Methyl Aminolevulinate Cream + Benzyl Alcohol

Update on Drugs and Drug News

Name/Company	Approval Dates and Comments
Benzyl Alcohol Lotion 5% Sciele Pharma	The US FDA approved this prescription medication in April 2009 for the treatment of head lice infestation for use in patients 6 months of age and older.
Red Light Technology Device + Methyl Aminolevulinate Cream Aktilite® CL 128 + Metvix® Photocure/ Galderma	Health Canada approved this LED-based narrow band red light technology device in combination with methyl aminolevulinate in April 2009 for the treatment of actinic keratosis and superficial basal cell carcinoma.

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Drug News

Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals, Inc. announced in April 2009 that a Phase III trial evaluating sorafenib tablets (Nexavar®) in patients with unresectable Stage III or Stage IV melanoma was stopped early following a planned interim analysis by the independent Data Monitoring Committee (DMC). The trial was sponsored by the National Cancer Institute (NCI) and led by the Eastern Cooperative Oncology Group (ECOG) under a Clinical Trials Agreement between NCI and Bayer and Onyx. The DMC concluded that the study would not meet the primary endpoint of improved overall survival among patients receiving sorafenib in combination with the chemotherapeutic agents carboplatin and paclitaxel vs. patients receiving placebo plus the chemotherapeutic agents. The treatment effect was comparable in each arm. There were no unexpected serious side-effects, though the final analysis of the data will occur per protocol and statistical analysis plan. Bayer and Onyx will further review the findings of this analysis to determine what, if any, impact these data might have on other ongoing sorafenib melanoma trials. Data from this study are expected to be presented at an upcoming scientific meeting.

In a study presented at the 2009 Annual Meeting of the American Academy of Allergy, Asthma & Immunology*, researchers at Mount Sinai Hospital in New York studied 14 patients with persistent atopic dermatitis who received traditional Chinese medicine at Ming Qi Natural Health Center in Manhattan between August 2006 and May 2008. The treatments consisted of Erka Shizheng Herbal Tea, a bath additive, creams, and acupuncture. The study authors utilized 2 measures: the SCORAD index to gauge atopic dermatitis severity and the Dermatology Life Quality Index (DLQI) to calculate impairment to life quality. Baseline median scores for SCORAD and DLQI were 89 and 17, respectively. After a median 8 months of treatment, the median scores fell to 11 for SCORAD and 1 for DLQI. In all but 1 patient, SCORAD measures decreased between 60% to 90% after 3.3 months of treatment. More than 50% improvement in DLQI scores was documented in all but 1 patient after 2.4 months. Patients also reported a reduction in the use of steroids, antibiotics, and antihistamines within 3 months of being treated with traditional Chinese medicine. There were no abnormalities of liver and kidney function observed. While the researchers concluded that the use of traditional Chinese medicine is safe and effective for patients with persistent atopic dermatitis, especially those with a severe case and significant life quality impairment, it is still recommended to speak with a physician before taking any complementary or alternative medicines. * Wisniewski J, Nowak-Wegrzyn A, Steenburgh-Thanik H, et al. Efficacy and safety of traditional Chinese medicine for treatment of atopic dermatitis (AD). J Allergy Clin Immunol 123(Suppl 2):Abstract #131 (2009 Feb).

Actinic Keratosis Treatments

What Is Actinic Keratosis?

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips,
backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun. You’ll most often see the plural,
“keratoses,” because there is seldom just one.

In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper. There are many times the number of invisible (subclinical) lesions as visible ones on the skin surface.

Most often, actinic keratoses develop slowly and reach a size from an eighth to a quarter of an inch. Early on, they may disappear only to reappear later. Most become red, but some will be light or dark tan, pink, red, a combination of these, or the same color as your skin. Occasionally they itch or produce a pricking or tender sensation. They can also become inflamed and surrounded by redness. In rare instances, actinic keratoses can even bleed.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

How to Recognize Actinic Keratosis

Examples of typical actinic keratoses are shown here, so examine your skin regularly for lesions that look like them. But it’s not always that simple:

Many actinic keratoses have quite a different appearance, so if you find any unusual or changing growth, be suspicious and see your doctor promptly. Numerous actinic keratoses can reveale chronic sun damage. They are elevated, rough in texture, and resemble warts.

