Acne Treatment
Acne Treatment
Today, virtually every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that:
Resolution takes time. Treatments that promise “fast,” miraculous” or “overnight” results often capture the attention of acne sufferers hoping for quick resolution. However, the fact remains that acne does not clear overnight. On average, 6 to 8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.
What works for one person may not work for another. What is an appropriate treatment for one person may not clear another’s acne because many factors affect resolution, including the cause(s) of the acne, a person’s skin type and the kind of acne lesions present.
A dermatologist’s help may be required. With so many factors affecting clearance and a multitude of treatment options available (some only by prescription), a dermatologist’s help can make a difference. Before prescribing treatment, dermatologists consider several factors, including the severity of the acne, types of lesions present, co-existing conditions, as well as the patient’s age, skin type, lifestyle and motivation.
The knowledge gained from considering these factors allows dermatologists to create effective individualized therapy that will resolve the patient’s acne over time and prevent new lesions from forming.
Sometimes a dermatologist may combine two or more treatment options. A patient may be instructed to use one medication in the morning and the other at night. Or, two medications may be combined in one prescription medication. Due to possible side effects, over-the-counter medications should not be combined unless directed by a dermatologist or other medical practitioner.
Acne responds especially well to early treatment. Dermatologists recommend that acne be treated early to maximize effectiveness as well as help prevent scarring.
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Acne Therapies
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More About Treating Acne
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Treating Mild Acne
Mild acne consists of small lesions, such as blackheads, whiteheads or pustules, which appear at or near the surface of the skin. As such, mild cases of acne can sometimes be controlled at home by:
Gently washing the affected area(s) with warm water and a mild soap twice a day to remove dead skin cells and excess oil
Using a topical (applied to the skin) over-the-counter acne treatment containing benzoyl peroxide or salicylic acid
Following the 12 Ways to Get Better Results from Acne Treatment
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Most mild acne can be controlled by gently washing the affected area(s) and using a topical preparation, such as benzoyl peroxide. |
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At-home treatment requires 4-8 weeks to see improvement. Once acne clears, treatment must be continued to prevent new lesions from forming.
Even mild cases of acne may require the help of a dermatologist. If the acne does not respond to at-home treatment, a dermatologist can assess the situation and determine an appropriate therapy. In these cases, combination therapy (two or more treatments) may be used. Combination therapy may include use of a prescription topical antimicrobial or topical retinoid. These prescription topicals can be very effective in clearing mild acne.
Treating Moderate to Severe Acne
In moderate to moderately severe acne, numerous whiteheads, blackheads, papules and pustules appear that cover from ¼ to ¾ of the face and/or other affected area(s). Moderate to moderately severe acne usually requires the help of a dermatologist and combination therapy (using two or more treatment options). Treatments used to treat moderate to moderately severe acne are:
Physical methods, such as comedo extraction or light therapy
Prescription Medications
Over-the-counter topical acne medications
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Dermatologists recommend early treatment for moderate to moderately severe acne |
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Dermatologists recommend early treatment for moderate to moderately severe acne because when moderate to severe acne is not treated early, scars can develop. Acne scars take two forms—as raised thickened tissue or as a depression, such as pits or pock marks. The only reliable method of preventing or limiting the extent of these scars is to treat acne early in its course, and for as long as necessary. Additionally, anyone with acne who has a known tendency to scar should be under the care of a dermatologist.
Treating Severe Acne
Severe acne is characterized by deep cysts, inflammation, extensive damage to the skin and scarring. It requires an aggressive treatment regimen and should be treated by a dermatologist. Severe, disfiguring forms of acne can require years of treatment and may experience one or more treatment failures. However, almost every case of acne can be successfully treated.
