Acne

Acne Treatment

If over-the-counter acne products haven’t improved your skin after several weeks, a dermatologist can help determine the best prescription treatment for your acne. Early and appropriate care can:

• Control acne outbreaks

• Prevent scarring and long-term skin damage

• Reduce the appearance of existing scars

Acne treatments work by reducing oil production, controlling inflammation, and addressing bacterial growth. Most prescription treatments take 4–8 weeks before improvement is noticeable, and complete clearance may require several months or longer.

The choice of treatment depends on age, acne type and severity, and your commitment to following the regimen. Many treatment plans involve twice-daily topical applications, sometimes combined with oral medications. Special considerations are needed for pregnant or breastfeeding women due to potential side effects.

Topical Medications

Topical treatments are applied directly to the affected skin and are often the first line of prescription therapy:

• Retinoids and Retinoid-like Drugs:
  Medications containing tretinoin (Retin-A), adapalene (Differin), or tazarotene (Tazorac) prevent hair follicle plugging and improve skin turnover. These are typically applied in the evening, starting a few times per week and gradually increasing to daily use. Retinoids can increase sun sensitivity and may cause dryness or redness, especially in darker skin tones.

• Topical Antibiotics:
  Clindamycin or erythromycin, often combined with benzoyl peroxide, reduce bacteria and inflammation. Using antibiotics with benzoyl peroxide helps prevent resistance. Topical antibiotics alone are not recommended.

• Azelaic Acid and Salicylic Acid:
  Azelaic acid has antibacterial properties and can treat acne-related discoloration. Salicylic acid helps prevent clogged hair follicles. Both may cause mild irritation or redness. Azelaic acid is safe for use during pregnancy and breastfeeding.

• Dapsone:
  Dapsone 5% gel is effective for inflammatory acne, particularly in women, with mild side effects like dryness or redness.

Other ingredients such as zinc, sulfur, or nicotinamide have limited evidence supporting their effectiveness in prescription acne therapy.

Oral Medications

• Oral Antibiotics:
  Tetracyclines (doxycycline, minocycline) or macrolides (erythromycin, azithromycin) reduce acne-causing bacteria. They are used short-term and often combined with benzoyl peroxide to prevent resistance. Sun sensitivity is a common side effect.

• Combined Oral Contraceptives:
  Certain contraceptives (Ortho Tri-Cyclen, Yaz) can help treat acne in women by regulating hormones. Benefits may take several months, and side effects can include weight changes, breast tenderness, and nausea. These medications carry additional risks, including cardiovascular issues and certain cancers.

• Anti-androgen Agents:
  Spironolactone may be prescribed for women and adolescent girls if other therapies fail. It reduces androgen effects on oil glands. Side effects include breast tenderness and menstrual changes.

• Isotretinoin:
  Reserved for moderate to severe acne that does not respond to other treatments, isotretinoin significantly reduces oil production and inflammation. It carries potential risks, including severe birth defects, depression, and gastrointestinal issues. Participation in an FDA-approved risk management program and regular medical monitoring are required.

Additional Therapies

• Light Therapy:
  Various light-based treatments can reduce acne lesions. Multiple sessions are usually needed. More research is required to determine the most effective method.

• Chemical Peels:
  Superficial peels with salicylic acid, glycolic acid, or retinoic acid may improve mild acne and skin appearance, but repeated treatments are often necessary.

• Drainage and Extraction:
  Comedones or cysts resistant to medications can be removed by a dermatologist to improve appearance temporarily. Some risk of scarring exists.

• Steroid Injections:
  Corticosteroid injections can treat large, painful nodules or cysts, providing rapid relief. Side effects may include thinning or discoloration of the skin at the injection site.

Treating Acne in Children

• FDA-approved topical medications (benzoyl peroxide, adapalene, tretinoin) are now considered safe for preadolescents.

• Pediatric dermatologists can guide appropriate dosages, monitor for side effects, and assess the impact on growth and development.