Two typical keratoses on rim of ear. The top lesion is crusted, the lower one rough in appearance.

While most keratoses have a fine sandpapery roughness, others such as this lesion have an obviously scaly, crusty surface.

Chronic sun exposure is the cause of almost all actinic keratoses. Sun damage to the skin is cumulative, so even a brief period in the sun adds to the lifetime total. Cloudy days aren’t safe either, because 70-80 percent of solar ultraviolet (UV) rays can pass through clouds. These harmful rays can also bounce off sand, snow and other reflective surfaces, giving you extra exposure.

The ultraviolet radiation given off by the lamps in a tanning salon can be even more dangerous than the sun, so dermatologists warn against indoor tanning.

Occasionally, actinic keratoses may be caused by extensive exposure to X-rays or a number of industrial chemicals.

What Age Has to Do with It

Because the total amount of time spent in the sun adds up year by year, older people are most likely to develop actinic keratoses. However, nowadays, some individuals in their 20s are affected. Still, actinic keratoses become much more common in people over the age of 50. Some experts believe almost everyone over 80 has actinic keratoses.

Also, individuals whose immune defenses are weakened by cancer chemotherapy, AIDS, organ transplantation or excessive UV exposure are less able to fight off the effects of the radiation and thus more likely to develop actinic keratoses.

Why Is It Treated?

While actinic keratosis is the most common precancer, not all keratoses turn into cancers. Unfortunately, there is no way to know ahead of time which actinic keratoses are precursors of squamous cell carcinoma. That is why it is fortunate that there are so many effective treatments for eliminating actinic keratoses.

When an actinic keratisis is suspected to be an early cancer, the physician may take tissue for biopsy. This is done by shaving off the top of the lesion with a scalpel or scraping it off with a curette. Local anesthesia is required. Bleeding is usually stopped with a styptic agent.

TOPICAL MEDICATIONS

Medicated creams and solutions are very effective by themselves or in combination with another form of treatment when a person has many actinic keratoses.

5-fluorouracil (5-FU) ointment or liquid in concentrations from 0.5 to 5 percent has FDA approval and is the most widely used topical treatment for actinic keratoses. It is effective against not only the surface lesions but also the subclinical ones. Rubbed gently onto the lesions once or twice a day for two to four weeks, it produces cure rates of up to 93 percent. Reddening, swelling and crusting may occur, but they are temporary. The lesions usually heal within two weeks of stopping treatment. There is rarely scarring and the cosmetic result is good.

Imiquimod 5% cream, also FDA-approved, works in a different way: It stimulates the immune system to produce interferon, a chemical that destroys  cancerous and precancerous cells. It is rubbed gently on the lesion twice a week for four to sixteen weeks. The cream is generally well tolerated, but some individuals develop redness and ulcerations.

Diclofenac is a non-steroidal anti-inflammatory drug used in combination with hyaluronic acid, a chemical found naturally in the body. The resulting gelis applied twice a day for two to three months. The diclofenac prevents an inflammatory response, so this topical is well-tolerated, and the hyaluronic acid delays uptake of the diclofenac, leading to higher concentrations in the skin. It is used in persons who are oversensitive to other topical treatments.

CRYOSURGERY

This is the most commonly used treatment method when a limited number of lesions exist. No cutting or anesthesia is required. Liquid nitrogen, applied with a spray device or cotton-tipped applicator, freezes the growths. The lesions subsequently shrink or become crusted and fall off. Temporary redness and swelling may occur after treatment, and in some patients, white spots may remain permanently.

COMBINATION THERAPIES

If one form of therapy is good, two may be better; some of the treatment options described here are especially effective when used together or in sequence. This approach can both improve the cure rate and reduce side effects. One to two weeks of 5-FU followed by cryosurgery can reduce the healing time for 5-FU and decrease the likelihood of white spots following cryosurgery.