Physical methods and prescription medications that dermatologists use to treat severe acne include:
Drainage and Surgical Excision
Some large cysts do not respond to medication and may require drainage and extraction. Drainage and extraction, or “acne surgery” as it is also called, should not be performed by patients. Dermatologists are trained in the proper technique and perform acne surgery under sterile conditions. Patient attempts to drain and extract comedones by squeezing or picking, can lead to infection, worsening of the acne and scarring.
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Severe acne requires an aggressive treatment
regimen and should be treated by a dermatologist. |
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Interlesional Corticosteroid Injection
When an acne cyst becomes severely inflamed, there is a good chance it will rupture and scarring may result. To treat these severely inflamed cysts and prevent scarring, dermatologists may inject such cysts with a much-diluted corticosteroid. This lessens the inflammation
and promotes healing. An interlesional corticosteroid injection works by "melting" the cyst over a period of 3 to 5 days.
Isotretinoin
Isotretinoin is a potent drug reserved for treating severe cystic acne and acne that has proven itself resistant to other medications. Isotretinoin is a synthetic (man-made) retinoid (form of vitamin A) that comes in pill form. It is usually taken once or twice a day for 16 to 20 weeks.
Today, it is the most effective acne treatment available because it is the only acne treatment that works on all four factors that predispose a person to acne - excess oil production, clogged skin pores, P. acnes and inflammation. The remissions achieved with isotretinoin usually last for many months to many years. For many patients, only one course of isotretinoin therapy is needed.
The effectiveness of isotretinoin in treating severe acne is shown in the following before-and-after photos:
Severe acne before treatment with isotretinoin |
After treatment with isotretinoin |
While isotretinoin is the most effective acne treatment available, it cannot be prescribed to everyone due to a number of potential side effects—some serious. One of the most serious side effects is the potential to cause severe birth defects in a developing fetus. For this reason, the U.S. Food and Drug Administration (FDA) requires that women not be (or become) pregnant while taking isotretinoin. FDA regulations require women of childbearing age to take 2 pregnancy tests prior to beginning isotretinoin therapy and use 2 forms of birth control for 1 month before therapy begins, while taking the drug and for 1 full month after therapy. It is also important that women not breast feed during this time. Women who wish to become pregnant after taking isotretinoin should talk to their dermatologist and gynecologist about when it is safe to get pregnant after receiving isotretinoin therapy.
Other possible severe side effects that may occur while taking isotretinoin include:
Severe pain in the chest or abdomen
Trouble swallowing or painful swallowing
Severe headache, blurred vision or dizziness
Bone and joint pain
Nausea or vomiting
Diarrhea or rectal bleeding
Depression
Dryness of the skin, eyes and nose
Thinning hair
If any side effect occurs, the patient’s dermatologist or other healthcare practitioner should be contacted immediately because some of these side effects can lead to serious health problems.
While taking isotretinoin, patients are regularly monitored for side effects through follow-up visits. For most people, these side effects are tolerable and not a reason to discontinue therapy before remission is achieved. However, it is important to keep appointments for follow-up visits because monitoring can reveal conditions that a patient might not notice. For example, a patient may not realize a rapid increase in bad cholesterol that is detected through a blood test.
The decision to use isotretinoin should be made jointly by patient and dermatologist. When used with all due caution under close medical supervision, isotretinoin can resolve severe acne that has not responded to other therapy. It has proven especially effective in resolving cystic acne, a severe form of acne that usually does not respond to other therapies.
For a substantial number of patients, one course of isotretinoin therapy is all they will ever need. A small number of patients require more than one course of isotretinoin therapy to control severe acne.
It is important to take isotretinoin as prescribed—even if the skin clears before all of the pills have been taken—to prevent relapse. At the end of an effective course of isotretinoin therapy, all or most of the acne lesion will have cleared. Patients may notice residual erythematous (reddish) macules (flat spots) where acne lesions were present. These macules are not scars, and they will fade in 6 to 8 weeks.
After therapy, patients should continue to follow the 12 Ways to Get Better Results from Acne Treatment.
