Acne Treatment

Acne develops when there is excess sebum (oil) production, clogged skin pores, skin cells that shed too quickly or inflammation. For treatment to work it must interfere with what is causing the acne.

Virtually every case of acne can be resolved. The key to getting rid of acne lesions and preventing new ones from forming lies in knowing that resolution takes time, and what works for one person may not work for another.

No matter what the treatment is, acne does not clear overnight. On average, 6 to 8 weeks are needed to see initial results. Once acne significantly improves or clears, continued treatment is needed to keep acne from re-appearing. If acne does not improve in 6 to 8 weeks, treatment may need to be adjusted as not every acne treatment clears every case of acne.

Mild Acne - Mild acne consists of small lesions, such as blackheads, whiteheads or pustules, which appear at or near the surface of the skin.

Mild cases of acne can sometimes be controlled at home by gently washing the affected area(s) with warm water and a mild soap twice a day to remove dead skin cells and excess oil and using a topical (applied to the skin) over-the-counter acne treatment containing benzoyl peroxide or salicylic acid. If your acne does not respond to at-home treatment within 4-8 weeks, prescription medications may be required.

Moderate to Moderately Severe Acne - In moderate to moderately severe acne, numerous whiteheads, blackheads, papules and pustules appear that cover from ¼ to ¾ of the face and/or other affected area(s). Moderate to moderately severe acne usually requires combination therapy (using two or more treatment options). Treatments used to treat moderate to moderately severe acne are acne lesion extraction or light therapy, prescription medications, topical antimicrobials, topical retinoids, oral antibiotics, oral contraceptives, or over-the-counter topical acne medications. When moderate to severe acne is not treated early, scars can develop.

Severe Acne - Severe acne is characterised by deep cysts, inflammation, extensive damage to the skin and scarring and requires an aggressive treatment regimen. Severe, disfiguring forms of acne can require years of treatment and may experience one or more treatment failures.

However, almost every case of acne can be successfully treated. Physical methods and prescription medications that can be used to treat severe acne include:

Drainage and Surgical Excision - Some large cysts do not respond to medication and may require drainage and extraction. Drainage and extraction, or “acne surgery” as it is also called, should not be performed by patients. Patient attempts to drain and extract comedones (acne lesions) by squeezing or picking, can lead to infection, worsening of the acne and scarring.

Interlesional Corticosteroid Injection - When an acne cyst becomes severely inflamed, there is a good chance it will rupture and scarring may result. To treat these severely inflamed cysts and prevent scarring, cysts may be injected with a much-diluted corticosteroid. This lessens the inflammation and promotes healing. An interlesional corticosteroid injection works by "melting" the cyst over a period of 3 to 5 days.

Isotretinoin - Isotretinoin is a potent drug reserved for treating severe cystic acne and acne that has proven itself resistant to other medications. Isotretinoin is a synthetic (man-made) retinoid (form of vitamin A) that comes in pill form. It is usually taken once or twice a day for 16 to 20 weeks.

Over the Counter Products

Alcohol and Acetone - Found together in some over-the-counter medications used to treat acne, acetone works as a degreasing agent and alcohol has mild antimicrobial properties. When used alone, acetone tends to have no effect.
Benzoyl Peroxide - Benzoyl peroxide works to clear up acne by reducing P. acnes (bacteria) and removing dead cells from the skin to prevent lesions. It was one of the first agents found to be effective in treating mild acne and has been used in acne treatment for decades. Use of benzoyl peroxide should be continued after acne clears to prevent new lesions from forming.
Herbal, Organic and Natural Products - Over-the-counter products labeled “herbal,” "organic" or "natural" are marketed as acne treatments but their effectiveness has rarely been tested in clinical trials. The value of such treatments is generally unknown.
Resorcinol - A popular ingredient in over-the-counter acne medications, resorcinol controls small acne lesions and is frequently combined with sulfur in over-the-counter products.
Salicylic acid - Effective in treating non-inflammatory acne lesions, salicylic acid helps correct the abnormal shedding of skin cells and unclog pores to resolve and prevent lesions. Salicylic acid does not have any effect on oil production or bacteria.

Physical Treatments

Glycolic Acid Peel - Light chemical peels of glycolic acid and other chemical agents are used to loosen blackheads and decrease acne papules (inflammatory lesions that resemble small, red bumps on the skin).
Comedo (Lesion) Extraction - Sometimes removing acne lesions (comedones) proves beneficial. To extract whiteheads and blackheads, a sterile pen-sized device is used. This procedure should only be performed by a medical professional. Patients’ attempts to extract comedones and drain cysts by squeezing or picking, can lead to worsening of the acne, scarring and infection.
Drainage and Surgical Extraction - Some large cysts do not respond to medication and may require drainage and extraction. Drainage and extraction, which is also called “acne surgery,” reduces the pain associated with these cysts and decreases the likelihood of scarring.
Phototherapy (Laser and Light Treatments) - Several laser and light treatments are available to treat acne. Your doctor can determine if laser or light treatment is appropriate for your skin condition.

Acne Skin Care Guidelines

Do NOT pop, squeeze or pick at acne
Gently wash your face twice a day with a mild cleanser and pat dry
Use “noncomedogenic” (does not clog pores) cosmetics and toiletries
If you have oily hair, keep it off your face and wash it daily
Avoid hair products that contain oil such as pomades and gel
Give acne products enough time to do their job
Use medications as directed
Avoid solariums, sun lamps, and excess exposure to sunlight

Please ask your Doctor for further information.

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We wish to acknowledge that the information and photos provided are courtesy of the American Academy of Dermatology