CHEMICAL PEELING

This method, best known for reversing the signs of photoaging, is also used to remove some actinic keratoses on the face. Trichloroacetic acid (TCA) and/or similar chemicals are applied directly to the skin. The top skin layers slough off and are usually replaced within seven days. This technique requires local anesthesia and can cause temporary discoloration and irritation.

LASER SURGERY

A carbon dioxide or erbium YAG laser is focused onto the lesion, and the beam cuts through tissue without causing bleeding. This is a good option for lesions in small or narrow areas, and, therefore, can be particularly effective for keratoses on the face and scalp, as well as actinic cheilitis on the lips.

However, local anesthesia may be necessary, and some pigment loss can occur. Lasers are useful for people taking blood thinners or as a secondarytreatment when others have not succeeded.

PHOTODYNAMIC THERAPY (PDT)

PDT can be especially useful for lesions on the face and scalp. Topical 5-aminolevulinic acid (5-ALA), a photosensitizing agent, is applied to thelesions. Subsequently, the medicated area is exposed to strong light that activates 5-ALA. The treatment selectively destroys actinic keratoses, causing little damage to surrounding normal skin, although some swelling and redness often occur.

How to Prevent Actinic Keratosis

The best way to prevent actinic keratosis is to protect yourself from the sun. Here are some sun-safety habits that really work.

* Seek the shade, especially between 10 A.M. and 4 P.M.
* Do not burn.
* Use a sunscreen with an SPF of 15 or higher every day.

* Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after  swimming or excessive sweating.
* Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
* Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
* Examine your skin head-to-toe every month.
* See your doctor every year for a professional skin exam.
* Avoid tanning and UV tanning salons.

Medical Reviewers:
Rex A. Amonette, MD
David J. Leffell, MD
Perry Robins, MD

A PUBLICATION OF THE SKIN CANCER FOUNDATION
For more information or to order this article as a brochure, please contact:
The Skin Cancer Foundation
149 Madison Ave., Suite 901,
New York, NY 10016
© 2008

Photos courtesy of:
Pearon G. Lang, Jr., MD, and
MSKCC Dept. of Dermatology
Photos courtesy of:
Pearon G. Lang, Jr., MD, and
Memorial Sloan Kettering Cancer Center
Deptartment of Dermatology

Skin Infections and Antiviral Drugs

Infection – is an invasion by and multiplication of pathogenic microscopic organisms, such as bacteria, viruses and fungi, in a bodily part or tissue of a host organism which may produce subsequent tissue injury and progress to overt disease through a variety of cellular or toxic mechanisms. The infecting organism, or pathogen, interferes with the normal functioning and perhaps the survival of the host organism.

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Skin infections are common. Breaks in the skin integrity, particularly those that let in infectious agents(pathogens) like bacteria and fungi, frequently cause or aggravate skin infections. All skin infections can be divided into 3 classes by a disease-causing agent:

• bacterial,
• viral or
• fungal

The difference between an infection and colonization by microorganisms is often only a matter of circumstance. Organisms which are normally non-pathogenic and live on the surface of healthy skin can become pathogenic under the right conditions, and even the most infectious organism requires certain circumstances to cause a compromising infection. As an example, the staphylococcus species present on skin remain harmless on the skin, but, when present in a normally sterile space, such as in the capsule of a joint or the peritoneum, will multiply without resistance. The variables involved in the outcome of a host becoming inoculated by a pathogen and the ultimate outcome include:

1. the route of entry of the pathogen and the access to host regions that it gains
2. the intrinsic capacity of a microorganism to cause disease (virulence) of the particular organism
3. the quantity or load of the initial substance introduced into the organism (inoculant)
4. the immune status of the host being colonized

Any one who has a break in the skin is at risk for infection. However, certain conditions or diseases can put a person at greater risk for infection, including: diabetes (which causes poor blood flow to the skin), AIDS (because of a depressed immune system that is unable to fight the infection), skin damaged by sunburn or scratching.

