areas.3 Although hydroquinone is used extensively in North America, there have only been about 30 reported cases of exogenous ochronosis from hydroquinone use in North America.
Adverse reactions from hydroquinone use include irritant and allergic contact dermatitis, and nail discoloration. Postinflammatory hyperpigmentation may occur from the contact dermatitis. Hypopigmentation of the normal skin surrounding the treated areas may also occur. These usually resolve with the discontinuation of the hydroquinone treatment.2
Other Phenolic Agents
Monobenzone, the monobenzyl ether of hydroquinone, is a special topical phenolic agent, which is indicated only for the final depigmentation of disfiguring vitiligo. It is applied topically to permanently depigment normal skin surrounding vitiliginous areas in patients with disseminated vitiligo (greater than 50% body surface area). The cream is applied in a thin layer, rubbed into the normally pigmented areas two or three times daily. Depigmentation is usually achieved after 6-12 months with 20% monobenzone treatment. It should then be applied only as often as required to maintain depigmentation. Monobenzone cream can produce satellite depigmentation at sites distant from the site of initial application.
N-acetyl-4-cysteaminylphenol (NCAP) is another phenolic agent that is currently being developed and is not yet available in North America. NCAP acts to decrease intracellular glutathione by stimulating pheomelanin rather than eumelanin.4 It also inhibits tyrosinase activity, has been found to be more stable, and causes less irritation than hydroquinone. In a retrospective study of 12 patients with melasma using 4% NCAP, 66% showed marked improvement, and 8% showed complete loss of melasma lesions. Changes of melanoderma were evident after 2-4 weeks of daily topical application of NCAP.5
Azelaic Acid
Azelaic acid is a naturally occurring non-phenolic, saturated, nine-carbon dicarboxylic acid. Its use originated from the finding that Pityrosporum species can oxidize unsaturated fatty acids to dicarboxylic acids, which competitively inhibit tyrosinase. Azelaic acid was initially developed as a topical drug with therapeutic effects for the treatment of acne. However, because of its effect on tyrosinase, it has also been used to treat melasma, lentigo maligna and other disorders of hyperpigmention.2,6 Azelaic acid has been reported to be effective for hypermelanosis caused by physical or photochemical agents, and lentigo maligna melanoma as well as other disorders characterized by abnormal proliferation of melanocytes. Its mechanism of action is to inhibit DNA synthesis and mitochondrial enzymes, thereby inducing direct cytotoxic effects toward the melanocyte.6 Topical azelaic acid has no depigmentation effect on normally pigmented skin, freckles, senile lentigines, and nevi. This specificity may be attributed to its selective effects on abnormal melanocytes. Azelaic acid can be used for postinflammatory hyperpigmentation in acne.7 Free radicals are believed to contribute to hyperpigmentation, and azelaic acid acts by reducing free radical production.8 Azelaic acid 20% is currently available in the US and is only indicated for the treatment of acne, although it has off-label use for hyperpigmentation. In the treatment of melasma, a 24-week study in South America found that a 20% concentration of azelaic acid was equivalent to 2% hydroquinone.9 In the Philippines, a study found that 20% azelaic acid was better than 2% hydroquinone.10
Kojic Acid
Kojic acid (5-hydroxy-2-(hydroxy methyl)-4-pyrone), a naturally occurring hydrophilic fungal derivative evolved from certain species of Acetobacter, Aspergillus and Penicillium, is used in the treatment of hyperpigmentation disorders.11 It acts by inhibiting the production of free tyrosinase with efficacy similar to hydroquinone. In Japan, kojic acid has been increasingly used in skin care products. This is because, until recently, topically applied kojic acid at 1% concentration had not exhibited any sensitizing activity.12 However, more recent long-term Japanese studies have shown that kojic acid has the potential for causing contact dermatitis and erythema.12
Arbutin
Arbutin, which is the b-D-glucopyranoside derivative of hydroquinone, is a naturally occurring plant derived compound that has been used for postinflammatory hyperpigmentation.13 It is effective in the treatment of disorders of hyperpigmentation characterized by hyperactive melanocytes.13 The action of arbutin is dependent on its concentration. Higher concentrations are more efficacious than lower concentrations, but they may also result in a paradoxical hyperpigmentation.13 In comparative in vitro studies of various compounds used to improve the appearance of disorders of hyperpigmentation, arbutin was found to be less toxic than hydroquinone. A dose-dependent reduction in tyrosinase activity, as well as melanin content in melanocytes, was also demonstrated.14
Licorice Extract
Licorice extract is not yet available in North America, but has been used in other parts of the world, particularly in Egypt. Its mechanism of action is similar to that of kojic acid. The main component of the hydrophobic fraction of licorice extract is glabridin, which has an effect on the skin. Studies investigating the inhibitory effects of glabridin on melanogenesis and inflammation have shown that it inhibits tyrosinase activity of melanocytes. No effect on DNA synthesis was detectable.15
Topical Retinoids
The efficacy of topical tretinoin 0.05-0.1% as monotherapy for postinflammatory hyperpigmentation has been reported.16 Tretinoin was also used as monotherapy in a study on 38 African- American patients with melasma and 68%-73% of patients improved. In 88% of the patients, moderate side-effects of desquamation and erythema were observed.17,18 Darker skinned patients who develop a dermatitis from tretinoin may develop postinflammatory hyperpigmentation secondary to the dermatitis.
The mechanism of action of tretinoin in the treatment of melasma is poorly understood. Clinical improvement has been found to be associated with a reduction in epidermal melanin, possibly as a result of the inhibition of tyrosinase by the action of tretinoin.19
Although tretinoin can be effective as monotherapy for hyperpigmentation and melasma, it requires 20 to 40-week treatment periods. Tretinoin can also be used in conjunction with hydroquinone or other depigmenting agents to improve efficacy. The first published study of combination therapy used tretinoin 0.1%, hydroquinone 5%, and dexamethasone 0.1% for postinflammatory hyperpigmentation.20 Tretinoin was shown to reduce the atrophy of the corticosteroid and facilitated the epidermal penetration of the hydroquinone. The tretinoininduced irritation was reduced by the corticosteroid. The first triple combination topical therapy approved by the US FDA for melasma is a modified formulation comprising fluocinolone acetonide, hydroquinone 4% and tretinoin 0.05%. In studies of patients with melasma, 78% had complete or near clearing after 8 weeks of therapy. Similar results and favorable safety profile were seen in a 12-month study.21
In a randomized clinical trial, the efficacy of adapalene 0.1% was found to be comparable to that of tretrinoin 0.05% cream in the treatment of melasma (mainly epidermal type). The results showed fewer side-effects and greater acceptability among patients using adapalene.19
Conclusion
The treatment of hyperpigmentation disorders can be a long process. The psychosocial impact of these disorders should be taken into consideration. There are several topical treatment options available, the most common of which is hydroquinone. The use of combination therapy and monotherapy with nonphenolic agents is increasingly common. These treatment options are primarily for epidermal disorders ofhyperpigmentation. Dermal disorders of hyperpigmentation are difficult to treat, and have not been effectively managed using currently available therapy.

