Isotretinoin. If you experience deep, painful cysts and nodules, you may need more aggressive treatment. This oral derivative of vitamin A (commonly referred to by the brand name Accutane) shrinks oil glands and limits how much oil they produce. “This is a fantastic medication that does something no other acne medication does,” says Dr. Lee. After taking it for four to six months, “we say that your acne goes into remission.” Because the drug carries a risk of birth defects, you can absolutely not get pregnant while taking it, so patients are required to take pregnancy tests before, during, and after taking the med.
Among the most widely successful strategies they employ is prescribing different topical medications – which are frequently “coupled” in a single lotion, gel or other delivery substance – in combination with oral antibiotics to address multiple causes and effects of acne.
Use your fingertips to apply a non-abrasive, gentle formula that won’t strip your skin.1 Using a washcloth, mesh, or other rough fabrics can irritate your skin.1 Talk to your dermatologist about products that work with your acne treatment.
Benzoyl peroxide (BPO) is a first-line treatment for mild and moderate acne due to its effectiveness and mild side-effects (mainly skin irritation). In the skin follicle, benzoyl peroxide kills P. acnes by oxidizing its proteins through the formation of oxygen free radicals and benzoic acid. These free radicals are thought to interfere with the bacterium’s metabolism and ability to make proteins. Additionally, benzoyl peroxide is mildly effective at breaking down comedones and inhibiting inflammation. Benzoyl peroxide may be paired with a topical antibiotic or retinoid such as benzoyl peroxide/clindamycin and benzoyl peroxide/adapalene, respectively.
Get at least eight hours of sleep. Sleeping kills two birds with one stone, as it helps to relax your body as well as detoxify it. If you aren’t getting enough sleep, chances are your skin hasn’t had the time or ability to renew its skin cells. Regulate your sleep cycle by going to bed at a consistent time every night and sleeping for a minimum of eight hours at least.
Benzoyl peroxide causes red and scaly skin irritation in a small number of people, which goes away as soon as one stops using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide come into contact with fabrics, leaving unsightly white spots on colored clothes, shirts, towels, and carpets.
Washing your skin too vigorously, too often, or with the wrong products can do more harm than good. Just be patient with your salicylic acid and benzoyl peroxide, get a facial, and if that doesn’t work, visit your dermatologist.
Before prescribing isotretinoin, the dermatologist looks at the test results. If the results are okay, the dermatologist will discuss possible side effects of isotretinoin. After learning about isotretinoin, a patient must decide whether to take this medicine.
American Academy of Dermatology: “Acne Treatment Revolutionized by 25 Years of Treatment,” “Acne,” “Food Does Not Cause Acne,” “Treating Acne in Skin of Color,” “Prescription Medications for Treating Acne.”
Tea tree oil is an antibacterial agent that can help clear out the microbes clogging your skin. Avoid using undiluted tea tree oil — it’ll burn your skin, and worsen acne. Read the warning label on the bottle.
There is no clear evidence that acne vulgaris is related to poor hygiene or that frequent face washing lessens acne. Patients should be instructed to wash their face gently with warm water and mild soap twice daily; rough scrubbing can cause new lesions because of follicular rupture. The only antibacterial soaps that may be effective are those containing benzoyl peroxide.19
Hydroquinone lightens the skin when applied topically by inhibiting tyrosinase, the enzyme responsible for converting the amino acid tyrosine to the skin pigment melanin, and is used to treat acne-associated postinflammatory hyperpigmentation. By interfering with new production of melanin in the epidermis, hydroquinone leads to less hyperpigmentation as darkened skin cells are naturally shed over time. Improvement in skin hyperpigmentation is typically seen within six months when used twice daily. Hydroquinone is ineffective for hyperpigmentation affecting deeper layers of skin such as the dermis. The use of a sunscreen with SPF 15 or higher in the morning with reapplication every two hours is recommended when using hydroquinone. Its application only to affected areas lowers the risk of lightening the color of normal skin but can lead to a temporary ring of lightened skin around the hyperpigmented area. Hydroquinone is generally well-tolerated; side effects are typically mild (e.g., skin irritation) and occur with use of a higher than the recommended 4% concentration. Most preparations contain the preservative sodium metabisulfite, which has been linked to rare cases of allergic reactions including anaphylaxis and severe asthma exacerbations in susceptible people. In extremely rare cases, repeated improper topical application of high-dose hydroquinone has been associated with an accumulation of homogentisic acid in connective tissues, a condition known as exogenous ochronosis.
Salicylic acid is a topically applied beta-hydroxy acid that stops bacteria from reproducing and has keratolytic properties. It opens obstructed skin pores and promotes shedding of epithelial skin cells. Salicylic acid is known to be less effective than retinoid therapy. Dry skin is the most commonly seen side effect with topical application, though darkening of the skin has been observed in individuals with darker skin types.
Medical conditions that commonly cause a high-androgen state, such as polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors, can cause acne in affected individuals. Conversely, people who lack androgenic hormones or are insensitive to the effects of androgens rarely have acne. An increase in androgen and oily sebum synthesis can be seen during pregnancy. Acne can be a side effect of testosterone replacement therapy or of anabolic steroid use. Over-the-counter bodybuilding and dietary supplements are commonly found to contain illegally added anabolic steroids.
