The purpose of medical care is to prevent scarring until the disease characteristically spontaneously remits after the conclusion of puberty. Many treatment options are available to treat all forms of acne. Medications are the main treatment for acne and usually work well. Several preparations are available over the counter, while others require a prescription from a doctor.
- Over-the-counter medications: Nonprescription or over-the-counter medications for acne are plentiful and can be effective for milder forms of acne. They come in the form of soaps, washes, and cleansers.
- Many contain benzoyl peroxide, which does two things. First, benzoyl peroxide kills the acne-causing bacteria, which are thought to play a role in acne. Second, benzoyl peroxide can cause drying and flaking off of skin, which can help prevent the pores from becoming plugged. Plugged pores can develop into acne blemishes.
- Scrubbing excessively with any over-the-counter preparation can actually cause acne to worsen by additionally irritating the hair follicles.
- Prescription medications: Doctors can prescribe medications when acne becomes moderate to severe or is not controlled by over-the-counter medications. Prescription drugs can be used effectively alone or in combination with other prescription and nonprescription medications.
- Azalaic acid products: These products are useful in mild acne composed mostly of comedones. The are unlikely to produce inflammation and are applied twice a day.
- Antibiotics: Antibiotics can be effective in treating most inflammatory acne (papules and pustules). They work by decreasing inflammation caused by bacteria and other irritating chemicals present in the sebaceous follicle.
- Antibiotics may be applied to the skin in the form of gels and lotions or by way of pills. Giving an antibiotic by mouth is often needed for acne that is more extensive, red, and tender.
- Antibiotics may be combined with benzoyl peroxide, which is contained in over-the-counter medications, to form a topical solution that can be obtained with a doctor's prescription.
- Antibiotics taken by mouth for relatively extended periods can be very effective in controlling acne. Although the development of resistant bacteria is a theoretical concern as a result of protracted courses of antibiotics, this does not seem to occur commonly in acne patients. As with any systemic medication, they can be associated with more side effects than if applied to the skin and may interact with other drugs. Sensitivity to the sun can result in a "bad sunburn" in some people who take antibiotics in the tetracycline family.
- Retinoids: Medicines structurally similar to vitamin A are useful in preventing several types of acne lesions. Topical retinoids are effective in treating the noninflammatory types of acne (blackheads and whiteheads).
- Topical retinoids (applied directly to the skin) help to open clogged pores and produce a mild peeling effect. Drying and redness of the skin can be a frequent side effect and limit its usefulness
in some patients.
- An oral retinoid (isotretinoin) may be prescribed for treating the more extensive nodular type of acne or severe inflammatory acne, which has not responded to other treatments
and is likely to cause scarring. All patients on isotretinoin will experience a peeling and drying of the skin. Most patients who take the appropriate dosage for an appropriate duration should expect a permanent remission in their acne. Isotretinoin is associated with a number of serious side effects, including birth defects in babies of women who become pregnant while taking the medicine. The drug can also cause elevated blood lipids and damage to the liver. Your doctor must perform certain blood tests to check for these problems and to make sure you are not pregnant (assuming that it is possible) if you are given oral retinoids. Depression and inflammatory bowel disease have been reported while taking oral retinoids. All patients on isotretinoin in the United States must be registered in a government-mandated program, the I PLEDGE PROGRAM, which is accessible online or by telephone. Beside the patient, the patient's physician and the dispensing pharmacy must also register with this program.
- Other medications: A doctor may recommend other types of drugs or therapy to improve acne. For women, medications such as birth control pills or certain "water pills" may be helpful. These drugs counteract the acne-causing effect of male hormones. Newer treatments for acne include the use of light or zinc. Your doctor can advise you whether these types of acne therapy might be good for you.
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