How to select a sunscreen

Do you know that some sunscreens can prevent sunburn, reduce your risk of getting skin cancer, and help prevent early signs of skin aging? This infographic tells you how to choose a sunscreen that does all three.
 How to select a sunscreen

Related resources

    Download a printable version of How to Select a Sunscreen.

Clindamycin phosphate topical gel

General Information
Clindamycin phosphate topical gel, 1% is a topical antibiotic approved for the treatment of acne vulgaris. This drug belongs to the class of antibiotics known as lincosamides. By inhibiting bacteria protein synthesis at the ribosomal level (the site of protein synthesis), clindamycin is believed to kill bacteria associated with acne.
The term "acne vulgaris" refers to the more common form of acne, consisting of non-inflammatory and mildly inflammatory lesions. The more severe form of acne is characterized by the presence of nodules. Nearly 17 million people in the United States have acne, making it the most common skin disease. Although acne is not a serious health threat, severe acne can lead to disfiguring, permanent scarring, which can be upsetting for people who suffer from the disorder.

Clinical Results
Trial results indicated that clindamycin phosphate gel was more effective than a vehicle gel in the treatment of mild to moderate acne vulgaris. The 12-week, multicenter, randomized, vehicle-controlled trial compared clindamycin phosphate topical gel, 1% once daily to a vehicle gel administered once daily.
The mean percent reduction in lesion counts at the end of treatment was 51% for clindamycin phosphate gel versus 40% for the vehicle gel for inflammatory lesions. For non-inflammatory lesions, the mean percent reduction was 25% for clindamycin phosphate gel and 12% for the vehicle gel. The total mean percent reduction in lesion counts at the end of treatment was 38% for clindamycin phosphate gel and 27% for the vehicle gel.
In a contact sensitization trial, four of the 200 subjects appeared to develop suggestive evidence of allergic contact sensitization to clindamycin phosphate gel. There was no signal for contact sensitization in the clinical trials under normal use conditions.

