Acne: Diagnosis and treatment

 Consult your doctor about prescription-strength drugs if you've used over-the-counter (nonprescription) acne remedies for a few weeks and they haven't helped. A dermatologist can assist:

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

Medication for acne works by either curing bacterial infections or lowering oil production and puffiness. You might not see results from the majority of prescription acne medications for four to eight weeks. Your acne may not fully go away for several months or even years.

The recommended course of therapy by your physician will vary depending on your age, acne type and severity, and level of commitment. For a few weeks, you might need to cleanse the afflicted area twice a day and apply medication. Oral meds and topical treatments are frequently used in conjunction with one another. Pregnant women have fewer treatment options because of the possibility of adverse effects.

Discuss the advantages and disadvantages of the drugs and other therapies you are thinking about with your physician. And until your skin gets better, schedule follow-up visits with your physician every three to six months.

Topical medications

The following are the most often prescribed topical medicines for acne:

• Retinoids and retinoid-like drugs. For mild to moderate acne, medications containing tretinoin or retinoic acid are frequently helpful. They are available as lotions, gels, and creams. Adapalene (Differin), tazarotene (Tazorac, Avage, etc.), and tretinoin (Avita, Retin-A, etc.) are a few examples. This treatment is applied in the evening, three times a week at first, and then every day until your skin adjusts. It keeps hair follicles from becoming clogged. Applying tretinoin and benzoyl peroxide simultaneously is not advised.

  The sun sensitivity of your skin is increased with topical retinoids. Additionally, they can result in redness and dry skin, particularly in those with brown or black skin. Adapalene might be the most tolerable.
• Antibiotics. These reduce redness and irritation and eliminate extra skin germs. You may apply both a retinoid and an antibiotic during the first few months of treatment; the retinol in the evening and the antibiotic in the morning. Benzoyl peroxide is frequently added to antibiotics to lessen the chance of antibiotic resistance developing. Examples include erythromycin plus benzoyl peroxide (Benzamycin) and clindamycin with benzoyl peroxide (Benzaclin, Duac, etc.). Using topical antibiotics by themselves is not advised.

• Azelaic acid and salicylic acid. Yeast naturally produces an acid called azelaic acid. It is antibacterial. When applied twice daily, a 20% azelaic acid cream or gel appears to be just as effective as many traditional acne treatments. It is possible to use prescription azelaic acid (Azelex, Finacea) both when pregnant and while nursing. It can also be used to treat the discoloration that some forms of acne cause. Skin redness and mild skin irritation are examples of side effects.

  Salicylic acid comes in wash-off and leave-on forms, and it may help avoid clogged hair follicles. Few studies have demonstrated its efficacy. Skin darkening and mild skin irritation are examples of side effects.
• Dapsone. For inflammatory acne, especially in women with acne, dapsone (Aczone) 5% gel is advised twice daily. Dryness and redness are among the side effects.

The use of zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium, or aluminum chloride as topical acne therapies is not well supported by the evidence.

Oral medications

• Antibiotics. You could require oral antibiotics to lower bacteria if you have moderate to severe acne. When treating acne, tetracyclines (minocycline, doxycycline) or macrolides (erythromycin, azithromycin) are typically the first medications prescribed. For those who cannot take tetracyclines, such as pregnant women and children under the age of eight, a macrolide may be a choice.
• To avoid antibiotic resistance, oral antibiotics should be used as little as feasible. They should also be taken in conjunction with other medications, including benzoyl peroxide, to lower the chance of developing antibiotic resistance.
• It is rare for antibiotics used to treat acne to cause severe negative effects. Yes, some medications make your skin more sensitive to the sun.
• Combined oral contraceptives. The FDA has approved four combination oral contraceptives for women who want to use them for contraception in addition to treating acne. These are products (Ortho Tri-Cyclen 21, Yaz, etc.) that mix progestin and estrogen. Using different acne drugs in the initial few weeks of this treatment may help, as you might not see results for several months.
• Weight gain, breast discomfort, and nausea are common side effects of combination oral contraceptives. Additionally, there is a higher chance of cardiovascular issues, breast cancer, and cervical cancer when using these medications.
• Anti-androgen agents. In women and teenage girls, spironolactone, also known as Aldactone, may be prescribed if oral antibiotics aren't working. It functions by preventing androgen hormones from having an impact on the glands that produce oil. Painful periods and breast discomfort are potential side effects.
• Isotretinoin. A derivative of vitamin A is isotretinoin (Amnesteem, Claravis, and other brands). Those with moderate to severe acne who have not responded to prior therapies may be prescribed it.
• Severe birth abnormalities, depression, and inflammatory bowel disease are possible side effects of oral isotretinoin. Everyone taking isotretinoin needs to take part in a risk management program that has been approved by the FDA. They'll also need to visit their doctors frequently so that any adverse effects can be observed.

Therapies

The following treatments, either by themselves or in conjunction with medication, may be beneficial for certain individuals.

• Light therapy. Many light-based therapies have been attempted, with varying degrees of effectiveness. Most will necessitate several trips to your physician's office. It will take further research to find the best technique, light source, and dosage.
• Chemical peel. A chemical solution, such as salicylic acid, glycolic acid, or retinoic acid, is applied repeatedly during this process. It is a modest form of acne treatment. It may make the skin look better, but the results are usually temporary, requiring more treatments.
• Drainage and extraction. If topical treatments haven't cleared up your whiteheads, blackheads, or cysts, your doctor may use specific instruments to carefully remove them. Although this method momentarily enhances the look of your skin, scarring may result from it as well.
• Steroid injection. Steroid injections are one method of treating nodular and cystic lesions. Pain has reduced and improvement has occurred quickly as a result of this therapy. Skin thinning and discoloration in the treated region are possible side effects.

Treating children

Most research on acne medications has focused on subjects who are 12 years of age or older. Acne is becoming more common in younger kids as well. The list of topical medications that the FDA has approved for use in children has grown. Additionally, topical benzoyl peroxide, adapalene, and tretinoin in preadolescent children are effective and don't raise the risk of adverse effects, according to guidelines from the American Academy of Dermatology.

You should think about seeing a pediatric dermatologist if your child has acne. Inquire about pharmaceuticals that should not be given to children, the right dosages, drug interactions, side effects, and how a child's development may be impacted by treatment.