Many invading organisms produce substances that cause allergic sensitivity in the host; the immune response to virus infection has been implicated in some diseases. Infections may be spread via respiratory droplets, direct contact, contaminated food, or vectors, such as insects. They can also be transmitted sexually (see sexually transmitted diseases) and from mother to fetus. Immunity is the term used to describe the capacity of the host to respond to infection. Drugs that help fight infections include antibiotics and antiviral drugs.

Dermabrasion 101

Dermabrasion is one of three commonly used office-based surgical skin resurfacing and rejuvenation procedures. The technique takes its origin from ancient Egypt in 1500 B.C. where healers used a form of sandpaper to even out scars. Today the technique has seen over 3500 years of evolution.

Dermabrasion mechanically removes the most superficial layers of the skin and allows your skins normal healing properties to rejuvenate the skin itself. It is designed to reduce or remove moderate wrinkles, fine lines, skin blemishes, and uneven skin surfaces. In addition to wrinkle treatment, the technique has been used to treat acne scars, hide or camouflage surgical or traumatic scars and in select cases to remove precancerous lesions.

Microdermabrasion is not the same treatment as dermabrasion and will not be discussed further than this paragraph. Microdermabrasion is a much more superficial and thus a less dramatic rejuvenation procedure with little to no recovery period. Being a more mild procedure than dermabrasion, multiple treatments of micordermabrasion are often required and may never achieve the same degree of rejuvenation as traditional dermabrasion. Microdermabrasion uses a device that sprays a fine beam of aluminum oxide microcrystals to superficially peel the skin surface while simultaneously removing the tissue debris. As microdermabrasion is not as invasive a procedure, non-medical personnel offer this treatment through many spas and clinics.

Skin rejuvenation can also be performed with lasers or chemical peels. These modalities will not be discussed in this article.

CAUTIONS
Patients with darker skin complexions (Fitzpatrick skin types III to VI) may experience permanent skin discoloration or blotchiness with dermabrasion procedures. Patients of African, Asian and Hispanic descent should specifically be cautioned about skin discoloration.

PRE-TREATMENT CARE

Patients with a history of oral herpes infections should be placed on oral acyclovir prior to this treatment to avoid a herpes flare or extension of the condition following dermabrasion.
THE PROCEDURE
Dermabrasion is performed in an out-patient (often office) setting under local anesthesia. Full-face dermabrasion is performed under conscious sedation or general anesthesia, often with the assistance of an anesthetist. A small motorized hand piece rotates a wire brush or diamond fraise at speeds of 15,000 to 30,000 rpm. Skilled manipulation of the rotating brush or fraise removes the upper layers of skin in the areas requiring treatment. This results in a raw, open, partial thickness (through skin) wound that heals by epithelialization of the surface of the skin in a relatively short period of time. Initially the small pinpoint bleeding of the raw wound may be alarming but will subside rapidly with appropriate wound care.

THE RECOVERY
The recovery following dermabrasion skin resurfacing is approximately 2-3 weeks. Early post-operative pain is controlled with prescription medications for the first few days. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. The skin may weep for the first 10-12 days but eventually stops as the surface layers of the skin are restored. Redness of the treated area is a normal part of recovery and disappears within 3-4 weeks of the procedure. Complete sun avoidance on the treated area must be observed until the redness in the skin has disappeared. Remember good sun protection should still be observed well after the healing period, as it was likely the sun damage to your skin that has driven you to seek this form of treatment in the first place.

Make-up can be used to cover the early skin discoloration once the skin has healed. Please ask your physician or surgeon for directions on when make-up can be used safely.
COMPLICATIONS

A discussion of potential complications is essential with every discussion about a surgical procedure. It is important to know that although complications from surgery are possible they are not common. Some possible complications associated with a dermabrasion are listed into both early and late complications:

EARLY
* Excessive surface bleeding
* Redness (fades with time)
* Infection (viral)
* Skin sensitivity

LATE
* Hyperpigmentation
* Hypopigmentation
* Milia
* Asymmetry (between sides)
* Residual wrinkles
* Scarring

For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.

COST
Dermabrasion procedures are not covered under most insurance plans and the final cost for such procedures will be at the discretion of the plastic surgeon performing the procedure. Most surgeons quote costs based on the number of aesthetic areas being treated. The average cost of this procedure, is $1000 and higher.