Oral Antibiotics
Oral antibiotics have been a mainstay of therapy for severe acne for many years. Like topical antibiotics, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation. Treatment with oral antibiotics usually begins with a high dosage, which is reduced as the acne resolves. Over time, the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When this happens, another antibiotic can be prescribed. Numerous studies support the effectiveness of the following broad-spectrum oral antibiotics that are used to treat acne in the United States: doxycline, erythromycin, minocycline and tetracycline. For information about each of these oral antibiotics, see Prescription Acne Medications.
Oral Contraceptives
Oral contraceptives have been shown to effectively clear acne in women by suppressing the overactive sebaceous glands. Oral contraceptives can be used as long-term acne therapy; however, this medication should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynecologist.
Spironolactone, a synthetic steroid, may be used in combination with oral contraceptives to treat acne in adult females. Spironolactone inhibits androgen production. Side effects include irregular menstruation, breast tenderness, headache and fatigue.
Acne Therapies
Over-the-Counter Products
Used to treat mild, moderate and severe acne, the effectiveness of over-the-counter medications lies in the product’s active ingredient(s). Not all active ingredients work the same way. The active ingredient benzoyl peroxide reduces P. acnes; whereas, salicylic acid helps correct abnormal skin shedding. For lesions to clear, the product(s) must be effective against the factor(s) causing the acne. The following describes common active ingredients used in over-the-counter acne medications sold in the United States. Check with your dermatologist or pharmacist before combining acne products.
Alcohol and acetone
Found together in some over-the-counter medications used to treat acne, acetone works as a degreasing agent and alcohol has mild antimicrobial properties. When used alone, acetone tends to have no effect.
Benzoyl peroxide
The mainstay of over-the-counter acne treatment, benzoyl peroxide works to clear up acne by reducing P. acnes and removing dead cells from the skin to prevent comedones. It was one of the first agents found to be effective in treating mild acne and has been used in acne treatment for decades. The principal side effect is excessive dryness of the skin, so be sure to follow directions and not use more than stated unless otherwise instructed by a physician. Care should also be taken when applying it to avoid the bleaching effect. Benzoyl peroxide has been known to bleach hair, sheets, towels and clothing. For this reason, an old shirt should be worn after applying benzoyl peroxide to acne on the back or chest. Benzoyl peroxide is available over-the-counter as a lotion or gel. Use of benzoyl peroxide should be continued after acne clears to prevent new lesions from forming.
“Herbal,” “organic” and "natural" products
Over-the-counter products labeled “herbal,” "organic" or "natural" are marketed as acne treatments but their effectiveness has rarely been tested in clinical trials. The value of such treatments is generally unknown.
Resorcinol
A popular ingredient in over-the-counter acne medications, resorcinol controls small acne lesions and is frequently combined with sulfur in over-the-counter products.
Salicylic acid
Effective in treating non-inflammatory acne lesions, salicylic acid helps correct the abnormal shedding of skin cells and unclog pores to resolve and prevent lesions. Salicylic acid does not have any effect on sebum production or P. acnes. Like benzoyl peroxide, salicylic acid must be used continuously. Once stopped, pores clog and acne returns. Salicylic acid is found in many over-the-counter acne products, including lotions, creams and pads. It may be irritating to the skin.
Sulfur
Sulfur has been used for more than 50 years in combination with other agents, such as alcohol, salicylic acid and resorcinol and is found in many over-the-counter acne medications. While long used to treat acne, it is not known how sulfur works to clear acne. Due to its unpleasant odor, sulfur is not frequently used alone as an acne treatment.
Physical Procedures for Treating Acne
Dermatologists occasionally use procedures to help clear acne. These methods, which are described below, should be performed by a dermatologist or other health care practitioner. Trying these at home can lead to infection, worsening of the acne and scarring.
Chemical Peels
Light chemical peels of glycolic acid and other chemical agents are used by dermatologists to loosen blackheads and decrease acne papules.
