ACNE

Acne is often triggered by a change in hormones, which leads to problems with bacteria and clogged pores. Treatment of acne often requires a combination of treating the active breakouts with medication and taking action to prevent future breakouts or minimizing future breakouts. At times, some patients note that a diet high in refined starches, sugars, excessive dairy and fried foods may make their acne worse.

Treatments and drugs
If over-the-counter (nonprescription) products haven’t cleared up your acne, we can help manage all aspects of your care.

  • Control your acne
  • Avoid scarring or other damage to your skin
  • Make scars less noticeable

Dermatoligst acne treatments work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely. The Dermatologist acne treatment recommended depends on the type and severity of your acne. It might be something you apply to your skin (topical medication) or take by mouth (oral medication). Often, drugs are used in combination. Pregnant women will not be able to use oral prescription medications for acne.

Topical medications
These Dermatologist acne treatments work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling. Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication. The most common topical prescription medications for acne are:

  • Retnoids. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
  • Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
  • Dapsone (Aczone). This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.

Oral medications

  • Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Dermatologist acne treatment choices include tetracyclines, such as minocycline and doxycycline. Your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve or as soon as it becomes clear the drugs aren’t helping — usually, within three to four months. Tapering helps prevent antibiotic resistance by minimizing undue exposure to these medications over a long time. You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance. Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin’s sun sensitivity. They can cause discoloration of developing permanent teeth and reduced bone growth in children born to women who took tetracyclines while pregnant.
  • Combined oral contraceptives. Combined oral contraceptives are useful in treating acne in women and adolescent girls. The Food and Drug Administration approved three products that combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz). The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.
  • Anti-androgen agent. The Dermatologist acne treatment spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
  • Isotretinoin/accutane. This Dermatologist acne treatment is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn’t respond to other treatments. Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects. In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Therapies
These therapies may be suggested in select cases, either alone or in combination with medications.

  • Laser therapy. Laser therapy targets the bacteria that cause acne inflammation, as well as ‘turns the oil-producing pores off’ for a period of time. In clinical studies, laser therapy with Smoothbeam can be as effective as accutane. Possible side effects of light therapy include pain, temporary redness and sensitivity to sunlight.
  • Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids. Chemical peels aren’t recommended for people taking oral retinoids because together these treatments can significantly irritate the skin. Chemicals peels may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin.
  • Extraction of whiteheads and blackheads. Your provider uses special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications. This Dermatologist acne treatment may cause scarring.
  • Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this Dermatologist acne treatment include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.

Treating acne scars
Procedures used to diminish scars left by acne include the following:

  • Soft tissue fillers. Injecting soft tissue fillers, such as collagen or fat, under the skin and into indented scars can fill out or stretch the skin. This makes the scars less noticeable. Results are temporary, so you would need to repeat the injections periodically. Side effects include temporary swelling, redness and bruising.
  • Chemical peels. High-potency acid is applied to your skin to remove the top layer and minimize deeper scars.
  • Laser resurfacing. This is a skin resurfacing procedure that uses a laser to improve the appearance of your skin.
  • Light therapy. Certain lasers, pulsed light sources and radiofrequency devices that don’t injure the epidermis can be used to treat scars. These Dermatologist acne treatments heat the dermis and cause new skin to form. After several treatments, acne scars may appear less noticeable. This treatment has shorter recovery times than some other methods. But you may need to repeat the procedure more often and results are subtle.
  • Skin surgery. Using a minor procedure called punch excision, your doctor cuts out individual acne scars and repairs the hole at the scar site with stitches or a skin graft.

Some natural treatments may be helpful in reducing acne inflammation and breakouts:

  • Diet. A diet high in refined starches, sugars, excessive dairy and fried foods may make their acne worse. Eat ‘whole foods as much as possible, without added sugar, refined starches. Add more fruits, vegetables and healthy fats to your diet, such as coconut oil, flaxseed oil, olive oil, avocado/ avocado oil.
  • Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly. Possible side effects include contact dermatitis and, if you have rosacea, a worsening of those symptoms. One study reported that a young boy experienced breast development after using a combination lavender and tea tree oil hair product. Tea tree oil should be used only topically.
  • Alpha hydroxy acid. This natural acid is found in citrus fruit and other foods. When applied to your skin, alpha hydroxy acid helps remove dead skin cells and unclog pores. It may also improve the appearance of acne scars. Side effects include increased sensitivity to the sun, redness, mild stinging and skin irritation.
  • Azelaic acid. This naturally occurring acid has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments when used twice a day for at least four weeks. It’s even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breastfeeding.
  • Zinc. Zinc in lotions and creams may reduce acne breakouts.
  • Green tea extract. A lotion of 2 percent green tea extract helped reduce acne in two studies of adolescents and young adults with mild to moderate acne.
  • Aloe vera. A 50 percent aloe vera gel was combined with a conventional acne drug (tretinoin) and tested for eight weeks on 60 people with moderate acne. The combination approach was significantly more effective than tretinoin alone.
  • Brewer’s yeast. A specific strain of brewer’s yeast, called CBS 5926, seems to help decrease acne. Brewer’s yeast is the only item in this list that’s taken orally. It may cause flatulence.

More research is needed to establish the potential effectiveness and long-term safety of these and other natural acne treatments, traditional Chinese medicine and ayurvedic herbs.