DISCLAIMER
This website does not cover all of the medical knowledge related to dermabrasion nor does it deal with all possible risks and complications of skin resurfacing procedures. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical or treatment procedure. For a more detailed discussion on expected results, recovery, and specific complications, please see your plastic surgeon or dermatologist.

Author: Dr. Bryce J Cowan BSc MSc MD PhD FRCS(C)
Plastic, Reconstructive, Mohs & Aesthetic Surgeon

Skincare Dollars and Sense

Many consumers are frustrated by skin care products that don’t do what they claim to. Worse still is investing in an expensive yet ineffective cream or treatment only to discover the cheapest drug-store brand would work just as well. In a world of hyper-consumerism, false advertising and a plethora of products from which to choose, how do you choose the good from the bad?

There are some great products on the market that can genuinely improve your skin’s appearance and help your skin look smoother, more radiant, and youthful. But, there are literally thousands of products to choose from and unless you spend hours a day researching beauty products, it’s difficult to find the one of the few that actually produces real results and eliminates years of aging from your face and body.

Not only should a quality skin product help reduce bags under, and fine lines around, the eyes, but it should even out coloration inconsistencies caused by age spots and other unwanted pigment concentrations.

In a marketing-rich world of super models and glamorous actors, many will understandably spend any amount of money to make themselves look better or younger. Cosmetic surgery and skin care is a multi-billion dollar industry.

As the law of supply and demand proves, the higher the demand for youth and beauity, the more manufacturers will rush to provide the solution. Many times this rush results in the creation of an inferior product with little to no research and development to back it.

All of the money goes into the marketing of the product. On the surface everything looks great. The bottles and jars that the creams come in look appealing. The magazine advertisements are glossy, complete with a youthful looking model or a well known celebrity who doesn’t even really use the products.

You can’t really blame these companies. When you are spending a fortune paying for marketing, whether it be on the product containers, magazine, radio, and TV ads, royalties paid to celebrities and models, you have to charge a lot of money for your products or you’re going to lose money.

On the other hand, this doesn’t mean you and I have to fall for these types of marketing schemes. After all, these companies aren’t going to encounter any shortage of people who will open their wallets and purses to purchase their products anytime soon. The reality is most people simply won’t take any time to research products and understand what ingredients work and what ingredients are actually bad for your skin!

Retinoids and Dry Skin

Dry skin recommendations and supplements that can help your skin

RETINOIDS
The group of medicines known as retinoids are derived from Vitamin A. Creams containing the retinoids retinol and retinaldehyde can be obtained over the counter at pharmacies and supermarkets. Other topical retinoids containing tretinoin or isotretinoin require a doctor’s prescription. Adapalene is a related prescription medicine.  Topical retinoids can be applied to any area but are most often used on the face, the neck and the back of hands.

When you first start using the retinoid, apply your night cream first then re-apply the retinoid. Do this every third night for two weeks. Then apply moisturizer followed by retinoid every other night. If no redness occurs after two weeks you can adjust your regimen and apply the retinoid after cleansing but before your night cream. Then apply the night cream after the retinoid. Do this, using the retinoid every other day, for one week.

If you experience redness or flaking, begin using the retinoid every night. In about twenty-four weeks you will notices fewer wrinkles and smoother skin as well as preventing future wrinkles. Since retinoids speed up the rare at which skin cells divide, some flaking is normal. This flaking is not additional dryness, but rather dead skin cells sloughing off. You can use a facial scrub once or twice a week before an important event to remove these fakes, allowing your skin to look radiant. Stronger products are more irritating than those with a lower percentage of retinoids, so you can switch products depending on your needs.

FAQ on Sunscreens and Sunburns

1. “How Much Sunscreen Should I Apply?”

The average user of sunscreen tends to use significantly less sunscreen than the amount required to achieve the SPF listed on the container.

2. “How Often Should I Apply Sunscreen When I’m Out In The Sun?’”

Many experts recommend that frequent application during sun exposure is required. However, a group of children were tested by spreading on 1 application of sunscreen to one side of their bodies, and four applications to the other.