Side Effects
Adverse reactions associated with the use of clindamycin phosphate gel include itching and peeling skin.
Cases of diarrhea, bloody diarrhea, and colitis have been reported as adverse reactions in subjects treated with oral and parenteral (intravenous) formulations of clindamycin, and have been reported rarely with topical clindamycin. Abdominal pain and gastrointestinal disturbances, as well as gram-negative folliculitis (bacterial infection and inflammation of hair follicles), have also been reported in association with the use of topical formulations of clindamycin.
Mechanism of Action
Although clindamycin phosphate is inactive in vitro, rapid in vitro hydrolysis converts this compound to clindamycin which has antibacterial activity. Clindamycin inhibits bacteria protein synthesis at the ribosomal level by binding to the 50S ribosomal subunit and affecting the process of peptide chain initiation. (from FDA label)

Non-prescription treatment for acne

Soap and water. Gentle cleansing of the face with soap and water no more than twice a day can remove the excess oils and help the "oily skin" often associated with acne. However, this does not clear up acne that is already present. Avoid aggressive scrubbing, which can injure the skin and cause other skin problems.
Cleansers. There are many cleansers and soaps advertised for treating acne. However, these are unnecessary if the acne is being properly treated and can in fact aggravate acne.
Benzoyl peroxide. For mild acne, you may try, or your doctor may recommend, treatment with a non-prescription medication that contains benzoyl peroxide. It's believed that this compound works by killing the bacteria associated with acne and by preventing dead skin cells clogging pores. It usually takes at least four weeks to work and it may need to be continued once the acne has cleared to help keep acne at bay until you outgrow getting acne. It is available in a wide range of forms: creams, lotions, washes and gels. Benzoyl peroxide can cause dry skin and can bleach fabrics, so take care when applying it. Consider wearing an old T-shirt to bed if you are applying it to your back or chest overnight and using old or white bedclothes if applying to your face.

7 Secrets that Cured My Acne without Chemicals


All I ever wanted for Christmas was clear skin
Acne and I: inseparable since 7th grade. It requires pages to explain the myriad of treatments, lotions, potions and prescriptions under my belt. Basically, I’ve tried every prescription besides Acutane and birth control pills (and I will never touch those). Everything from drugstore cleansers to $90 serums have graced my medicine cabinet. I’ve even invested in at-home peel chemical peels, a Clarisonic, and laser treatments

1. Oil Cleansing in the Evening

 I was apprehensive about smothering my face with oil, since my face has always been veritable oil slick one hour after I wash it. So it took a big dose of courage to throw out my face wash and try . I love it! It removes all traces of makeup and leaves my skin soft.
Most importantly, my face’s oil production is normalizing. This is because–in conjunction with the facial oil I’ll talk about–it does not need to overcompensate with oil production like it did when I cleansed with soap

1. Oil Cleansing in the Evening.jpg

2. Honey Cleansing in the Morning

 In the mornings, I wash my face with honey  With slightly dampened fingers, I massage about 1/2 teaspoon of raw honey over my dry face and then rinse. The antibacterial properties of honey work to inhibit breakouts. Additionally, it removes excess oil but leaves skin moisturized.
2. Honey Cleansing in the Morning

3. Apple Cider Vinegar Toner

  Mornings and evenings, I spray my face with a mixture of 2/3 alcohol free which hazel and 1/3 raw apple cider vinegar. The apple cider contains gentle exfoliating acids to calm acne and it balances the skin’s pH. It also allows my homemade facial oil to absorb quickly and evenly.

4. Homemade Acne Facial Oil

 Yep, here we are again putting oil on acne. Counterintuitive, no? But it works. It took maybe a week or two of extra oiliness for my skin to adjust, but then it suddenly became way less oily, with less breakouts, too!
My recipe is: 2/3 Jojoba Oil, (which doesn’t clog pores), 1/3 of this Tea Tree and Vitamin E Oil, plus a few drops of rosemary essential oil (which is very antibacterial). I just moisten my face with the toner, warm a few drops of this oil mixture between my fingertips and massage lightly onto my face. As a bonus, it feels like a quick aromatherapy treatment.
4. Homemade Acne Facial Oil.jpg

5. Honey, Cinnamon and Nutmeg Spot Treatment 

 If you ever visit my house without giving me prior warning, you might just see me walking around with dots of gooey cinnamon on my zits. This is my normal routine ever since discovering that this mask makes a super effective spot treatment.
I mix raw honey with enough cinnamon to form a paste, add some freshly grated nutmeg, and store it in a small container in my bathroom. I’ll leave this spot treatment on for a couple of hours. If you want to use it as a full face mask, leave it on for only 10-15 minutes
5. Honey, Cinnamon and Nutmeg Spot Treatment

6. Baking Soda Exfoliant

 A couple times a week, I mix up a paste of baking soda and water and apply it to my face, chest, and back. I leave it on for a few minutes before my bath or shower. It provides gentle chemical exfoliation to even skin tone, dry up breakouts, and eliminate blackheads. As a bonus, this effective treatment is simple and economical!

