Use topical benzoyl peroxide
lotion or gel
Benzoyl peroxide or salicylic acid helps kill skin bacteria, unplug
the oil ducts and heal acne pimples. It is the most effective
acne treatment you can get without a doctor's prescription. Many
brands are available in different levels of strength (2.5 percent,
5 percent or 10 percent). Read the labels or ask your pediatrician
or pharmacist about it.
Depending on the person's acne, this might mean
using prescription creams that prevent pimples from forming, taking
antibiotics that kill the bacteria that help create pimples, or
if the acne is severe, taking stronger medicines such as isotretinoin
or even having minor surgery.
· TRETINOIN (RETIN-A) CREAM OR GEL helps
unplug oil ducts but must be used exactly as directed. Be aware
that exposure to the sun (or tanning parlors) can cause increased
redness in some people who are using the medication.
· TOPICAL ANTIBIOTIC SOLUTIONS may be used in addition
to other medications for a type of acne called pustular acne.
· ORAL ANTIBIOTIC PILLS may be used in addition to creams,
lotions or gels if your acne doesn't respond to topical treatments
Acne and Birth Control Pills
Some women find that birth control pills help to clear up their
In 1996, the Food and Drug Administration (FDA)
approved a low-dose birth control pill to be used as an effective
treatment for acne in women over 15 years of age. Research has
shown that certain birth control pills lower the levels of hormones
that cause acne. However, taking birth control pills along with
other medications for the prevention of acne may reduce the effectiveness
of both medications. If you are taking birth control pills, talk
to your pediatrician about their effect on acne.
Treatment for Blackheads, Whiteheads, and
Mild Inflammatory Acne
Doctors usually recommend an OTC or prescription topical medication
for people with mild signs of acne. Topical medicine is applied
directly to the acne lesions or to the entire area of affected
Benzoyl peroxide, resorcinol, salicylic acid, and sulfur are the
most common topical OTC medicines used to treat acne. Each works
a little differently. Benzoyl peroxide is best at killing P. acnes
and may reduce oil production. Resorcinol, salicylic acid, and
sulfur help break down blackheads and whiteheads. Salicylic acid
also helps cut down the shedding of cells lining the follicles
of the oil glands. Topical OTC medications are available in many
forms, such as gel, lotion, cream, soap, or pad.
In some patients, OTC acne medicines may cause side effects such
as skin irritation, burning, or redness. Some people find that
the side effects lessen or go away with continued use of the medicine.
Severe or prolonged side effects should be reported to the doctor.
OTC topical medicines are somewhat effective in treating acne
when used regularly. Patients must keep in mind that it can take
8 weeks or more before they notice their skin looks and feels
Treatment for Moderate to
Severe Inflammatory Acne
Patients with moderate to severe inflammatory acne may be treated
with prescription topical or oral medicines, alone or in combination.
Prescription Topical Medicines
Several types of prescription topical medicines are used to treat
acne, including antibiotics, benzoyl peroxide, tretinoin, adapalene,
and azelaic acid. Antibiotics and azelaic acid help stop or slow
the growth of bacteria and reduce inflammation. Tretinoin, a type
of drug called a retinoid that contains an altered form of vitamin
A, is an effective topical medicine for stopping the development
of new comedones. It works by unplugging existing comedones, thereby
allowing other topical medicines, such as antibiotics, to enter
the follicles. The doctor may also prescribe newer retinoids or
retinoid-like drugs, such as tazarotene or adapalene, that help
decrease comedo formation.
Like OTC topical medicines, prescription topical medicines come
as creams, lotions, solutions, or gels. The doctor will consider
the patient's skin type when prescribing a product. Creams and
lotions provide moisture and tend to be good for people with sensitive
skin. Gels and solutions are generally alcohol based and tend
to dry the skin. Therefore, patients with very oily skin or those
who live in hot, humid climates may prefer them. The doctor will
tell the patient how to apply the medicine and how often to use
Some people develop side effects from using prescription topical
medicines. Initially, the skin may look worse before improving.