They then spent 6 hours in the sun. One application provided the same level of protection as four applications, confirming the adequacy of a single daily application of a sunscreen in that situation.

3. “How Long Before Sun Exposure Should I Apply Sunscreen To My Skin?”

As molecules of sunscreen are present in their active state in the sunscreen, sunscreens work immediately upon application. The only reason for application early is to allow absorption into the skin so that the sunscreen is less likely to be washed off, should the person be entering the water. Even so, modern sunscreens are quite resistant to removal from the skin.

4. “Sun Protection Factor (SPF) - What Is It?”

SPF is the ratio of the minimal ultraviolet dose required to produce redness with and without a sunscreen. For example, if it took ½ hour for your skin to become sunburned without any sunscreen, then for a sunscreen that has a 15 SPF rating, you could stay in the sun for 15 times longer (or 7.5 hours) before you get sunburned. This is provided, of course, that you’ve applied the sunscreen properly so that you’re getting the prescribed protection.

5. “Reactions To Sunscreens?”

Sunscreens can be both an irritant and an allergen, though allergic reactions are rare. Irritant reactions, however, abound. One classic error in sunscreen application is to put a large amount of sunscreen on the forehead. Perspiration and gravity can cause the sunscreen to migrate down your forehead into your eyes, causing a stinging sensation. Some people attribute this to an allergic reaction and discontinue use. It’s also important to wash your hands after applying sunscreen, since rubbing your sunscreen covered finger near your eyes can induce an irritant reaction.

6. “Why Is It Important To Use Sunscreens During Childhood?”

It appears that a great deal of time can elapse between actual sun damage and the development of skin cancer or other skin problems like photoaging. Therefore, it is important to protect your skin from an early age when you are out in the sun.

7. “Sunscreens And The Elderly?”

Many elderly people can become quite obsessed by sun avoidance, and their quality of life can suffer. Sometimes, if they are diagnosed with an actinic keratosis or basal cell carcinoma, they can become anxious and almost leap from shadow to shadow. However, few of them are likely to develop new skin cancers from present sun exposure. As long as they are prudent about avoiding excessive sun exposure and protecting their skin to prevent sunburn, they can continue to enjoy time outdoors.

8. “Can Sunscreens Prevent Cancer?”

There is clear evidence that sunscreens are helpful in preventing actinic keratoses, which are warty lesions that can occur on sun-exposed skin of the face or hands. Research has shown that these lesions can develop into a cancer called squamous cell carcinoma, and that this is linked to a cumulative exposure to the sun.

However, there is surprisingly little evidence that sunscreens have much effect in preventing another kind of skin cancer called basal cell carcinoma, or for malignant melanoma. For malignant melanoma and for basal cell carcinoma, the character and timing, that is, the type of sunlight and your age at the time of the exposure to the sun appears to be more important than the cumulative dose.

Adapted from an article by David I. McLean, MD, and Richard Gallagher, MA.

Side Effects and Conditions Caused By Isotretinoin

Minor discomforts such as dry mouth or nose, dry eyes, dry skin, or itching usually go away as the body adjusts to the drug and do not require medical attention unless they continue or are bothersome.

Other side effects should be brought to a physician’s attention. These include:
•    burning, redness, or itching of the eyes
•    nosebleeds
•    signs of inflammation of the lips, such as peeling, burning, redness or pain

Bowel inflammation is not a common side effect, but it may occur. If any of the following signs of bowel inflammation occur, stop taking isotretinoin immediately and check with a physician:
•    pain in the abdomen
•    bleeding from the rectum
•    severe diarrhea

Conditions Caused By Benzoyl Peroxide and Tretinoin

The most common side effects of antiacne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Other side effects should be brought to a physician’s attention. Check with a physician as soon as possible if any of the following side effects occur:

•    blistering, crusting, or swelling of the skin
•    severe burning or redness of the skin>
•    darkening or lightening of the skin (This effect will eventually go away after treatment with an antiacne drug ends.)
•    skin rash

Other side effects are possible with any type of antiacne drug. Anyone who has unusual symptoms while using antiacne drugs should get in touch with his or her physician.
Interactions

Patients using antiacne drugs on their skin should tell their physicians if they are using any other prescription or nonprescription (over-the-counter) medicine that they apply to the skin in the same area as the antiacne drug.

