Hi There,
Thanks for writing in.
I am a medical specialist with an additional degree. I read your mail with diligence. Here I am going to run through all the POSSIBLE treatment, some of which your friend has tried skip those and move on to the next. If your friend has not considered it please write back in followup query reasons there far. I guess

Types of acne treatments include:
1. Over-the-counter topical treatments. Acne lotions may dry up the oil, kill
bacteria and promote sloughing of dead skin cells. Over-the-counter (OTC)
lotions are generally mild and contain benzoyl peroxide, sulfur, resorcinol,
salicylic acid or sulfur as their active ingredient. These products can be helpful
for very mild acne. OTC acne medications may cause initial side effects — such
as skin irritation, dryness and flaking — that often improve after the first month
of therapy. He must have tried some of these. So you can skip this one

2. Topical treatments available by prescription. If his acne doesn't respond to
OTC treatments, consider seeing a doctor or dermatologist to get a stronger
prescription lotion. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and
tazarotene (Tazorac, Avage) are examples of topical prescription products
derived from vitamin A. They work by promoting cell turnover and preventing
plugging of the hair follicles. A number of topical antibiotics also are available.
They work by killing excess skin bacteria. I am not sure a dermatologist has
treated him. Even so, consult a different Dermatologist now. Start afresh.

3. Often, a combination of such products is required to achieve optimal results. A
number of benzoyl peroxide and antibiotic combination medications are
available, including different dose combinations of benzoyl peroxide and
clindamycin (Benzaclin, Duac, Acanya) and benzoyl peroxide and erythromycin
(Benzamycin). Dapsone gel (Aczone) is a newer acne treatment that's
particularly effective in treating inflammatory acne. Prescription topical
treatments for acne may cause skin side effects, such as stinging, burning,
redness or peeling. Your doctor may recommend steps to minimize these side
effects, including using a gradually increased dose, washing off the medication
after a short application or switching to another medication.

4. Antibiotics. For moderate to severe acne, you may need a short course of
prescription oral antibiotics to reduce bacteria and fight inflammation. Since
oral antibiotics were first used to treat acne, antibiotic resistance has
increased significantly in people with acne. For this reason, your doctor likely
will recommend tapering off these medications as soon as your symptoms begin
to improve, or as soon as it becomes clear the drugs aren't helping — usually,
within three to four months. In most cases, you'll use topical medications and
oral antibiotics together. Studies have found that using topical benzoyl
peroxide along with oral antibiotics may reduce the risk of developing antibiotic
resistance. Antibiotics may cause side effects, such as an upset stomach,
dizziness or skin discoloration. These drugs also increase your skin's sun
sensitivity and may reduce the effectiveness of oral contraceptives.

5. Isotretinoin. For XXXXXXX cysts, antibiotics may not be enough. Isotretinoin
(Amnesteem, Claravis, Sotret) is a powerful medication available for scarring
cystic acne or acne that doesn't respond to other treatments. This medicine is
reserved for the most severe forms of acne. It's very effective, but people who
take it need close monitoring by a dermatologist because of the possibility of
severe side effects. Isotretinoin commonly causes side effects — such as dry
eyes, mouth, lips, nose and skin, as well as itching, nosebleeds, muscle aches,
sun sensitivity and poor night vision. The drug may also increase the levels of
triglycerides and cholesterol in the blood and may increase liver enzyme levels.
In addition, isotretinoin may be associated with an increased risk of depression
and suicide. Although this causal relationship has not been proved, doctors
remain on alert for these signs in people who are taking isotretinoin. If you feel
unusually sad or unable to cope while taking this drug, tell your doctor
immediately. So this is one drug, doctor may not prescribe to him!

7. Laser and light therapy. Laser- and light-based therapies reach the deeper
layers of skin without harming the skin's surface. Laser treatment is thought to
damage the oil (sebaceous) glands, causing them to produce less oil. Light
therapy targets the bacteria that cause acne inflammation. These therapies
can also improve skin texture and lessen the appearance of scars. More
research is needed to understand the most effective use of light and laser
therapies in acne treatment, and experts currently recommend these
approaches as stand-alone therapy only in people who can't tolerate approved
acne medications. These therapies may be uncomfortable and may cause
temporary skin problems that mimic a severe sunburn.
8. Cosmetic procedures. Chemical peels and microdermabrasion may be helpful in
controlling acne. These cosmetic procedures — which have traditionally been
used to lessen the appearance of fine lines, sun damage and minor facial scars
— are most effective when used in combination with other acne treatments.
They may cause temporary, severe redness, scaling and blistering, and long-
term discoloration of the skin.

Secondary depression in such situation is not uncommon, and how sure are you that all the avenues of treatment has been visited? Re assure him. May be he gets
lucky this time.
If you have any query for me I shall be happy to answer.

With Best Wishes
Dr Anil Grover,
Cardiologist
M.B.;B.S, M.D. (Internal Medicine) D.M.(Cardiology)
http://www/ WWW.WWWW.WW

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