Acne has a characteristic appearance and is not difficult to diagnose. General practitioners, pediatricians, and internists can treat most individuals with mild and moderate forms of acne. People with more severe cases of acne however, are often referred to a dermatologist or a skin disease specialist. The practitioner will take a complete medical history that includes questions about skin care, cosmetic use, and diet; factors that trigger flare-ups; medication use; occupational and environmental exposures; and prior treatment. The practitioner will also examine the face, chest, back, and other areas for blemishes, lesions, and scars. Several factors, including the size of the blemishes and whether or not they are inflamed, help a practitioner determine the most appropriate treatment.
Treatment of Acne
The main goals of acne treatment are to prevent scarring, reduce the number of painful lesions, and minimize the stress and embarrassment related to the condition. The basic principle of skin care is to wash the affected area no more than one to two times per day with a mild, nondrying soap. Frequent washing and the use of harsh soaps can actually make the condition worse. Healthcare practitioners will often recommend topical medications as their first choice for treating acne (generally either benzoyl peroxide or a class of drugs known as retinoids). These are designed to wear away the top layer of skin (exfoliate) as well as to reduce abnormal clumping of cells in the follicles, oil and bacteria production, and inflammation. Additionally, facial steaming with accompanying manual extraction of the comedones (such as by a professional aesthetician) is valuable for exfoliation as well. Expect to use medications and/or complementary and alternative remedies for at least 6 to 8 weeks before seeing a noticeable improvement in symptoms. Seek medical care if infantile acne does not improve within three months.
Medications
Topical
Topical medications (those applied directly to the skin) are available in many forms including gels, lotions, creams, soaps, or pads. The most commonly used topical medications for acne include:
Benzoyl peroxide — works by killing bacteria and unclogging pores. This medication comes in prescription and over-the-counter preparations. Benzoyl peroxide should not be applied at the same time of day as topical retinoids. To avoid adverse reactions, apply to small area on forearm and observe the area for two to three days. If no reaction occurs, application to the face should be safe.
Retinoids — work by unclogging pores and reducing inflammation. These medications come in prescription form only. Commonly prescribed retinoids include tretinoin, adapalene, and tazarotene. They are intended for individuals with significant numbers of both open and closed comedones as well as papules and pustules. Side effects may include redness, peeling, and photosensitivity (high risk of sunburn). Most retinoids are applied at night and should not be applied at the same time as benzoyl peroxide (with the exception of adapalene). Topical retinoids should not be used during pregnancy as they may cause harm to the fetus.
Antibiotics — work by killing bacteria and reducing inflammation. Topical antibiotics such as clindamycin or erythromycin are available in prescription form. They may be used to treat mild to moderate acne.
In some cases, healthcare practitioners may recommend a combination of topical medications, such as benzoyl peroxide and clindamycin. Other topical acne medications available by prescription include sodium sulfacetamide and azelaic acid.
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Oral
Healthcare practitioners may prescribe oral (taken by mouth) antibiotics either alone or in addition to topical medications for individuals with moderate to severe acne. For those with severe, inflammatory acne that does not improve with other medications, healthcare practitioners may prescribe an oral retinoid called isotretinoin. Further information about these medications is discussed below:
Antibiotics—work by killing bacteria and reducing inflammation. Commonly prescribed oral antibiotics include doxycycline, minocycline, and tetracycline. Oral antibiotics should not be used during pregnancy or by those under 9 years of age.
Isotretinoin—works by reducing the size of oil glands and lowering sebum production. It is usually prescribed by a dermatologist for individuals with severe, inflammatory acne that does not improve with other medications. Isotretinoin is taken twice a day for 20 weeks. It should not be used by pregnant women as it may cause harm to the fetus.
In some cases, healthcare practitioners may also prescribe certain oral contraceptives in addition to acne medications.
Surgery and Other Procedures
Individuals with severe acne scars may require surgery or other procedures to improve the appearance of their skin. Dermatologists can perform skin resurfacing techniques such as dermabrasion (a procedure that uses a rapidly rotating brush to remove acne scars or pits) or chemical peeling (a chemical solution is applied to the skin that causes it to blister and eventually peel off). Dermatologic surgeons can also perform scar excisions (a technique in which the scar is removed and the surrounding healthy skin is joined together) and punch grafting (a method in which the surgeon punches a hole in the skin, removes the scar, and replaces it with a small plug of new skin) to correct deep acne scars.
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