Isotretinoin may interact with other medicines. When this happens, the effects of one or both drugs may change or the risk of side effects may be greater. Anyone who takes isotretinoin should let the physician know about all other medicines being used and should ask whether the possible interactions can interfere with drug therapy.

Among the drugs that may interact with isotretinoin are listed below:
•    Etretinate (Tegison), used to treat severe psoriasis. Using this medicine with isotretinoin increases side effects.
•    Tretinoin (Retin-A, Renova). Using this medicine with isotretinoin increases side effects.
•    Vitamin A or any medicine containing vitamin A. Using any vitamin A preparations with isotretinoin increases side effects. Do not take vitamin supplements containing vitamin A while taking isotretinoin.
•    Tetracyclines (used to treat infections). Using these medicines with isotretinoin increases the chance of swelling of the brain. Make sure the physician knows if tetracycline is being used to treat acne or another infection.

Parental Concerns

Acne comes at a difficult time, the adolescent years. While mild acne can be treated with over-the-counter medications, more severe acne needs medical attention. Experts advise against a wait-and-see attitude. Treatment options can help control acne and avoid scarring.

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Sexually active adolescent females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In addition, acne treatments that can dry the skin should be used with caution by people with skin of color.

Benzoyl peroxide and Isotretinoin

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Acne treatments that can dry the skin should be used with caution by people with skin of color.
Tretinoin (Retin-A) is available only with a physician’s prescription. It comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians experienced in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.
Recommended Dosages

The recommended dosage depends on the type of antiacne drug. These drugs usually come with written directions for patients and should be used only as directed by the prescribing physician. Teens who have questions about how to use the medicine should check with their physician or pharmacist.

Patients who use isotretinoin usually take the medicine for a few months, then stop for at least two months. Their acne may continue to improve even after they stop taking the medicine. If the condition is still severe after several months of treatment and a two-month break, the physician may prescribe a second course of treatment.
Precautions

Isotretinoin

Isotretinoin can cause serious birth defects, including mental retardation and physical deformities. This medicine should not be used during pregnancy. Females who are able to bear children should not use isotretinoin unless they have very severe acne that has not cleared up with the use of other antiacne drugs. In that case, a woman who uses this drug must have a pregnancy test two weeks before beginning treatment and each month she is taking the drug. Another pregnancy test must be done one month after treatment ends. The woman must use an effective birth control method for one month before treatment begins and must continue using it throughout treatment and for one month after treatment ends.

Females who are able to bear children and who want to use this medicine should discuss this information with their healthcare providers. Before using the medicine, they will be asked to sign a consent form stating that they understand the danger of taking isotretinoin during pregnancy and that they agree to use effective birth control.
People using this drug should not donate blood to a blood bank while taking isotretinoin or for 30 days after treatment with the drug ends. This will help reduce the chance of a pregnant woman receiving blood containing isotretinoin, which could cause birth defects.
Isotretinoin may cause a sudden decrease in night vision. If this happens, users should not drive or do anything else that could be dangerous until vision returns to normal. They should also let the physician know about the problem.

This medicine may also make the eyes, nose, and mouth dry. Ask the physician about using special eye drops to relieve eye dryness. To temporarily relieve the dry mouth, chew sugarless gum, suck on sugarless candy or ice chips, or use saliva substitutes, which come in liquid and tablet forms and are available without a prescription. If the problem continues for more than two weeks, check with a physician or dentist. Mouth dryness that continues over a long time may contribute to tooth decay and other dental problems.
Isotretinoin may increase sensitivity to sunlight. Patients being treated with this medicine should avoid exposure to the sun and should not use tanning beds, tanning booths, or sunlamps until they know how the drug affects them.

In the early stages of treatment with isotretinoin, some people’s acne seems to get worse before it starts getting better. If the condition becomes much worse or if the skin is very irritated, they should check with the physician who prescribed the medicine.

