To diagnose acne, a dermatologist will first examine your skin to make sure you have acne. Other skin conditions can look like acne. If you have acne, the dermatologist will:
- Grade the acne. Grade 1 is mild acne. Grade 4 is severe acne
- Note what type, or types, of acne appear on your skin
Treatment for acne depends upon its severity. The goal of treatment is to reduce or eliminate outbreaks and to prevent scarring. Virtually every case of acne can be controlled.
People who have mild acne have a few blemishes, may also have whiteheads, blackheads, papules, and/or pustules (pimples). Acne treatment does not work overnight but requires 4-8 weeks to see improvement. Once acne clears, treatment must be continued to treat the skin to prevent breakouts.
Topical medications are applied to the skin and are often used to treat mild to moderate acne. Some common topicals are:
Application of topical medicines:
Benzoyl peroxide is available by prescription in lesser strengths over the counter. It is usually applied once or twice a day to work best against pustules. It can be irritating if used around the eyes and mouth. It should be used carefully since it can bleach skin and clothing. If used excessively, benzoyl peroxide can cause drying and redness.
Salicylic acid is effective in treating non-inflammatory acne lesions. Salicylic acid helps correct the abnormal shedding of skin cells and unclogs pores to resolve and prevent lesions. It has no effect on oil production or bacteria. Like benzoyl peroxide, salicylic acid must be used continuously. Salicylic acid is found in many over-the-counter acne products, including lotions, creams and pads. It may be irritating to the skin.
Retinoids are derivatives of vitamin A and have been a mainstay in acne treatment for 25 years. They decrease the stickiness of plugged sebaceous glands. They work best against blackheads and reduce papules and non-inflamed pimples. They shpuld be used once per day at bedtime; if overused, they can cause drying. Retinoids can make skin more sensitive to sun. Using sunscreen is recommended.
Topical antibiotics come in solution, gel, or cream form. They help reduce the amount of bacteria on the surface of the skin thereby preventing inflammation and the formation of new pimples. They are to be applied to the skin twice a day.
Azelaic acid is used to treat mild to moderate acne. It is believed that azelaic acid clears acne by reducing the populations of bacteria, decreasing the abnormal shedding of skin cells and reducing inflammation. Side effects may include skin dryness and lightening of the skin where applied.
To decrease the chance of skin irritation, apply to dry skin 20 minutes after washing your face and apply every other day for the first 2 weeks. Apply medicine to all areas of your face which are acne prone. It’s fine to apply multiple topical medicines at the same time.
Systemic medications are swallowed and work internally to control moderate to severe acne. Systemic medications are prescribed by clinicians and may include the following:
Antibiotics are used for mild-to-moderate and moderate-to-severe acne. They work to reduce bacteria thereby reducing inflammation. A typical course of treatment can be six months or longer. Tetracycline, doxycycline, erythromycin and minocycline are commonly used antibiotics. Tetracycline should not be taken with milk, milk products, or antacids because these products decrease its absorption. For the same reason it should also be taken at least one hour before or two hours after meals. As tetracycline, doxycycline, and minocycline can also cause sun sensitivity, it is recommended that you wear sun screen and avoid overexposure to the sun.
Oral contraceptives have been shown to effectively clear acne in women by decreasing circulating male hormones called androgens, thereby decreasing sebum (oil) production.
Isotretinoin is a potent oral medication that is used for cystic, refractory acne that does not respond to any of the other medication. Used over about a six month period, it works to decrease inflammation as well as formation of comedones. Because of some potentially serious side-effects, Isotretinoin is usually prescribed and monitored by a dermatologist.
Duration of effects
New whiteheads usually stop appearing after 4 to 6 weeks of treatment, but should be continued for several months. If someone is taking antibiotics, their health care provider will ask them to stop taking them to see if antibiotics are still needed. Sometimes acne treatment must be continued for several years.
Many factors may worsen acne temporarily. For example, women may notice that their acne gets worse before each menstrual period. So even with proper treatment, results may vary over time. Try to discover and change, when possible, the factors in environment or lifestyle that make the acne worse.