Medicine for acne : Corticosteroids

Corticosteroids.
Corticosteroids can be considered in recalcitrant cases of acne not responsive to oral contraceptives or spironolactone and for patients with elevated DHEAS. Corticosteroids can be used alone or in combination with oral contraceptives and antiandrogens. Elevated DHEAS indicates adrenal androgen overproduction. Either dexamethasone (0.125 to 0.5 mg at bedtime) or prednisone (2.5 to 7.5 mg at bedtime and 2.5 mg on waking) is prescribed. Low-dose steroids administered at bedtime prevent the pituitary from producing extra ACTH and thereby reduce the production of adrenal androgens. Dexamethasone may be the more rational choice for adrenal suppression with its longer duration of action. The drug is given at bedtime so that effective levels will be present during the early morning hours when ACTH secretion is most active. Initial dosage should be dexamethasone 0.25 mg or prednisone 2.5 mg, and the dosage should be increased to dexamethasone 0.5 mg or prednisone 5.0 to 7.5 mg if the DHEAS level has not been lowered after 3 to 4 weeks of treatment. Therapy is continued for 6 to 12 months, but the benefits may persist beyond that. This low dosage produces a clinical improvement and suppresses DHEAS levels. At these dosages, few patients experience shutdown of the adrenal-pituitary axis or other adverse effects of the drug. ACTH stimulation tests or early morning cortisol levels may be performed every few months to make sure that there is no adrenal suppression. Not all patients respond.