Treatment Options

Treatment of acne can be divided into two basic levels, mild acne treatment and treatment for moderate to severe acne including nodules and cysts.

Mild acne treatment is often characterized as "home treatment" since the main products are purchased Over The Counter (OTC). It's important to note that these OTC products take time to work and their benefits are often not seen until after two weeks, and sometimes take 6 to 8 weeks before their full effectiveness is achieved.

The most common home treatment recommendation is to wash the face two or three times a day with an anti-bacterial soap once in the morning, mid-day and before going to bed. If you participate in sports or work that causes excessive sweating, you should wash immediately after this activity.

The two ingredients found in most OTC products are benzoyl peroxide cream and salicylic acid. Benzoyl peroxide cream kills the the acne causing bacteria and causes the skin to dry and flake off - which prevents the clogging of pores. By killing the acne associated with bacteria, benzoyl peroxide cream can prevent new acne lesions from forming. Benzoyl peroxide creams often come in white or flesh tone and are most often applied at night before going to bed. The flesh tone cream can be applied and worn during the day as a kind of make-up that both hides the blemish while healing it. If the flesh tone benzoyl peroxide does not match your skin tone, you can mix it together with small amounts of white benzoyl peroxide cream to achieve a color that is closer to your facial skin tone.

Salicylic acid often comes in cotton pads that are soaked in the solution and used to exfoliate the skin. When applied to the skin, the exfoliating agent encourages the peeling of the top layer of skin. This prevents a build up of dead skin cells which combine with sebum to block pores. Besides prevention, salicylic acid can unclog pores that are already blocked. It's important to note that aggressive and excessive scrubbing or exfoliation of the skin can actually cause acne to worsen since it can damage or irritate the hair follicles.

Treatment for moderate to severe acne
If the acne does not respond well to these OTC treatments, or is visibly a moderate to severe form of acne vulgaris including nodules or cysts, medical treatment under the guidance of a doctor (most likely a dermatologist) is recommended. Doctor prescribed medications come in two basic forms, topical and oral. Treatment plans may include a combination of both types.

Oral Prescription Medications:

Similar to topical medicines, oral acne medication is either antibiotic or retinoid in nature and common treatment methods in cases of moderate to severe acne including nodules or cysts. Oral antibiotics aim to control the acne by halting bacterial growth and reducing inflammation. Common antibiotics used to treat acne include: tretracycline, minocycline, doxycycline, and lymecycline. Oral antibiotics have stronger side-effects than their topical counterpart and may include reducing the effectiveness of birth control pills, as well as sensitivity to the sun for those who take tetracycline.

Even though they will reduce the amount of acne causing bacteria, oral antibiotics do not reduce the oil secretion (sebum) and abnormal cell behavior that causes pores to become plugged. Acne is becoming more and more resistant to antibiotics and will return if you stop using them.

To stop or slow the over-production of oil from the glands, your dermatologist may prescribe oral retinoids. A vitamin A derivative, oral retinoids such as isotretinoin (brand name Accutane) have shown themselves to be effective in treating 80 percent of moderate to severe acne cases. "The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical supervision by a dermatologist because the drug has many known side effects (which can be severe)." (3)

Your doctor will review the possible side-effects with you which include: dry skin, nosebleeds, and an initial flare up of acne within a month of taking the medicine.

The most severe side-effect, however, is for women who are or may become pregnant. According to the National Institue of Health's MedlinePlus Drug Encyclopedia: "Isotretinoin must not be used to treat women who are able to bear children unless other forms of treatment have been tried first and have failed. Isotretinoin must not be taken during pregnancy because it causes birth defects in humans. If you are able to bear children, it is very important that you read, understand, and follow the pregnancy warnings for isotretinoin."(4)

Because of this danger to possible pregnancies, the National Institue of Arthritis and Musculoskeletal and Skin Diseases recommends that women take 2 forms of birth control beginning 1 month before treatment, lasting the entire dosage period and for one month after discontinuation of isotretinoin dosage. (2)

The good news is that in most cases, isotretinoin may only have to be taken for 4-6 months.

About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4-6 months may be indicated to obtain desired results. It is often recommended that one lets a few months pass between the two treatments, because the condition can actually improve somewhat in the time after stopping the treatment and waiting a few months also give the body a chance to recover. Occasionally a third or even a fourth course is used, but the benefits are often less substantial. (3)

Other Treatment Options:

In addition to the topical and oral treatments mentioned above, your doctor may employ one or more of the following:

• Hormonal Treatments: Since it is known that the male hormone, androgen, plays a role in the over-production of sebum, females may benefit from certain combinations of estrogen (female hormone) and anti-androgen medications.
• Cortisone (steroid): Cortisone has been widely used in medical applications as an anti-inflammatory agent. In cases of severe acne, nodules or cysts, your doctor may inject cortisone directly into the acne lesion. This method works almost immediately by reducing the inflammation and decreasing the redness. This is an effective method in reducing the scars that left behind by severe acne, nodules or cysts.
• Phototherapy: Recent developments in the use of photo or light therapy, absent harmful UV rays, via a specific device has shown remarkable results for the treatment of acne. According to the BBC, doctors in London tested a red and blue light mixture on patients during 12 week study and found that it decreased visible spots by 76 percent.
• Surgery: In some cases, doctors will remove blackheads or whiteheads with a special comedone extractor. Doctors may also use a sharp instrument to drain the lesion of pus, oil and bacteria which relieves the pain, pressure and quickens the healing time.
• Cryotherapy: While rarely used, cryotherapy uses liquid nitrogen to "freeze" and break up or flake off the lesion.