Comedo Extraction
Sometimes removing comedones proves beneficial. To extract whiteheads and blackheads, dermatologists use a sterile pen-sized device. This procedure should only be performed by a dermatologist or other medical professional. Patients’ attempts to extract comedones and drain cysts by squeezing or picking, can lead to worsening of the acne, scarring and infection. Tissue injured by squeezing or picking can become infected by staphylococci, streptococci and other bacteria.
Drainage and Surgical Extraction
Some large cysts do not respond to medication and may require drainage and extraction. Drainage and extraction, which is also called “acne surgery,” reduces the pain associated with these cysts and decreases the likelihood of scarring. It should not be performed by patients. Patients’ attempts to drain cysts or extract comedones by squeezing or picking, can lead to infection, worsening of the acne and scarring. Dermatologists are trained in the proper technique and perform “acne surgery” under sterile conditions.
Phototherapy (Laser and Light Treatments)
Several laser and light treatments are available to treat acne. Some of these laser and light treatments target only one factor that causes acne—P. acnes. For many patients, this is not a comprehensive treatment for resolving their acne. A dermatologist can determine if laser or light treatment is appropriate for a patient.
Advantages to laser and light treatments include not having to remember to apply or take any medication and the ability to treat hard-to-reach areas, such as the back. However, laser and light treatments can be quite expensive, and long-term effectiveness has not been proven.
Over the last several years, laser technology has also assumed an increasingly important role in the treatment of acne scars.
Anyone considering laser or light therapy should consult a dermatologist experienced in providing the therapy. Don’t be afraid to ask questions about the physician’s experience and qualifications.
Prescription Medications for Treating Acne
A variety of prescription medications are used today to clear acne. Topical (applied to the skin) medications may be prescribed for mild to severe acne. Systemic (works internally) therapy is needed to treat severe acne and may be used for moderate cases. These medications, which play an important role in acne treatment, attack the different factors that lead to acne. To achieve long-term control and resolution, dermatologists may combine therapies. The following describes the prescription medications used in the United States to treat acne:
Interlesional Corticosteroid Injection
When an acne cyst becomes severely inflamed, there is a good chance that it will rupture and scarring may result. To treat these severely inflamed cysts and prevent scarring, dermatologists may inject such cysts with a much-diluted corticosteroid. This lessens the inflammation and promotes healing. An interlesional corticosteroid injection works by "melting" the cyst over a period of 3 to 5 days.
Isotretinoin
Isotretinoin is a potent oral retinoid that is reserved for treatment of very severe cystic acne and severe acne that has proven itself resistant to other medications. For more information about isotretinoin, see Treating Severe Acne.
Oral Antibiotics
For patients with moderate to severe and persistent acne, oral antibiotics have been a mainstay of therapy for years. Like topical antimicrobials, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation. Treatment with oral antibiotics usually begins with a higher dosage, which is reduced as acne resolves. Generally, antibiotics are prescribed for six months or less.
Over time, the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When resistance occurs, acne is no longer controlled. Another antibiotic or alternative treatment can be prescribed. Numerous studies support the effectiveness of the following oral broad-spectrum antibiotics, which are used to treat acne in the United States:
Erythromycin. It is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.
Tetracycline and derivatives. Tetracyclines reduce the papules and pustules (inflammatory lesions) of acne. These medications should not be taken by children younger than 8 years of age because they can affect growth and stain teeth. They should also not be taken by a woman who is pregnant or breast feeding. During pregnancy and breastfeeding, tetracyclines can affect the development of the child’s bones and teeth, leading to skeletal defects.
A typical tetracycline regimen for treating moderate to severe acne starts with a dose of 500 to 1000 milligrams a day, which is decreased as improvement occurs. Long-term, low-dose tetracycline therapy may be continued for many months to suppress acne. Higher doses may be prescribed for very severe acne.
