There are
many different acne treatments for acne.
Acne is often treated by dermatologists (doctors who specialize in skin problems). These
doctors treat all kinds of acne, particularly severe cases. Doctors
who are general or family practitioners, pediatricians, or internists
may treat patients with milder cases of acne.
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The goals of acne treatment are
to heal existing lesions, stop new lesions from forming, prevent
scarring, and minimize the psychological stress and embarrassment
caused by this disease. Drug treatment is aimed at reducing several
problems that play a part in causing acne: abnormal clumping of cells
in the follicles, increased oil production, bacteria, and
inflammation. Depending on the extent of the person's acne, the doctor
will recommend one of several over-the-counter (OTC) medicines or
prescription medicines that are topical (applied to the skin) or
systemic (taken by mouth). The doctor may suggest using more than one
topical medicine or combining oral and topical medicines.
Treatment for Blackheads, Whiteheads, and Mild Inflammatory Acne
Doctors
usually recommend an OTC or prescription topical medication for people
with mild signs of acne. Topical medicine is applied directly to the
acne lesions or to the entire area of affected skin.
Benzoyl
peroxide, resorcinol, salicylic acid, and sulfur are the most common
topical OTC medicines used to treat acne. Each works a little
differently. Benzoyl peroxide is best at killing P. acnes and
may reduce oil production. Resorcinol, salicylic acid, and sulfur help
break down blackheads and whiteheads. Salicylic acid also helps cut
down the shedding of cells lining the follicles of the oil glands.
Topical OTC medications are available in many forms, such as gel,
lotion, cream, soap, or pad.
In some
patients, OTC acne medicines may cause side effects such as skin
irritation, burning, or redness. Some people find that the side
effects lessen or go away with continued use of the medicine. Severe
or prolonged side effects should be reported to the doctor.
OTC topical
medicines are somewhat effective in treating acne when used regularly.
Patients must keep in mind that it can take 8 weeks or more before
they notice their skin looks and feels better.
Treatment for Moderate to Severe Inflammatory Acne
Patients
with moderate to severe inflammatory acne may be treated with
prescription topical or oral medicines, alone or in combination.
Prescription Topical Medicines
Several
types of prescription topical medicines are used to treat acne,
including antibiotics, benzoyl peroxide, tretinoin, adapalene, and
azelaic acid. Antibiotics and azelaic acid help stop or slow the
growth of bacteria and reduce inflammation. Tretinoin, a type of drug
called a retinoid that contains an altered form of vitamin A, is an
effective topical medicine for stopping the development of new
comedones. It works by unplugging existing comedones, thereby allowing
other topical medicines, such as antibiotics, to enter the follicles.
The doctor may also prescribe newer retinoids or retinoid-like drugs,
such as tazarotene or adapalene, that help decrease comedo formation.
Like OTC
topical medicines, prescription topical medicines come as creams,
lotions, solutions, or gels. The doctor will consider the patient's
skin type when prescribing a product. Creams and lotions provide
moisture and tend to be good for people with sensitive skin. Gels and
solutions are generally alcohol based and tend to dry the skin.
Therefore, patients with very oily skin or those who live in hot,
humid climates may prefer them. The doctor will tell the patient how
to apply the medicine and how often to use it.
Some people
develop side effects from using prescription topical medicines.
Initially, the skin may look worse before improving. Common side
effects include stinging, burning, redness, peeling, scaling, or
discoloration of the skin. With some medicines, like retinoids, these
side effects usually decrease or go away after the medicine is used
for a period of time. Patients should report prolonged or severe side
effects to their doctor. Between 4 and 8 weeks will most likely pass
before patients see their skin improve.
Prescription Oral Medicines
For patients
with moderate to severe acne, the doctor often prescribes oral
antibiotics (taken by mouth). Oral antibiotics are thought to help
control acne by curbing the growth of bacteria and reducing
inflammation. Prescription oral and topical medicines may be combined.
