Acne Treatment

The acne treatment needed depends on the type of acne. Read on to learn about acne treatments.

If you just have a few blackheads, whiteheads and spots, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide. 

Some self-help techniques may also be useful: Do not wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse. Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.

Treatment of acne depends on the type and severity of lesions and on the patient's response to particular measures. Comedonal acne lesions are usually best managed with topical retinoids and acne surgery; superficial inflammatory acne lesions are treated with a range of topical therapies, including benzoyl peroxide, topical antibiotics (e.g., clindamycin or erythromycin), topical retinoids, azelaic acid, and sulfacetamide with or without sulfur. When superficial inflammatory acne is more severe or when there is a significant presence of deep inflammatory acne, oral antibiotic therapy is usually required. Because nodules are more likely than comedos to cause scarring, they are initially treated more aggressively, with the combination of a topical regimen and an oral antibiotic such as minocycline or doxycycline plus, if necessary, oral isotretinoin (see below). Intralesional corticosteroid injection administered by a dermatologist produces a rapid response and can prevent scarring, although local skin atrophy may result. Unroofing of sinus tracts (marsupalization) and other surgical procedures are best performed by physicians with expertise in dermatologic surgery [see Table 2]. Scars are not responsive to medical therapies, warranting treatment with a physical modality such as dermabrasion or laser abrasion. The appearance of depressed scars may be improved by ceratin chemical peels, punch excision, and resurfacing procedures, as well as by the injection of filler substances.

Numerous over-the-counter cleansing agents are available to help patients remove seborrhea and oily debris from the skin, resulting in subjective improvements. However, many over-the-counter products are abrasive and irritating to skin, leading to reduced tolerability when acne medications are applied. Self-manipulation of acne lesions by picking, squeezing, or excessive washing can lead to exacerbation of lesions, dyschromia, and even scarring.

Topical skin care preparations, including sunscreens, cleansers, moisturizers, and cosmetics, should be oil-free and noncomedogenic. Many over-the-counter oil-free, noncomedogenic moisturizers are available and can be used to prevent or lessen the dryness, redness, and peeling that may occur with topical acne treatment. There is no clearly defined role for dietary manipulation in the management of acne. Previous beliefs that chocolate or oily foods cause acne have not been substantiated.

Topical Therapy

Comedonal acne Topical retinoids—tretinoin, adapalene and tazarotene—are among the most effective therapies for comedonal and inflammatory acne; these preparations reduce follicular hyperkeratinization, which reduces microcomedo formation, and also allow for increased penetration of topical antibiotics and benzoyl peroxide. In addition, retinoids exhibit direct anti-inflammatory activity, at least partially through downregulation of TLR-2 expression. As a component of an acne treatment regimen, retinoids can be used in combination with topical and oral antibacterial agents.10 Topical retinoids may be irritating to skin, especially during the first few weeks of use. Patients can reduce irritation by use of a moisturizer and a gentle skin cleanser or by temporarily reducing the frequency of application. Visible improvement is usually not evident for 6 to 8 weeks but can continue for 3 to 4 months and beyond. Newer formulations of retinoids that are reported to be less irritating include a tretinoin microsponge vehicle and adapalene.11,12 Tazarotene is less irritating in a cream formulation than in its gel vehicle. Tazarotene gel can also be used in a short-contact method, in which it is applied for seconds to minutes.13

Inflammatory acne

Topical antibiotics may be used in combination with benzoyl peroxide and a topical retinoid for inflammatory acne. Topical antibiotics used for acne treatment include clindamycin, erythromycin, and sulfacetamide. Evaluations in clinical trials indicate that clindamycin has sustained its therapeutic efficacy over time, whereas response to topical erythromycin has waned. Resistance of P. acnes to antibiotics has been documented and may potentially threaten the efficacy of antibiotic treatment in some patients.14,15 It is therefore useful to prescribe antibiotics in combination with benzoyl peroxide, which does not induce resistance and has been shown to reduce the emergence of resistant P. acnes strains. A combined formulation of clindamycin 1% and benzoyl peroxide 5% has been found to produce faster and greater reductions in P. acnes than formulations containing clindamycin alone.16 Moreover, the combination of benzoyl peroxide and clindamycin resulted in greater improvement in acne than either of its individual components alone.17 A 1% foam formulation of topical clindamycin, which is highly adaptable for widespread application because of easy spreadability and lack of residue or bleaching of fabric, may be used in combination with a benzoyl peroxide wash for mild or moderate truncal acne vulgaris; severe truncal involvement warrants the addition of an oral antibiotic to the topical regimen. In one commonly used regimen, a gel consisting of a combination of an antibiotic and benzoyl peroxide is applied in the morning, and a topical retinoid is used in the evening.

Azelaic acid, an anticomedonal and antibacterial agent, offers yet another choice for the topical treatment of acne. It can be used in combination with a topical retinoid, benzoyl peroxide, a topical antibiotic, and oral antibiotic therapy.18

Salicylic acid plays a minor role in the treatment of acne. Over-the-counter formulations of salicylic acid offer only limited efficacy for acne, because of their low concentration