Two synthetic derivatives of tetracycline used to treat acne are doxycycline and minocycline. Doxycycline proves especially effective in treating inflammatory acne. It can cause sun sensitivity in some patients. Minocyline has a long history of use in treating acne. It is often effective in treating acne that has not responded to other oral antibiotics. Minocycline also seems to produce fewer incidents of antibiotic resistance.
Oral Contraceptives
Oral contraceptives have been shown to effectively clear acne in women by suppressing the overactive sebaceous glands and can be used as long-term acne therapy. However, oral contraceptives should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynecologist.
Topical Antimicrobials
Topical antimicrobials work to inhibit the P. acnes populations and are used to treat patients with mild to moderately severe inflammatory acne. They may be used alone or combined with a medication that works on another factor that leads to acne aside from P. acnes. A dermatologist can determine whether a topical antimicrobial is appropriate for a patient and if so which topical antimicrobial should be prescribed. Prescription topical antimicrobials used to treat acne vulgaris in the United States include:
Azelaic acid. Naturally occurring in the skin, azelaic acid is used to treat mild to moderate inflammatory and non-inflammatory acne. It is believed that azelaic acid clears acne by reducing the populations of P. acnes, decreasing the abnormal shedding of skin cells and reducing inflammation. This medication has also proven effective in treating the dark spots that develop in some acne patients with skin of color. Azaleic acid is well tolerated by most people and can be safely used for years. Side effects may include skin dryness and lightening of the skin where applied.
Benzoyl peroxide. Benzoyl peroxide works by killing P. acnes. However, it does not have anti-inflammatory abilities. It is available in a wide range of strengths and can be found as a gel, lotion, cleanser, cream and wash. Many acne preparations include benzoyl peroxide because research shows that benzoyl peroxide increases the effectiveness of some medicines, such as erythromycin and clindamycin. When used in combination with antibiotics, benzoyl peroxide also reduces the likelihood of a patient developing resistance to the antibiotic. The most common side effects are skin irritation, the potential to bleach hair and fabrics as well as possible allergic reaction
Clindamycin. A semi-synthetic antibiotic, topical clindamycin has a long history of successfully treating acne. It works by reducing P. acnes and decreasing inflammation. In topical form, clindamycin has proven safe and is well tolerated. Skin dryness and irritation are possible side effects. It is important to use as directed to decrease bacterial resistance that can occur with antibiotic use
Erythromycin. This topical antibiotic is active against a broad spectrum of bacteria, including P. acnes. Topical erythromycin, which is an antimicrobial and anti-inflammatory, is used primarily to treat acne. When topical erthyromycin is combined with benzoyl peroxide, the combination proves to be quite effective as the patient gets the effects of two antimicrobial agents. Like topical clindamycin, erythromycin may cause skin dryness and possible irritation. It is important to use as directed to decrease bacterial resistance that can occur with antibiotic use
Sodium sulfacetamide. A topical antibiotic that inhibits P. acnes and opens clogged pores, sodium sulfacetamide is effective in treating inflammatory acne. Many products containing sodium sulfacetamide include sulfur. Some patients do not like the smell of the sulfur or its grittiness. Usually, the newer products that contain sulfur do not have these problems.