Common side effects include stinging, burning, redness, peeling,
scaling, or discoloration of the skin. With some medicines, like
retinoids, these side effects usually decrease or go away after
the medicine is used for a period of time. Patients should report
prolonged or severe side effects to their doctor. Between 4 and
8 weeks will most likely pass before patients see their skin improve.
Prescription Oral Medicines
For patients with moderate to severe acne, the doctor often prescribes
oral antibiotics (taken by mouth). Oral antibiotics are thought
to help control acne by curbing the growth of bacteria and reducing
inflammation. Prescription oral and topical medicines may be combined.
For example, benzoyl peroxide may be combined with clindamycin,
erythromycin, or sulfur. Other common antibiotics used to treat
acne are tetracycline, minocycline, and doxycycline. Some people
have side effects when taking these antibiotics, such as an increased
tendency to sunburn, upset stomach, dizziness or lightheadedness,
and changes in skin color. Tetracycline is not given to pregnant
women, nor is it given to children under 8 years of age because
it might discolor developing teeth. Tetracycline and minocycline
may also decrease the effectiveness of birth control pills. Therefore,
a backup or another form of birth control may be needed. Prolonged
treatment with oral antibiotics may be necessary to achieve the
Treatment for Severe Nodular or Cystic
People with nodules or cysts should be treated by a dermatologist.
For patients with severe inflammatory acne that does not improve
with medicines such as those described above, a doctor may prescribe
isotretinoin (Accutane*), a retinoid. Isotretinoin is an oral
drug that is usually taken once or twice a day with food for 15
to 20 weeks. It markedly reduces the size of the oil glands so
that much less oil is produced. As a result, the growth of bacteria
* Brand names included in this booklet are provided as examples
only, and their inclusion does not mean that these products are
endorsed by the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned, this
does not mean or imply that the product is unsatisfactory.
Advantages of Isotretinoin (Accutane)
Isotretinoin is a very effective medicine that can help prevent
scarring. After 15 to 20 weeks of treatment with isotretinoin,
acne completely or almost completely goes away in up to 90 percent
of patients. In those patients where acne recurs after a course
of isotretinoin, the doctor may institute another course of the
same treatment or prescribe other medicines.
Disadvantages of Isotretinoin (Accutane)
Isotretinoin can cause birth defects in the developing fetus of
a pregnant woman. It is important that
women of childbearing age are not pregnant and do not get pregnant
while taking this medicine. Women must use two separate
effective forms of birth control at the same time for 1 month
before treatment begins, during the entire course of treatment,
and for 1 full month after stopping the drug. They should ask
their doctor when it is safe to get pregnant after they have stopped
Some people with acne become depressed by the changes in the appearance
of their skin. Changes in mental health may be intensified during
treatment or soon after completing a course of medicines like
Accutane. A doctor should be consulted if a person feels unusually
sad or has other symptoms of depression, such as loss of appetite
or trouble concentrating.
Other possible side effects include dry eyes, mouth, lips, nose,
or skin; itching; nosebleeds; muscle aches; sensitivity to the
sun; and, sometimes, poor night vision. More serious side effects
include changes in the blood, such as an increase in triglycerides
and cholesterol, or a change in liver function. To make sure Accutane
is stopped if side effects occur, the doctor monitors blood studies
that are done before treatment is started and periodically during
treatment. Side effects usually go away after the medicine is
Treatments for Hormonally Influenced Acne
Clues that help the doctor determine whether acne in an adult
woman is due to an excess of androgen hormones are hirsutism (excessive
growth of hair in unusual places), premenstrual acne flares, irregular
menstrual cycles, and elevated blood levels of certain androgens.
The doctor may prescribe one of several drugs to treat women with
this type of acne. Low-dose estrogen birth control pills help
suppress the androgen produced by the ovaries. Low-dose corticosteroid
drugs, such as prednisone or dexamethasone, may suppress the androgen
produced by the adrenal glands. Finally, the doctor may prescribe
an antiandrogen drug, such as spironolactone (Aldactone). This
medicine reduces excessive oil production. Side effects of antiandrogen
drugs may include irregular menstruation, tender breasts, headache,
Other Treatments for Acne
Doctors may use other types of procedures in addition to drug
therapy to treat patients with acne. For example, the doctor may
remove the patient's comedones during office visits. Sometimes
the doctor will inject cortisone directly into lesions to help
reduce the size and pain of inflamed cysts and nodules.
