High costs cited as major reason patients do not adhere to their treatments

Has anybody seen the changes in the cost of medications lately? In case you have not noticed, they have soared completely out of control. For example, a bottle of 100 doxycycline capsules used to cost about $4. Today that same bottle is well over $100.  Patients are faced with high copayments for their medications, which is leading to problems of affordability.

Physicians need to play their part too. All to often I see physicians prescribing expensive medications when a suitable generic alternative is available at a fraction of the cost.

Here are my simple recommendations:

Over-the-counter topical medications:

  • Differin Gel 1% — In 2017 this went over the counter. It is great for unclogging pores. There is no reason to get tretinoin (Retin A) or any other topical retinoid before using this for several months. The average cost is $18
  • Benzoyl Peroxide 2.5% – 5% gel–this is great at killing the bacteria that causes acne. in fact, there is nothing better.  This medication will bleach clothes and sheets so be careful. The average cost is about $5-10.
  • Benzoyl Peroxide 10% wash–this works well for acne on the back, chest, and shoulders. Use this once or twice day to these areas in the shower. Use towels that you do not like as they will get discolored.
  • Salicylic Acid–there are many preparations for this which helps to unclog the pores. It does not work nearly as well as Differin, but it can be used in addition to it.
  • Glycolic Acid–there are many preparation for this which also helps to unclog the pores. Some preparation combine this with salicylic acid. The two together work very well, but still not as well as Differin gel.

Always ask  your doctor if one of these above options will be suitable, as they will be FAR cheaper than prescription medications.

Those with deep seated cysts will require oral medications, which are available by prescription only.

Always request generic medications. You can always price them out on goodrx.com and get coupons with that site. For medications that are not covered, try to find one that is covered. In most cases, this insurance carrier is telling you that there is a cheaper alternative that can be prescribed. If you are paying for the medication or have a high copay for it, shop around.

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CO2 Laser a Good Option for Acne Scar Treatment

Acne scars remains one of the most challenging condition to treat. In short, there is no one single treatment that is best for everyone. That being said, I see many patients whom are extremely frustrated after trying treatments that are not effective for their type of acne.

The carbon dioxide (CO2) laser is an effective treatment for atrophic (slightly depressed) scars. In the recent years, it has been used less as others are trying “simpler” procedures with little or no downtime, although with far less benefit. In this study over 77% of participants reported at least mild improvement, while 40% of the participants noted moderate to significant improvement.

That being said, this is not the only treatment for this type of scarring. Dermabrasion and medium depth chemical peels (i.e. TCA – trichloroacetic acid) are good options as well. Short term options include fillers, such as Restylane.

Citation: Elcin G, Yalici-Armagan B. Fractional carbon dioxide laser for the treatment of facial atrophic acne scars: Prospective clinical trial with short and long-term evaluation. 2017;32(9):2047-2054. doi:10.1007/s10103-017-2322-7.

The Acne One-Two Punch–the best over-the-counter treatment

Finally, patients are able to self-treat mild to moderate inflammatory and comedonal acne with over-the-counter treatments.

Blackheads and whiteheads can now be treated effectively with Differin gel, which went over-the-counter earlier this year. This medication is similar to Retin A, the drug everyone knows about. These medications help to unclog pores are and more effective than any other over-the-counter medication.

Inflammatory lesions, such as red bumps and pustules, can be treated using a 5% benzoyl peroxide gel (use 5% or less as higher concentrations result in more skin irritation).

I do not recommend spot treating as acne is a chronic disease, so the idea is to treat the lesions that one has, but we also want to prevent new lesions from coming up.

Those with cystic or very inflammatory lesions will benefit from oral antibiotics and/or Accutane, both of which require a prescription.

Those with scarring should seek professional advice from a board-certified Dermatologist as soon as possible.

Diet & Acne: What to avoid

For decades, we have told patients that there were no studies to support that drinking soda made acne worse, although if that was their experience then they should not consume soda. Over the recent years, more and more evidence has emerged showing that diet can affect acne. The first study showed that drinking non-organic milk may exacerbate acne. Recently a study published in the The Journal of Academic Nurtition (J Acad Nutr Diet. 2017 Jun 9. doi: 10.1016/j.jand.2017.03.024 ) showed that consuming high-glycemic index carbohydrates is correlated with worsening of acne. 

In short, the recommendations have not changed–for all persons, eating a good healthy diet is recommended. What has changed is the evidence showing that poor eating habits is connected with worsening of acne. For all of my patients, acne or not, I recommend avoiding white rice, white potatoes, white flour, and sugar in their diet. Unfortunately, most of my patients, with or without acne, consume a large amount of these high-glycemic index foods, which contributes to obesity, fatigue, and the development of type II diabetes.