Topical Retinoids
Prescribed to treat acne ranging from mild to moderately severe, topical retinoids are a derivative of vitamin A and considered a cornerstone in acne treatment. Retinoids work to unclog pores and prevent whiteheads and blackheads from forming. Topical retinoids can irritate the skin and increase sun sensitivity so it is important to use sun protection and follow the dermatologist’s directions to maximize effectiveness. An added benefit in using topical retinoids is that they may help diminish the signs of aging, such as fine lines and wrinkles. Topical retinoids currently prescribed for acne treatment in the United States include:
Adapalene. A synthetic retinoid applied as a gel or cream, adapalene unclogs pores and possesses moderate to potent anti-inflammatory abilities. Improvement is usually seen in 8 to 12 weeks. Side effects include minor skin irritation and dryness
Tazarotene. A synthetic retinoid available as a gel or cream, it works to keep the skin’s pores clear and has proven effective in treating acne. This medication should not be used by women who are pregnant, and effective contraception is needed while taking tazarotene because the medication has produced birth defects in animals. Skin irritation is a possible side effect
Tretinoin. The first retinoid developed for topical use, tretinoin is a natural retinoid. It works to gradually unclog pores and keep them unplugged. In the past, many patients found tretinoin too harsh for their skin; however, the newer forms are proving less irritating. Side effects include redness, scaling, dryness, itching and burning. If these occur, talk with the dermatologist who prescribed tretinoin as these side effects can be managed by adjusting the amount applied and when it is applied.
More On Treating Acne
Acne Medications Not for Use During Pregnancy
Some potent acne medications must not be used by women who are pregnant or who may become pregnant because of the potential harm to a fetus. These medications include:
Women in their child-bearing years need to avoid pregnancy while using these medications.
Here’s the lowdown on why these medications should not be used during pregnancy:
Hormone therapy
The “female” hormone, estrogen, and the anti-androgens, flutamide and spironolactone, are sometimes used to treat acne in women. None should be taken while a woman is pregnant. Flutamide and spironolactone can cause birth defects. It is not known if these medications can be passed along when a woman is breast feeding so the medications must also not be used if a woman chooses to breast feed.
Isotretinoin
Isotretinoin must not be used by a woman who is pregnant, trying to become pregnant or breast feeding.
This potent acne medication has revolutionized acne therapy due to its effectiveness in treating severe and therapy-resistant acne. However, isotretinoin also has the potential to cause some serious side effects. The most serious is the potential to cause severe birth defects in a developing fetus. For this reason, it is imperative that women taking isotretinoin follow the pregnancy-prevention program. This requires using 2 forms of birth control continuously beginning 1 month before therapy starts and not ending until 1 month after isotretinoin therapy is complete. A women taking isotretinoin must also be carefully monitored by her dermatologist during therapy. If pregnancy occurs, isotretinoin must be stopped immediately. Women planning a pregnancy should discontinue taking isotretinoin and maintain birth-control methods for at least 1 month before trying to become pregnant.
Oral tetracyclines
Tetracycline as well as doxycycline and minocycline—which are synthetically derived from tetracycline—must not be used by women who are pregnant or breast feeding because of potential side effects. These broad-spectrum oral antibiotics can inhibit bone growth and discolor permanent teeth in both a fetus and a child being breast fed.
Topical retinoids
The topical (applied to the skin) retinoids adapalene, tazarotene and tretinoin carry warnings stating that it is not known if these medications can adversely affect a developing fetus or child that is being breast fed
Acne Treatment Revolutionized by 25 Years of Research
Acne is definitely not treated the same way it was 25 years ago — or even 10 years ago. Scientific research has greatly increased our knowledge of how acne develops, leading to many new acne therapies and changes in existing treatment options.
Newer products include acne treatments made for different skin types and less-irritating topical (applied to the skin) retinoids. Retinoids are medications derived from vitamin A. Newer topical retinoids have dramatically changed the way acne is treated. Twenty-five years ago, use of topical retinoids was commonly accompanied by side effects, such as redness, stinging, and peeling. With the advent of newer topical retinoids and patient-tailored dosing regimens, topical retinoids are now the first-line treatment for most patients with mild to moderately severe acne. Research shows that topical retinoids can effectively reduce blackheads, whiteheads, and the inflamed or red acne lesions. Early treatment with retinoids also can reduce scarring.
When a topical retinoid is prescribed along with a topical antimicrobial, such as benzoyl peroxide, or an oral antibiotic, such as doxycycline, most patients’ skin clears faster and the results last longer. This combination also allows patients to stop taking oral antibiotics sooner and eliminates the need for long-term use of oral antibiotics, which was common 25 years ago.
