Andover resident Angela Hartschen’s skin troubles started as a teenager.
For her, it wasn’t just a smattering of pimples but “big, horrible, angry red acne” that was as painful as it was unsightly.
“In pure desperation, I’ve tried it all,” she said. “I don’t want to walk around looking like I’m 13 at 34.”
Hartschen’s acne treatments over the years often have included antibiotics.
In the past year, though, one Wichita dermatologist has altered entirely the way he treats acne because of concerns about the overuse of antibiotics. The problem, said Steven Passman of Mid-Kansas Dermatology, is that bacteria are becoming resistant to antibiotics, leaving doctors fewer options for fighting life-threatening staph infections.
“Patients want you to do something,” he said. “We’ve all (as doctors) gotten very callous about it.”
Passman is not Hartschen’s doctor, but she had her own reasons for looking beyond antibiotics. For one, they didn’t seem to be that effective on her acne. She also was not thrilled with the notion of being on antibiotics for the long term.
“To me, it doesn’t seem ideal,” she said.
So what’s the solution?
For Hartschen, whose acne is hormonally based, the answer has been spironolactone, an anti-androgen drug. Hartschen was able to start on it after she finished breast-feeding her third child. The drug is not a miracle fix – Hartschen still has significant flare-ups – but her skin is vastly improved.
Spironolactone is in Passman’s repertoire for women with hormonally induced acne – helping the body to produce less of the oil that clogs pores – but it is not appropriate for male patients, for pregnant women or for other types of acne, he said. Often, antibiotics still represent the best course of treatment for those patients.
In the past, when a patient’s acne indicated a need for an antibiotic, Passman used three varieties that also happened to be first-line drugs for fighting staph infections.
“I have virtually stopped using those drugs,” he said.
Passman also has stopped using topical antibiotics. Instead, his first move is to try less-common cephalosporin antibiotics.
“No matter what we do, we are going to increase resistance,” Passman said.
Topical treatments can include Retin-A or benzoyl peroxide, depending on the type of acne.
For a time, the drug Accutane garnered a lot of attention. Patients clamored for it and then became concerned about reports linking it to suicidal thoughts as a side effect. Accutane’s maker pulled the drug from the U.S. market, but Passman said the same drug, isotretinoin, is still available under different names.
He uses it where it is warranted: namely, when a patient has scarring, fails to respond to antibiotics and has the nodulocystic form of the disease.
Passman recommends a mild soap or Dove for sensitive skin for face washing.
“Wash your face once a day – not because it will make your acne better, but it will make your mother happy,” he said.
Hartschen’s neighbor Jaime McLain also has hormonally-induced acne. She took Accutane as a teenager, and then the birth-control pill she took kept her acne in check for many years.
“As soon as I turned 35, I started having issues again,” McLain says. “My acne came back, and it didn’t matter how clean my face was. “
McLain traded notes with Hartschen and also found relief in spironolactone, noticing significant improvement in just a month.
“It’s like night and day,” McLain said.