Skin Care Ingredients to Look For

Before we have a discussion of specific ingredients, it’s important to educate ourselves a little bit more on skin itself and what makes a product good or poor. Your skin is the largest organ of the body. Anything you put on it can be easily absorbed through the pores. When you use skin care products, they are typically applied all over the face, neck, and body. This covers a lot of surface area and, therefore, a great deal of chemical absorption occurs.

The biggest reason our skin, whether on the face or the rest of the body, develops lines and/or starts to sag, is that the collagen and elastin in our skin begins to break down. Collagen is a protein that is fibrous in nature. What makes collagen different from other kinds of protein is that it possesses great tensile strength, which means, among other things, it provides firmness to the skin.

You don’t need to be a scientist, therefore, to understand that as collagen breaks down due to aging, the firmness of our skin becomes…well, less firm. Wrinkles appear and skin starts to sag.

Elastin, too, is a protein that helps skin stay “flexible” and firm. If your skin is stretched, elastin is the protein that helps it return to its original position.

What all of this means for you as a consumer is you do want to avoid buying products that are nothing more than wrinkle or fine line ‘fillers.’ Some creams will give the appearance of plumper fuller skin while it still sits on the surface, but once absorbed or removed, the illusion is gone. Want you want to look for is a product that actually stimulates new collagen and elastin production in your skin. If you achieve this, you will, in reality, begin to turn back the clock.

Unfortunately, some cosmetic manufacturers will include some great ‘active ingredients’ while filling the majority of the product with inferior filler. Because these active ingredients are beneficial for the skin, they include just enough to be allowed to legally list them on the product label. This way, the typical consumer thinks they are getting a great product of high-quality. But, because these ingredients are expensive, and because, many well known companies spend much of their budget on marketing, the amount of these ‘active ingredients’ is limited to have any real benefit for your skin.

So, when choosing a skin care product, it’s not just about selecting one with good ingredients; it’s also about choosing one with a high concentration of these good ingredients.

•    Collagen

After the brief review of the importance of collagen, you would think that buying a product with collagen in it would be a great thing. And the marketers who sell products that contain collagen know this. But, again sadly, collagen molecules are much too large to penetrate into the skin when applied topically and there presence in a beauty product has no effect whatsoever. To be of any benefit, you must purchase a product with ingredients that have been shown to stimulate your body’s own collagen production.

•    Phytessence Wakame

Phytessence Wakame is an exotic kelp, native to the Japanese Sea. It works by blocking a harmful enzyme in your body called hyaluronidase. Hyaluronidase breaks down hyaluronic acid in your skin. Without hyaluronic acid, the elastin and collagen fibers lose their “glue,” which leads to a loss of youthful appearance and dark eye circles. Hyaluronan is a major component of skin, where it is involved in tissue repair.

•    CoQ10

If you look at the ingredient list for some of the better skin care products, you’ll often see CoQ10 listed. CoQ10 is short for Coenzyme Q10, so you may also see it listed this way. CoQ10 is a vitamin like substance that is found in all of our body’s cells and is very important for healthy skin. CoQ10 is a powerful antioxidant. A lot of skin damage and aging comes from free radicals wreaking havoc in our body’s cells. CoQ10’s antioxidant ability can counter these free radicals before damage occurs.

Unfortunately, like many other vital substances, as we age, the amount of CoQ10 in our bodies becomes depleted.

Although CoQ10 is a great ingredient, not all forms are equal. One in particular stands head and shoulders above the rest. This version of it is called Nano-Lipobelle H-EQ10.Most of the CoQ10 you buy in a typical skin care products are not readily usable when applied topically to the skin.

•    Nano-Lipobelle H-EQ10, on the other hand, is a special nano-emulsion form of CoQ10, which penetrates far down into the skin, thereby providing much greater benefits for skin health. In fact, Nano-Lipobelle H-EQ10 has been shown to penetrate seven layers deep into the skin, making it extremely effective at gobbling up free radicals in your skin. The result is a powerful anti-wrinkle effect.