7. Acupuncture

 Before starting the GAPS diet, my health was so poor that I rarely got periods. GAPS brought my cycle back, but also delivered intense PMS. I’m talking nausea, headaches, and doubling over in pain from cramps. Desperate for a solution, I gave acupuncture a try. After two months of weekly treatment, my periods are getting better and bette


Dealing With Adult Acne: Dos And Don’ts

For many people, the words “acne” or “pimples” generally recall uncomfortable memories from their teenage past. But for some, acne is a problem that continues to plague them even in their adult years. It is important to realize that adult acne is different from adolescent acne, and even different forms of treatment. Read on to learn more about adult acne, and ways to prevent taking a stroll down teenage-acne-memory lane.
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Adult VS Teen acne

The bare-bones mechanism of acne is the same for both adult and teen acne. Both involve a clogged pore (usually accumulated sweat, dirt, oils and bacteria), which can turn into the familiar blackhead or whitehead. As the bacteria multiply, they inflame the pore and cause painful, more serious cases of acne. Hormones have also shown to play a role in acne formation for both teens and adults
The main difference between adult and teen acne is adult acne appears more on the chin, jawline and neck, as opposed to a more even distribution in teen acne. Also, while teen acne is caused by hormone surges during growth and puberty, adult acne is correlated to general hormone imbalances. Hence, in the adult years, stress or endocrine disorders (such as PCOS) can cause an eruption of spots on the face, even though we have gone through puberty and stopped growing taller. Adult acne can affect adults in their late 20s, 30s, and even well into the 40s. While you can’t really “outgrow” adult acne, there are certainly ways to prevent frequent breakouts.

DOs

    Do consult a dermatologist. Your doctor can correctly diagnose the root of your acne and whether it’s a side effect of another underlying medical condition. A simple blood test can help screen hormone levels.
    Do check your stress levels. One of the most common causes of adult acne is stress, as stress affects hormone levels. Try doing a yoga class, or just take a moment to breathe; it may just prevent that pimple from erupting.
    Do quit smoking. The Journal of the American Academy of Dermatology has performed studies that show a correlation between smoking and postadolescent acne.
    Do eat a healthy diet consisting of low fat, low sugar and refined carbohydrates. Studies have shown low glycemic diets lead to less blemish eruptions in adults, as diets high in sugar may disrupt insulin levels of the body. When in doubt, load up on the veggies and whole grains, and say no to refined and processed foods.
    Do lose weight and exercise. Obesity and excess body fat have been linked to hormone disorders, such as polycystic ovary syndrome (PCOS) in women, as well as insulin disruption. All these factors may contribute to adult acne eruption.

DON’Ts

    Don’t purchase the same brand of acne facial products as you did when you were a teen. The cause of adult acne is different from adolescent acne, and the treatment most likely will cause adverse effects (such as peeling and excessive dryness) instead of getting rid of the spots.
    Don’t carry over your bad teenage acne habits. It may be tempting to pick at the blemish, but we need to remember that our skin is not as young and regenerative as it used to be, so open wounds and infected pimples will take even longer to heal than before.
    Don’t go to bed without cleaning your face. Clogged pores are the root of all pimples, and since it’s easier to wash a face than dealing with hormonal factors, make this a good habit daily. Consult your dermatologist for a regimen suitable for your adult skin.
    Don’t implement alternative therapies without professional consultation. There are international hormone creams and therapies boasting to have adult acne-curing properties, but they may also have dangerous side effects.
    Don’t hop on the new-age skin treatment bandwagon. Before partaking in any up-and-coming skin treatments promising to banish adult acne, be sure to do thorough research and discuss the risk and benefits with your dermatologist.

Thankfully, there are many acne-friendly cosmetics and concealers than can help an individual in need of a pimple cover up. Look for cosmetic items with salicylic acid or benzoyl peroxide as active ingredients to treat and hide the pimple. Be sure to also wash your face thoroughly afterwards to minimize clogged pores. Adult acne is manageable and may be prevented altogether with a few simple dos, don’ts, and a handy concealer.

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