If your acne is not improving with over-the-counter treatments or if you have more severe forms of acne, you will need to see your doctor. Your family doctor can assess your acne, determine if you are developing any scarring and prescribe treatments specific for your type of acne.
You have a good shot at getting rid of milder, non-hormonal breakouts without a prescription. Apply a treatment with 2 percent salicylic acid, which gently exfoliates, such as Benzac Acne Solutions Intensive Spot Treatment, twice daily all over your face, or one with benzoyl peroxide, which fights the bacteria that cause zits. (We like Neutrogena Rapid Clear Stubborn Acne Spot Gel, which has the highest concentration available without a prescription.) You can also switch to a daily cleanser with at least 0.5 percent salicylic acid, such as Philosophy’s Clear Days Ahead Oil-Free Salicylic Acid Acne Treatment Cleanser. Then, every time you feel the first tingles of a new zit forming, hit the spot with a dab of antibacterial spot treatment (like that Benzac one we mentioned). And be patient: It can take six to eight weeks before you notice a real change in your skin.
Acne treatments vary, depending on the severity of your acne. Many teenagers and adults can control mild acne with over-the-counter topical solutions, like acne cream and salicylic acid products that loosen blackheads and whitehea…
Jump up ^ White, Stephen D.; Bordeau, Patrick B.; Blumstein, Philippe; Ibisch, Catherine; GuaguÈre, Eric; Denerolle, Philippe; Carlotti, Didier N.; Scott, Katherine V. (1 September 1997). “Feline acne and results of treatment with mupirocin in an open clinical trial: 25 cases (1994–96)”. Veterinary Dermatology. 8 (3): 157–164. doi:10.1046/j.1365-3164.1997.d01-16.x. ISSN 1365-3164. Archived from original on 12 March 2017.
Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption. Nadifloxacin and dapsone (category C) are other topical antibiotics that may be used to treat acne in pregnant women, but have received less study. No adverse fetal events have been reported from the topical use of dapsone. If retinoids are used there is a high risk of abnormalities occurring in the developing fetus; women of childbearing age are therefore required to use effective birth control if retinoids are used to treat acne. Oral antibiotics deemed safe for pregnancy (all category B) include azithromycin, cephalosporins, and penicillins. Tetracyclines (category D) are contraindicated during pregnancy as they are known to deposit in developing fetal teeth, resulting in yellow discoloration and thinned tooth enamel. Their use during pregnancy has been associated with development of acute fatty liver of pregnancy and is further avoided for this reason.
Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, Cutibacterium acnes (formerly Propionibacterium acnes) infection, and inflammation. The grade and severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate.
Another main cause of pimples is stress. Your body functions get upset during stress, and this triggers pimples. Stress cannot alone cause a pimple, but it aggravate the problem by releasing inflammatory chemicals called neuropeptides (1, 2).
Hodgkiss-Harlow CJ, Eichenfield LF, Dohil MA. “Effective monitoring of isotretinoin safety in a pediatric dermatology population: A novel “patient symptom survey” approach.” J Am Acad Dermatol; 2011; 65: 517-24.
“Sunscreen is imperative to protect newly-forming skin and is a must when trying to heal scars,” says Dr. Bank. This daily moisturizer protects your skin with broad-spectrum SPF 50 in a seriously hydrating formula. But best of all, it offers color-correcting pigments that cover red and dark spots while they’re healing.
Polycystic Ovary Syndrome (PCOS) is the result of significant shifts in a woman’s hormones. This shift can cause the production of androgens to increase and overwhelm estrogen levels, signaling the production of excess sebum. This hormonal imbalance can result in painful cysts, period changes, infertility issues, heart disease, diabetes, and skin conditions like acne. One research study performed purported that 27 percent of all women struggling with acne also were diagnosed with PCOS. Those with PCOS are more prone to inflammation, which can worsen the severity of acne.
When topical and oral antibiotics fail to measure up against acne, using oral contraceptives or birth control pills can inhibit androgens from performing their tasks. Certain oral contraceptives prevent the release of sebum that fires up your acne by blocking the androgens that stimulate the oil glands. An antiandrogen is taken in combination with birth control pills in the event that the pill can’t handle the acne by itself, or if you have male symptoms like extra body hair or thinning scalp due to excess androgens. Learn more…
Many skin conditions can mimic acne vulgaris and are collectively known as acneiform eruptions. Such conditions include angiofibromas, epidermal cysts, flat warts, folliculitis, keratosis pilaris, milia, perioral dermatitis, and rosacea, among others. Age is one factor which may help distinguish between these disorders. Skin disorders such as perioral dermatitis and keratosis pilaris can appear similar to acne but tend to occur more frequently in childhood, whereas rosacea tends to occur more frequently in older adults. Facial redness triggered by heat or the consumption of alcohol or spicy food is suggestive of rosacea. The presence of comedones helps health professionals differentiate acne from skin disorders that are similar in appearance. Chloracne, due to exposure to certain chemicals, may look very similar to acne vulgaris.
Some large cysts do not respond to medication and may need to be drained or removed. Your dermatologist is the only person who should drain or remove these cysts. You should never try to drain or remove your acne by squeezing or picking. This can lead to infection, worsen your acne, and cause scarring.