In recent years, combination treatments have become common. Most acne treatments work on only one cause of acne. Combining two or more medications allows the different factors causing the acne to be attacked simultaneously. Today, dermatologists often combine medications to give patients faster clearing and better resolution.
Another significant change made during the past 25 years has been the acceptance of oral contraceptives as an effective form of acne therapy for women. Today’s low-dose oral contraceptives are generally a well-tolerated and effective way to treat acne.
Research continues to produce new acne therapies. Recently, several light and laser therapies have been introduced. While much is still unknown about using these therapies to treat acne, such as long-term effects, lasers and lights are being used as an alternative treatment when traditional methods fail.
Today, there are a number of very effective acne therapies, and virtually every case of acne can be resolved. Sometimes the help of a dermatologist is needed. If over-the-counter treatments have not worked for you, be sure to see a dermatologist. Acne treatments are definitely not what they were 25 years ago.
Adult Acne: Effective Treatment Available
While it may seem that nothing will clear a case of adult acne, the fact is that treatment can be effective. Often combination therapy (the use of two or more treatments), a dermatologist’s help, and a bit of patience are required.
The following describes treatment that can be effective for adult acne.
Topical Therapy
Topical treatment for acne includes creams, lotions, gels, and solutions. A topical medication that combines benzoyl peroxide and a topical antimicrobial such as clindamycin or erythromycin can be effective for adults with mild to moderate acne. Combining topical clindamycin with a retinoid also can be effective. These products require a prescription. An over-the-counter product that contains sodium sulfacetamide and sulfur helps some adults.
A topical retinoid is often used to treat the small bumps under the skin and blackheads. Some are available over-the-counter. The more effective ones require a prescription. Retinoids are the only medication believed effective for battling the microcomedone — the lesion that precedes acne.
While some patients shy away from using a topical retinoid because of the product’s reputation for irritating the skin, newer formulations are available that cause significantly less irritation. When using a retinoid, dermatologists recommend that patients apply sunscreen daily before going outdoors. A topical retinoid increases the risk of sunburn. An added benefit of using a topical retinoid is the product’s ability to reduce fine lines and wrinkles.
Acne-fighting cosmetics. Over-the-counter acne treatment for women is one of the fastest growing areas of skin care product development. Tried-and-true acne-fighting ingredients such as salicylic acid are finding their way into facial moisturizers and foundations. While the active ingredients are the same as those available in products tailored for teens, the products formulated for women are less drying. Many of these products include anti-aging ingredients.
While this may sound very promising, the active ingredients approved for over-the-counter products may not effectively control adult acne.
Oral Medications
As adult acne often involves hormonal swings, an oral medication may be necessary to minimize these fluctuations and control the acne. Medications that can minimize hormonal fluctuations in women include some oral contraceptive pills, spironolactone, and hormone replacement therapy. These therapies are not appropriate for every woman and should never be taken during pregnancy. Hormone replacement therapy is typically reserved for treating women when acne develops around or after menopause. This therapy is more likely to be prescribed when the acne is accompanied by mood swings, insomnia, anxiety, thinning hair, and decreased verbal skills.
An oral antibiotic also may be part of an adult’s acne treatment plan and can be used to help get the acne under control. Recent studies show that taking an oral antibiotic and using a topical retinoid for a few months and then stopping the antibiotic can be effective. The topical retinoid alone often can maintain the results over time.
If acne is severe or very resistant to treatment, oral isotretinoin may be prescribed. In some cases, intermittent therapy with isotretinoin can help adults maintain clear skin. Patients in their 50s and 60s who develop sporadic acne have been successfully treated with low-dose oral isotretinoin.
When oral medications are prescribed for acne, it is important that the patient consult a specialist trained in acne therapy, such as a dermatologist.