Early treatment is the best way to prevent acne scars. Once scarring
has occurred, the doctor may suggest a medical or surgical procedure
to help reduce the scars. A superficial laser may be used to treat
irregular scars. Another kind of laser allows energy to go deeper
into the skin and tighten the underlying tissue and plump out
depressed scars. Dermabrasion (or microdermabrasion), which is
a form of "sanding down" scars, is sometimes combined
with the subsurface laser treatment. Another treatment option
for deep scars caused by cystic acne is the transfer of fat from
one part of the body to the face.
Acne Care for Their Skin?
To help prevent the oil buildup that can contribute
to acne, wash your face twice a day with soap and warm water.
Don't scrub your face hard with a washcloth - acne can't be scrubbed
away, and scrubbing may actually make it worse by irritating the
skin and pores. Try cleansing your face as gently as you can.
If you wear makeup or sunscreen, make sure it's
labeled "oil-free," "noncomedogenic," or "nonacnegenic."
This means it won't clog your pores and contribute to acne. And
when you are washing your face, be sure you take the time to remove
all of your makeup.
Acne is often treated by dermatologists (doctors
who specialize in skin problems). The goals of treatment are to
heal existing lesions, stop new lesions from forming, prevent
scarring, and minimize the psychological stress and embarrassment
caused by this disease. Drug treatment is aimed at reducing several
problems that play a part in causing acne: abnormal clumping of
cells in the follicles, increased oil production, bacteria, and
inflammation. Depending on the extent of the person's acne, the
doctor will recommend one of several over-the-counter (OTC) medicines
or prescription medicines that are topical (applied to the skin)
or systemic (taken by mouth). The doctor may suggest using more
than one topical medicine or combining oral and topical medicines.
Clean Skin Gently
Most doctors recommend that people with acne gently wash their
skin with a mild cleanser, once in the morning and once in the
evening and after heavy exercise. Some people with acne may try
to stop outbreaks and oil production by scrubbing their skin and
using strong detergent soaps and rough scrub pads. However, scrubbing
will not improve acne; in fact, it can make the problem worse.
Patients should ask their doctor or another health professional
for advice on the best type of cleanser to use. Patients should
wash their face from under the jaw to the hairline. It is important
that patients thoroughly rinse their skin after washing it. Astringents
are not recommended unless the skin is very oily, and then they
should be used only on oily spots. Doctors also recommend that
patients regularly shampoo their hair. Those with oily hair may
want to shampoo it every day.
Avoid Frequent Handling of the Skin
People who squeeze, pinch, or pick their blemishes risk developing
scars or dark blotches. People should avoid rubbing and touching
their skin lesions.
Men who shave and who have acne can test both electric and safety
razors to see which is more comfortable. Men who use a safety
razor should use a sharp blade and soften their beard thoroughly
with soap and water before applying shaving cream. Nicking blemishes
can be avoided by shaving lightly and only when necessary.
Avoid a Sunburn or Suntan
Many of the medicines used to treat acne can make a person more
prone to sunburn. A sunburn that reddens the skin or suntan that
darkens the skin may make blemishes less visible and make the
skin feel drier. However, these benefits are only temporary, and
there are known risks of excessive sun exposure, such as more
rapid skin aging and a risk of developing skin cancer.
Choose Cosmetics Carefully
People being treated for acne often need to change some of the
cosmetics they use. All cosmetics, such as foundation, blush,
eye shadow, and moisturizers, should be oil free. Patients may
find it difficult to apply foundation evenly during the first
few weeks of treatment because the skin may be red or scaly, particularly
with the use of topical tretinoin or benzoyl peroxide. Oily hair
products may eventually spread over the forehead, causing closed
comedones. Products that are labeled as noncomedogenic (do not
promote the formation of closed pores) should be used; in some
people, however, even these products may cause acne.