Treating acne: medications and procedures

Acne can be devastating at any age, but you don't have to live with blemishes. With treatment, you can feel confident and ready to face the world again.

• Acne doesn't last forever—it just seems like it does. It can, however, take time to clear up—anywhere from several days for a crop of pimples to months or years for some types of cystic acne.
• For occasional blemishes, applying over-the-counter anti-acne preparations, and keeping your skin clean can make a real difference. For an extended outbreak, you'll need to see a dermatologist for prescription medications. Certain office procedures—cyst removal, skin peels, steroid injections—can also be very effective in treating severe cases.
• Here is a helpful overview of acne treatment options.

• If you have mild to moderate acne, home treatment should begin with over-the-counter antibacterial drugs. Look for remedies with benzoyl peroxide, which fights the P. acnes bacteria.
• Other products feature salicylic acid, a derivative of aspirin. Salicylic acid products are a good choice for whiteheads or blackheads (medically known as comedones), because they gently dry up and peel away the skin’s top layer, unclogging pores.

If your acne flare-ups are related to your period, ask your doctor about oral contraceptives. These can help because they regulate the release of monthly hormones, preventing the natural imbalances that contribute to acne.

If your acne doesn't improve, you may need to move on to topical or oral prescription antibiotics, which reduce skin bacteria and have an anti-inflammatory effect.

• You may get the best results by combining topical over-the-counter antibacterials with topical antibiotics, such as clindamycin or erythromycin. Oral antibiotics can be very effective at controlling acne when used long term. However, this practice is problematic because bacteria are becoming resistant to the drugs.
• For this reason, consider trying a synthetic form of vitamin A known as tretinoin. This topical prescription drug unclogs pores by regulating the growth of skin cells; it’s often used in combination with benzoyl peroxide. A word of warning: if you use tretinoin, your acne may actually look worse before it gets better. Because your skin will be extra sensitive, you'll also need to stay out of the sun.

Even more effective is the oral vitamin A derivative isotretinoin (Accutane), which shrinks the sebum-producing glands attached to hair follicles. Often dubbed a "miracle cure" for severe cystic acne, Accutane requires careful medical supervision because it can have serious side effects.

Dermatologists have an arsenal of useful techniques to help control problem lesions and prevent scarring. The major drawback is that these office procedures need to be done frequently.

• For comedone removal, doctors use a comedo (or loop) extractor to pull bacterial matter out of whiteheads and blackheads, thus reducing the risk they will develop into troublesome blemishes. (Some patients can learn to do this themselves.)
• For severe acne, doctors may inject steroids (corticosteroid drugs) directly into cysts and nodules to lessen inflammation and shrink the lesions. Superficial chemical skin peels are also done, but often they fail to minimize acne scars, which reflect damage to deeper layers of skin.

If you're among the one percent of acne sufferers who scars, new surgical procedures can have dramatic results.

• For one or two scars, consider collagen injections, which insert this natural body protein under the skin to "fill out" depressions.
• For a more extensive problem, dermabrasion is a very effective surgical treatment that dramatically minimizes even deep scars. Done under local anesthesia, a high-speed brush removes surface skin and alters the contour of scars.
• Laser treatments are an encouraging new development. They employ various wavelengths and intensities of light to recontour scar tissue, and are now being explored for the treatment of acne itself. Although your skin may be red for months, your scars will be changed for good.