Physical Procedures
To treat the occasional persistent nodule or cyst, a dermatologist may inject a corticosteroid into the lesion. This treatment quickly reduces pain and swelling as well as lessens the potential for scarring.
While chemical peels and other physical treatments available in spa-like settings claim to effectively treat acne, their role in treating adult acne has not been determined.
Proper Skin Care Essential
When it comes to skin care for their patients with acne, dermatologists generally recommend gently washing the face with a mild facial cleanser. Avoid vigorous scrubbing, as it can irritate the skin and make acne worse. Daily sun protection is essential because some acne medications increase the skin’s sensitivity to sunlight. It is equally important to use only skin and hair care products labeled “non-comedogenic” or “non-acnegenic.” Above all, do not pick, squeeze, or pop the lesions. This tends to make acne worse and cause scarring
Benefits of a Dermatologist’s Help
If over-the-counter acne treatments and good skin care fail to clear the acne, do not get discouraged. Seeing a dermatologist can give you peace of mind. The lesions may not be acne. Other skin conditions resemble acne. A dermatologist can tell. If acne is the problem, different medication may be required.
Getting the acne under control has benefits. It reduces the risk of scarring. The longer the acne persists, the more likely it is to cause scarring. Gaining control over acne also can improve one’s quality of life. Research shows that older adults report more negative effects on their quality of life from acne than do younger people.
The Truth About Oral Contraceptives and Acne
Yes, it’s true. An oral contraceptive, what many people call “the Pill,” can effectively clear acne in women. If you are using — or considering — an oral contraceptive to treat acne, here are a few other truths about oral contraceptives and acne that you should know:
Several Brands Effective
Several brands of oral contraceptives can effectively control acne. A few brands have received approval from the U.S. Food and Drug Administration (FDA) for treating acne in women.
For Best Results: Use with Other Acne Treatment
Oral contraceptives are effective because they target one of the four key causes of acne — excess sebum. Sebum, a natural oil that protects the skin against moisture loss, can clog pores when the body produces too much.
Since an oral contraceptive targets only one cause, it is generally not the only treatment used to clear acne. Here’s another key fact. Dermatologists generally do not prescribe an oral contraceptive until other acne medications have proven ineffective. Acne treatment usually begins with benzoyl peroxide and topical retinoids. Depending on the type and severity of the acne, an oral antibiotic also may be part of the treatment plan. If a woman’s acne does not respond to these treatments, an oral contraceptive may be considered.
Taking Other Medication? Tell Your Dermatologis
If an oral contraceptive is a potential treatment option, be sure to tell your dermatologist about other medication that you are taking. Medications can interact with each other — in some case producing undesirable side effects. Sometimes one medication can reduce the effectiveness of another medication. The anti-epilepsy drug, lamotrigine, can reduce the effectiveness of an oral contraceptive. A second form of birth control may be necessary to prevent pregnancy
Not for Every Woman
While oral contraceptives can safely and effectively treat acne long term, this medication is not appropriate for every woman. Due to potential side effects, oral contraceptives are usually prescribed to women who:
- Are 35 years of age or younger
- Do not smoke
- Do not have a history of migraines
- Have normal blood pressure
Dermatologists recommend that their patients who take oral contraceptives examine their breasts regularly and see a gynecologist for regular examinations.
Clearing Takes Time
The truth is clearing takes time. Patients can expect to see results about three months after beginning to take an oral contraceptive. Before then, some women’s acne worsens. If acne flares, continue to take the oral contraceptive as prescribed. Repeatedly missing doses decreases the medication’s effectiveness.
While taking an oral contraceptive for acne treatment, it is important to follow your dermatologist’s entire acne treatment plan. An oral contraceptive targets only one cause of acne — excess sebum.
Now that you know the truth about oral contraceptives and acne, you may wonder if this treatment may be right for you. A dermatologist can help a woman decide if this is an appropriate treatment option.
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