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.
- Topical Antibiotics can stop, slow
and prevent bacterial growth and reduce inflammation.
- Topical Retinoids are medicines made
from vitamin A and are effective in treating whiteheads
and blackheads by opening clogged pores. Dermatologists
claim that topical retinoids work to normalize the life
cycle of the pilosebaceous unit (follicle and sebaceous
- Other topical treatment products
that may be prescribed include include sulfur, zinc,
These topical medicines may have mild side-effects like
stinging, burning, redness, and peeling. These side effects
may go away with continued use. Just as in the case with
the OTC medications, the benefits of these prescription
based topical medicines may not be noticable for 4 to
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.