For example, benzoyl peroxide may be combined with clindamycin,
erythromycin, or sulfur. Other common antibiotics used to treat acne
are tetracycline, minocycline, and doxycycline. Some people have side
effects when taking these antibiotics, such as an increased tendency
to sunburn, upset stomach, dizziness or lightheadedness, and changes
in skin color. Tetracycline is not given to pregnant women, nor is it
given to children under 8 years of age because it might discolor
developing teeth. Tetracycline and minocycline may also decrease the
effectiveness of birth control pills. Therefore, a backup or another
form of birth control may be needed. Prolonged treatment with oral
antibiotics may be necessary to achieve the desired results.
Treatment for Severe Nodular or Cystic Acne
People with
nodules or cysts should be treated by a dermatologist. For patients
with severe inflammatory acne that does not improve with medicines
such as those described above, a doctor may prescribe isotretinoin (Accutane*),
a retinoid. Isotretinoin is an oral drug that is usually taken once or
twice a day with food for 15 to 20 weeks. It markedly reduces the size
of the oil glands so that much less oil is produced. As a result, the
growth of bacteria is decreased.
* Brand
names included in this booklet are provided as examples only, and
their inclusion does not mean that these products are endorsed by the
National Institutes of Health or any other Government agency. Also, if
a particular brand name is not mentioned, this does not mean or imply
that the product is unsatisfactory.
Advantages of Isotretinoin (Accutane)
Isotretinoin
is a very effective medicine that can help prevent scarring. After 15
to 20 weeks of treatment with isotretinoin, acne completely or almost
completely goes away in up to 90 percent of patients. In those
patients where acne recurs after a course of isotretinoin, the doctor
may institute another course of the same treatment or prescribe other
medicines.
Disadvantages of Isotretinoin (Accutane)
Isotretinoin
can cause birth defects in the developing fetus of a pregnant woman.
It is important that women of childbearing age are not pregnant and
do not get pregnant while taking this medicine. Women must use two
separate effective forms of birth control at the same time for 1 month
before treatment begins, during the entire course of treatment, and
for 1 full month after stopping the drug. They should ask their doctor
when it is safe to get pregnant after they have stopped taking
Accutane.
Some people
with acne become depressed by the changes in the appearance of their
skin. Changes in mental health may be intensified during treatment or
soon after completing a course of medicines like Accutane. A doctor
should be consulted if a person feels unusually sad or has other
symptoms of depression, such as loss of appetite or trouble
concentrating.
Other
possible side effects include dry eyes, mouth, lips, nose, or skin;
itching; nosebleeds; muscle aches; sensitivity to the sun; and,
sometimes, poor night vision. More serious side effects include
changes in the blood, such as an increase in triglycerides and
cholesterol, or a change in liver function. To make sure Accutane is
stopped if side effects occur, the doctor monitors blood studies that
are done before treatment is started and periodically during
treatment. Side effects usually go away after the medicine is stopped.
Treatments for Hormonally Influenced Acne in Women
Clues that
help the doctor determine whether acne in an adult woman is due to an
excess of androgen hormones are hirsutism (excessive growth of hair in
unusual places), premenstrual acne flares, irregular menstrual cycles,
and elevated blood levels of certain androgens. The doctor may
prescribe one of several drugs to treat women with this type of acne.
Low-dose estrogen birth control pills help suppress the androgen
produced by the ovaries. Low-dose corticosteroid drugs, such as
prednisone or dexamethasone, may suppress the androgen produced by the
adrenal glands. Finally, the doctor may prescribe an antiandrogen
drug, such as spironolactone (Aldactone). This medicine reduces
excessive oil production. Side effects of antiandrogen drugs may
include irregular menstruation, tender breasts, headache, and fatigue.
Other
Treatments for Acne
Doctors may
use other types of procedures in addition to drug therapy to treat
patients with acne. For example, the doctor may remove the patient's
comedones during office visits. Sometimes the doctor will inject
cortisone directly into lesions to help reduce the size and pain of
inflamed cysts and nodules.
Early
treatment is the best way to prevent acne scars. Once scarring has
occurred, the doctor may suggest a medical or surgical procedure to
help reduce the scars. A superficial laser may be used to treat
irregular scars. Another kind of laser allows energy to go deeper into
the skin and tighten the underlying tissue and plump out depressed
scars. Dermabrasion (or microdermabrasion), which is a form of
"sanding down" scars, is sometimes combined with the subsurface laser
treatment. Another treatment option for deep scars caused by cystic
acne is the transfer of fat from one part of the body to the face.
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