Health Topics A-Z

What Are the Treatments?

The occasional pimple needs no treatment. Over-the-counter cover-up creams and cosmetics, if used at all, should be water based and hypoallergenic. Even if outbreaks of acne cannot be eliminated, conventional treatment can provide relief.

The best treatments inhibit sebum and keratin production, limit bacterial growth, or encourage shedding of skin cells to unclog pores. Because many therapies can have important side effects, any patient with a skin problem should proceed with caution when trying a new treatment. People with severe, persistent cases need the care of a dermatologist.

Nonprescription Treatment

Soap and water. Gentle cleansing of the face with soap and water no more than two or three times a day can remove the excess oils and help the "oily skin" often associated with acne. However, this does not clear up acne that is already present. And aggressive scrubbing can injure the skin and cause other skin problems.

Cleansers. There are many cleansers and soaps advertised for treating acne. However, most of them are unnecessary if the acne is being properly treated and can in fact aggravate acne.

Benzoyl peroxide. For mild acne, you may try, or your doctor may recommend, treatment with a nonprescription medicine that contains benzoyl peroxide. It's believed that this compound works by destroying the bacteria associated with acne. It usually takes about two weeks to work and it must be used continuously to keep acne at bay until you outgrow getting acne. This is because 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 a wide range of vehicles: creams, lotions, gels. Before applying the medication, wash the affected area with a mild soap that is free of oils or scents. 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 or kill bacteria. It must be used continuously, just like benzoyl peroxide, since 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, salicylic acid and resorcinol, sulfur is a component of many over-the-counter acne medications. It usually isn't used by itself because of its unpleasant odor. It's unclear how sulfur works.

Resorcinol. Along with sulfur, resorcinol is a component of many of the most popular over-the-counter acne regimens.

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 medicines. Acetone alone probably has no effect on acne.

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.

Note: When pus-filled pimples are ready to break, apply a hot towel for a few minutes to encourage the natural bursting process. Infected pimples should be opened only by a nurse or doctor using surgical instruments and following antiseptic practices. Squeezing pimples yourself may lead to further infection — and maybe to permanent scars.

Prescription Treatments

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. There are several topical products available in creams, gels, pads and lotions. Topical antibiotics are limited in their ability to penetrate the skin and clear more deep-seated P. acnes, whereas systemic antibiotics circulate throughout the body and into sebaceous glands. Systemic antibiotics, therefore, 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.

Azelex and Finevin are drugs with anti-bacterial and anti-inflammatory properties.

Erythromycin is an antibiotic that is effective against a number of bacteria and an anti-inflammatory drug. It's often combined with benzoyl peroxide or alcohol and applied directly to the skin. Oral erythromycin is also available.

Clindamycin (sold under the brand name Cleocin) and sulfonamide (Klaron) are other topical antibiotics often used to treat acne.

Other oral antibiotics often used are tetracycline (Doryx, Monodox, Sumycin, Vibramycin), minocycline (Minocin), and doxycycline.

Antibiotics do not address the other causative factors in acne and may take several weeks or months to clear up acne. Antibiotics are often used in combination with other drugs that "unclog" follicles. Oral antibiotics for acne should not be used during pregnancy, and some may reduce the effectiveness of oral contraception pills, risking a pregnancy during treatment.

Retinoids or vitamin A derivatives. These drugs are available as topical or oral drugs. Topical retinoids clear up moderate-to-severe acne by normalizing 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 women, and women who are of childbearing age should take precautions to not become pregnant. Side effects of topical retinoids include redness, dryness, and itchy skin. Topical retinoids include:

• Differin
• Tazorac
• Avita, Tretinoin (vitamin A acid)

For severe cystic acne, two drugs, Accutane and Sotret, are the most effective therapies. The active ingredient of these drugs is isoretinoin. This pill is the only medication that intervenes in all of the causes of acne. It can often clear severe acne even that hasn't responded to other treatments. However, the product can have severe side effects. Also, it can cause severe birth defects and must NEVER be taken by a women who is pregnant or who is not using contraception It also can't be taken by a woman who is breastfeeding. Its use has also been associated with an increased risk of severe depression and suicide. A doctor must carefully monitor a person taking this drug.

Other side effects are dry skin and mouth, nausea, vomiting, bone and joint pain, headache, and thinning hair. For most people taking these drugs, side effects are tolerable and not a reason to discontinue therapy before the acne clears up.

Oral contraceptives. Oral contraceptives are female hormones that work by counteracting the effect of male hormones (such as testosterone) on acne. Their use is limited to female patients. Oral contraceptives containing estrogen (such a Estrostep and Ortho Tri-Cyclen 28) are very effective treatments for acne. The maximum benefit of oral contraceptives on acne occurs in three to four months. Side effects include nausea, weight gain, spotting, and breast tenderness.

Other. Corticosteroid pills may be taken to treat severe acne. The large number of side effects of these drugs limits the ability to take them for long periods of time.

A less common treatment option is to inject triamcinolone, a type of corticosteroid, directly into the cysts. This treatment may leave some patients' skin temporarily darkened around the lesion. A dermatologist (skin doctor) may also recommend controlled exposure to ultraviolet light to keep outbreaks in check.

A dermatologist may also recommend a variety of procedures that can be performed in the office to remove severe lesions and to express (push out the contents of) pimples.

Some adults carry scars or pitted skin from cysts or deep pimples that were scratched or severely infected. Two relatively aggressive surgical procedures can improve the skin's appearance: dermabrasion, in which a dermatologist essentially sandpapers frozen skin, and chemical peeling. Both procedures remove the scarred surface and expose unblemished skin layers. Before considering such treatment it is important to discuss the procedures, necessary precautions, and likely results with at least two dermatologists.

Warning!

Patients taking anti-acne drugs should be alert to possible side effects and interactions with other medicines and herbal remedies. The drugs tretinoin and benzoyl peroxide can leave skin reddened, dry, and sensitive to sunlight. Benzoyl peroxide may inhibit the healing effects of tretinoin, so never apply them at the same time. Taking antibiotics for more than a few weeks may leave women susceptible to yeast infections.

Other Therapies

Chemical peels. Dermatologists occasionally use glycolic acid and other chemicals to loosen blackheads and decrease pimples.

Microdermabrasion. This procedure may be used to remove the uppermost layers of skin allowing new skin to form.

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. That being said, sensible skin care is important, especially during adolescence. The basics include a daily bath or shower and washing the face and hands with unscented or mildly antibacterial soap. Teenage girls are better off not using cosmetics regularly. And despite advertising claims, few if any commercial skin medications help prevent or treat acne.