What Are the Treatments for Acne?
The occasional pimple can be concealed. If used at all, over-the-counter cover-up creams and cosmetics should be water-based. Even if outbreaks of acne cannot be eliminated, conventional treatment can provide relief.
The best treatments inhibit sebum production, limit bacterial growth, encourage shedding of skin cells to unclog pores, or a newer treatment that blocks male hormones in the skin. Because many therapies can have side effects, any patient with acne should proceed with caution when trying a new treatment. People with any type of acne that lowers their self-esteem or makes them unhappy, those with acne that is leaving scars or people with severe, persistent cases of acne, need the care of a dermatologist.
Nonprescription Treatment for Acne
Soap and water. Gentle cleansing of the face with soap and water no more than two times a day can help with acne. However, this does not clear up acne that is already present. Aggressive scrubbing can injure the skin and cause other skin problems.
Cleansers. There are many cleansers and soaps advertised for treating acne. They often contain benzoyl peroxide, glycolic acid, salicylic acid, or sulfur.
Benzoyl peroxide. For mild acne, you may try, or your doctor may recommend, treatment with a nonprescription drug that contains benzoyl peroxide. It's believed that this compound works by destroying the bacteria associated with acne. It usually takes at least four weeks to work and it must be used continuously to keep acne at bay. Like many over-the-counter and prescription products, it does not affect sebum production or the way the skin follicle cells are shed, and when you stop using it, the acne comes back. It is available in many forms: creams, lotions, washes, foams, cleansing pads, and gels. Benzoyl peroxide can cause dry skin and can bleach fabrics, so take care when applying it. Consider wearing an old T-shirt to bed if you are applying it to your back or chest overnight.
Salicylic acid. On the skin, salicylic acid helps to correct the abnormal shedding of cells. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on sebum production and does not kill bacteria. It must be used continuously, just like benzoyl peroxide, because its effects stop when you stop using it -- pores clog up again, and the acne returns. Salicylic acid is available in many acne products, including lotions, creams, and pads.
Sulfur. In combination with other substances such as alcohol, sodium sulfacetamide (a prescription medication), and salicylic acid, sulfur is a component of many over-the-counter acne medications. It usually isn't used by itself because of its unpleasant odor and temporary skin discoloration. Sulfur helps to prevent pores from being clogged and inhibits the growth of bacteria. but it has only a marginal benefit in most cases.
Topical retinol gel or creams. Retinol works to keep pimples from being able to form. It affects the growth of cells, causing increased cell turnover to unblock pores. Your acne may appear to get worse before it gets better because it will work on the pimples that have already started forming beneath your skin. It must be used continuously and may take 8-12 weeks to get results. Retinoids used to be available in only a prescription strength. Differin Gel is the only topical retinoid approved as an over-the-counter treatment for acne.
Alcohol and acetone. Alcohol is a mild anti-bacterial agent, and acetone can remove oils from the surface of the skin. These substances are combined in some over-the-counter acne drugs. These agents dry out the skin, have little or no effect on acne, and are generally not recommended by dermatologists.
Herbal, organic, and "natural" medications. There are many herbal, organic, and natural products marketed to treat or prevent acne. The effectiveness of these agents isn't proven and they are unlikely to have much benefit.
Note: When pus-filled pimples are ready to break, apply a hot towel for a few minutes to encourage the natural bursting process. Inflamed pimples should be opened only by a nurse or doctor using surgical instruments and following antiseptic practices. Squeezing pimples yourself may lead to further inflammation and perhaps permanent scars.
Prescription Treatments for Acne
Antibiotics. Antibiotics may be used on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the skin of acne-causing bacteria and reducing inflammation. There are several topical products available in creams, gels, solutions, pads, foams, and lotions. Topical antibiotics are limited in their ability to penetrate the skin and clear more deep-seated acne, whereas systemic antibiotics circulate throughout the body and into sebaceous glands. However, systemic antibiotics often cause more side effects than topicals, but they can be used for more severe kinds of acne. Usually, topical antibiotics aren't recommended alone as an acne treatment, as they can increase the risk for antibiotic resistance in skin bacteria. However, using benzoyl peroxide with a topical antibiotic may reduce the chances of developing antibiotic resistance.
Topical clindamycin (Cleocin T, Clinda-Derm) and erythromycin (Akne-Mycin, ATS, Erycette, Erygel, Ilotycin) are antibiotics that are also anti-inflammatory drugs and are effective against a number of bacteria. They should always be combined with benzoyl peroxide or a topical retinoid and applied directly to the skin. Oral erythromycin is also available, but you may become resistant to its effects, limiting its usefulness.
Other oral antiinflammatory antibiotics often used are doxycycline, minocycline, and tetracycline, all of which are quite effective in many cases of acne.
Antibiotics do not address the other causative factors in acne and may take several weeks or months to clear it up. Antibiotics are often used in combination with other drugs that "unclog" follicles. Many oral antibiotics for acne should not be used during pregnancy.
