To treat any case of acne, your dermatologist will first determine if you have a mild to moderate or severe type of condition. He or she will work with you to try and get your breakouts under control, avoid any scarring or other damage to your skin, and help reduce the appearance of any developed scars.
In some instances combination treatment may be assessed as the best route for you. This typically involves topical lotions or gels you can apply to the skin (blemishes only or entire area affected), and oral medications. Combination treatment will often offer you the best results, as well as help you avoid developing drug-resistant bacteria.
- Mild acne: Treatment typically involves gentle cleaning using a mild soap (Dove or Cetaphil) and warm water, and applying salicylic acid and benzoyl peroxide products to the skin. If these topical measures do not work, a prescription for stronger lotions, gels or creams may be given Your dermatologist may also along prescribe an antibiotic lotion that helps to unclog your pores.
- Moderate to severe acne: Your dermatologist may recommend stronger medicine or a combination of treatments. Blemishes which affect deeper layers of the skin (cysts and nodules) are more likely to leave scars. You may be prescribed oral antibiotics to promote the healing process (from the inside). Depending on the severity of your acne, you may be given a benzoyl peroxide to apply on the skin, as well as prescription antibiotic creams, gels or lotions, prescription retinoids and azelaic acid. Your doctor may need to drain large pimples and cysts for you. He or she will also prescribe oral antibiotics and oral retinoids (isotretinoin).
Medications work to help reduce oil production, speed up skin cell turnover, fight any bacterial infection and reduce inflammation. You may see improvement within 4 to 8 weeks of medication treatment. It is possible for your breakouts to get worse before showing any improvement while taking some medications. Your dermatologist will warn you about this. For some it can take many months or even years before your skin clears up completely.
Expectant moms will not be prescribed any oral medications for acne during their pregnancy.
- Topical medications: These work best when applied to clean and dried skin about 15 minutes after washing. Improvement to the skin can be seen within a few weeks. Redness (inflammation), dryness and even peeling can occur at the beginning of treatment but should improve with continuous use. A gradually increased dosage and other care instructions may be recommended by your dermatologist in order to minimise these side effects. Common topical prescriptions include retinoids (derived from vitamin A and include tretinoin, adapalene and tazarotene), antibiotics, and dapsone (Aczone) gel.
- Oral medications: Antibiotics reduce bacteria and help fight inflammation. Popular choices include tetracyclines (such as minocycline and doxycycline). Antibiotics may be tapered off as symptoms begin to improve or as soon as it becomes clear that the medication is not working. Tapering is necessary to prevent antibiotic resistance. Antibiotics may lead to side effects such as an upset stomach (ask your doctor about a probiotic that can be used to alleviate this) or dizziness. The skin’s sun sensitivity may also increase. Reduced bone growth in children born to women who took tetracyclines while pregnant has been noted as well, so it is important to discuss all medications you take or are thinking of taking with your doctor before and during pregnancy. Combined oral contraceptives (oestrogen and progestin) are often useful for treating acne in women and adolescent girls. Common side effects of these medications are headaches, nausea, weight gain, breast tenderness and breakthrough bleeding (spotting). A potentially serious complication is a slightly increased risk of blood clots. Anti-androgen agents may be considered for women and adolescent girls who have not seen any improvement using antibiotics. These work by blocking the effect of androgen hormones on the sebaceous glands. Side effects can include breast tenderness, retention of potassium and painful menstrual periods. Isotretinoin is generally recommended for those with the most severe cases of acne. It is a powerful drug and is very effective when taken orally. Potential side effects can be rather serious (especially for women of reproductive age) and will need to be monitored by your dermatologist very carefully. These can include ulcerative colitis, and increased risk of depression, severe birth defects and even suicide.
Other therapies to treat acne
- Light-based therapies have been tried with some degree of success. Light therapy targets bacteria that causes acne inflammation and can be done in a doctor’s office. Blue-light therapy can be done at home with a hand-held device. Some can experience pain, temporary redness (inflammation) and sensitivity to light as possible side effects.
- A chemical peel involves repeated applications of a chemical solution (salicylic acid) and is most effective when used in combination with other treatments (except oral retinoids as this can significantly irritate the skin). Some scaling, blistering, severe redness and even long-term discolouration of the skin can sometimes occur.
- You can also undergo an extraction of whiteheads and blackheads. Your dermatologist will use special tools to gently remove these blemishes that haven’t cleared up with topical medications. Some scarring can occur using this method.
- Nodular and cystic lesions can also be treated with a steroid injection. A steroid drug is injected directly into a nodular or cystic lesion. This can help to improve the appearance of the lesion or cyst (reduce swelling) without the need for extraction. It can however, cause thinning of the skin, lightening of the skin and the appearance of small blood vessels on the treated area.
Treating acne scars
Treatments which can help to reduce the appearance of scars include:
- Soft tissue fillers: Fillers such as collagen or fat is injected under the skin and into indented scars to fill out and stretch the skin, making them less noticeable. Results are temporary and can include side effects such as swelling, redness or bruising. Periodic injections may be needed. Downtime: None
- Chemical peels: A high-potency acid is applied to the surface of the skin to remove the top layers and reduce deeper scars. Downtime: The length of recovery depends on the depth of the chemical peel. Light peels have no downtime although slight redness may appear for a day or two, medium depth peels take anything from five to 10 days to heal and deep peels will usually take one to two weeks to heal.
- Dermabrasion: This involves sanding (planing) of the surface layer of the skin with a rotating brush. Scars caused by acne are blended in to the surrounding skin. This procedure is usually most effective for severe scarring. Dermabrasion does have significant downtime, with swelling taking a few days to a week to subside. Sensitivity and a light pink appearance may continue for up to several weeks.
- Laser resurfacing: A laser is used to improve the appearance of the skin through a resurfacing procedure. The length of recovery after a laser resurfacing procedure will depend on the type of laser used, the area treated and the individual’s capacity for healing but you can expect anything from a five to 14-day recovery period with CO2 laser resurfacing.
- Light therapy: Lasers, pulsed light sources and radiofrequency devices will be used to treat scars without injuring the epidermis. The treatment involves heating the dermis to encourage new skin to form. Acne scars will be reduced after several treatments and become less noticeable. There is generally no downtime after a light therapy session.
- Skin surgery: Punch excision is a minor procedure where your doctor will cut out individual acne scars and repair the hole (scar site) with stitches or a skin graft. Downtime will vary based on the individual, the area treated and amount of surgery needed and usually takes a week to 10 days.
Tips for treating acne at home
There is plenty you can do to help control acne breakouts with some self-care techniques:
- Use a gentle cleanser or mild soap with warm water on problem areas twice a day. Facial scrubs, astringents and masks can irritate the skin, as can excessive washing, shaving or scrubbing.
- Avoid oily or greasy cosmetics, moisturisers, sunscreens, concealers or hairstyling products. Use water-based or noncomedogenic products instead.
- Avoid picking or squeezing blemishes as this causes further infection or scarring.
- Be mindful of what touches your skin. Try and avoid resting your face on your hands or other objects that may carry bacteria. It is also a good idea to try and keep your hair clean and off your face. Tight clothing and hats can sometimes be problematic if you are prone to sweating. Sweat and oils can cause breakouts.
It is important to remember that most treatments for acne take time, with improvements only noticeable between 6 and 8 weeks. Some treatments may cause acne to worsen before any signs of improvement.