Retinoids or vitamin A derivatives. These drugs are available as topical or oral drugs. Topical retinoids clear up moderate-to-severe acne by affecting the way the skin grows and sheds. They can be used in combination with other acne products, such as benzoyl peroxide and oral antibiotics. Topical retinoids don't have the severe side effects of oral retinoids; however, they aren't recommended for pregnant or nursing women. Side effects of topical retinoids include redness, dryness, and itchy skin.
For severe cystic acne, isotretinoin (Absorica, Accutane, Amnesteem, Claravis, Sotret, Zenatane) is the most effective therapy. This drug is the only drug that intervenes in all of three of the causes of acne. It can often even clear severe acne that hasn't responded to other treatments. However, the product can have side effects. It can cause severe birth defects and must NEVER be taken by a woman who is pregnant or who is not using contraception. In addition, it shouldn't be taken by a woman who is nursing. Some studies suggest its use has been associated with an increased risk of depression, suicide, and inflammatory bowel disease. Talk to your doctor about the potential risks of this drug.
Other side effects are dry skin and lips, muscle and joint pain, headache, elevated triglyceride levels (a type of cholesterol), elevated liver enzymes, decreased night vision, and, rarely, temporary hair shedding. For most people taking these drugs, side effects are tolerable and not a reason to discontinue therapy before the acne clears up.
Azelaic acid. Another topical is azelaic acid, which comes in a gel, cream or foam and has antibacterial and anti-inflammatory properties. It is more commonly used for another type of condition called rosacea, but it may help mild acne.
Dapsone. Dapsone is a topical gel that is antibacterial and anti-inflammatory.
Oral contraceptives. Birth control pills contain female hormones that work by counteracting the effect of male hormones (such as testosterone) on acne. Their use is limited to female patients. The maximum benefit of oral contraceptives on acne occurs in three to four months. Side effects include nausea, spotting, breast tenderness, and blood clots.
Spironolactone(Aldactone). Spironolactone is an oral drug that can block the action of the body’s hormones on the skin’s oil glands. This medication is not FDA-approved for acne, but is especially helpful for women who have acne that worsens around the time of menstruation and menopause.
Clascoterone (Winlevi) is a newly approved topical treatment for moderate to severe acne which is considered an alternative to spironolactone. It targets the hormones that cause acne. Just how it works is not quite understood but it has been found to reduce acne in both males and females over the age of 12.
Another common drug your doctor may try is triamcinolone, a type of corticosteroid solution that is injected directly into acne nodules.
Warning About Acne Treatments
Patients taking acne drugs should be alert to possible side effects and interactions with other drugs and herbal remedies.
The topical retinoids and benzoyl peroxide can leave skin reddened, dry, and sensitive to sunlight.
Oral antibiotics may cause sensitivity to sunlight and stomach upset.
Benzoyl peroxide may inhibit the effects of some topical retinoids, so never apply them at the same time of day.
Taking oral antibiotics for more than a few weeks may leave women susceptible to yeast infections.
Some over-the-counter acne products can cause rare but serious allergic reactions or severe irritation. Seek emergency medical attention if you have symptoms such as throat tightness, difficulty breathing, feeling faint, or swelling of the face or tongue. Also stop using the product if you develop hives or itching. Symptoms can appear anywhere from minutes to a day or longer after use.
Acne Scar Treatments
Some adults carry scars from acne. Some relatively aggressive surgical procedures can improve scars. Procedures include dermabrasion, several types of lasers, and chemical peeling. These procedures remove the scarred surface and expose unblemished skin layers. Dermatologists may also use the following:
- microneedling to stimulate collagen and lessen the appearance of scars
- subcision where a needle is used under the scars to break them up
- fillers, which are injections under the scars to lift them up to the surrounding skin surface
Dermatologists may use more superficial peels such as glycolic or salicylic acid help to loosen whiteheads and blackheads and decrease pimples.
Microdermabrasion has little effect on acne itself, but is effective in combination with lasers. Before considering any treatment it is important to discuss the procedures, necessary precautions, and likely results with a doctor.
How Can I Prevent Acne?
Because of acne's association with fluctuating hormone levels and possible genetic influences, many doctors believe there is no way to prevent it. The accepted wisdom is that neither good hygiene nor diet can prevent outbreaks. Treatments can control acne and minimize future breakouts. Sensible skin care is recommended, especially during adolescence. The basics include a daily bath or shower and washing the face and hands with unscented or mildly antibacterial soap.
Other tips for preventing future outbreaks include:
- Use non-comedogenic or sensitive skin products to reduce the chance of new lesions and minimize skin irritation.
- Use a mild cleanser twice a day.
- Avoid cleansers or products that contain scrubbing particles or have a gritty texture. These products can irritate the skin and lead to breakouts.
- Use a daily non-comedogenic moisturizer and broad-spectrum sunscreen (SPF 30 with zinc oxide).
- Wear makeup that is non-comedogenic.
- Avoid picking, squeezing, or popping pimples. This can lead to scarring and skin infections.
