How is acne treated?

Your healthcare provider may suggest some non-prescription medications for your condition. Depending on the condition’s severity, your age, the type of acne you have and how effective the over-the-counter remedies have been, you may need stronger prescription medications.

The use of certain contraceptives can sometimes help a woman’s acne go away. The Food and Drug Administration has approved three types of birth control pills for treating acne. All four contain a combination of estrogen (the primary female sex hormone) and progesterone (a natural form of steroid that helps regulate menstruation).

Various medications and therapies have proven to be effective. They target the underlying factors that contribute to acne. You might require at least one or multiple, depending on the severity of your condition.

Medications applied topically:

  • Benzoyl peroxide is available as an over-the-counter product (such as Clearasil®, Stridex®, PanOxyl®) as a leave-on gel or wash. It targets surface bacteria, which often aggravates acne. Lower concentrations and wash formulations are less irritating to your skin. Irritation (dryness) is a common side effect.
  • Salicylic acid is available over-the-counter for acne, as a cleanser or lotion. It helps remove the top layer of damaged skin. Salicylic acid dissolves dead skin cells to prevent your hair follicles from clogging.
  • Azelaic acid is a natural acid found in various grains such as barley, wheat and rye. It kills microorganisms on the skin and reduces swelling.
  • Retinoids (vitamin A derivatives) such as Retin-A®, Tazorac®, and Differin® (which is now available without a prescription) break up blackheads and whiteheads and help to prevent clogged pores, the first signs of acne. Most patients are candidates for retinoid therapy. These medications are not spot treatments and must be used on the entire area of skin affected by acne to prevent the formation of new pimples. The most common side effect is irritation, which usually improves with moisturization and time on the medication.
  • Antibiotics (topical types include clindamycin and erythromycin) control surface bacteria that aggravate and often encourage the swelling of acne. Antibiotics are more effective when combined with benzoyl peroxide.
  • Dapzone (Aczone®) is a topical gel, which also has antibacterial properties, can be used for inflamed acne. It’s applied to the skin twice a day.

Medications taken orally (by mouth):

  • Antibiotics, especially tetracycline antibiotics such as minocycline and doxycycline, are commonly used to treat moderate to severe acne.
  • Oral contraceptives can help with breakouts associated with menstrual cycles. Three classes of medications have been approved by the FDA for acne patients. Some brand names include Estrostep®, Beyaz®, Ortho Tri-Cyclen® and Yaz ®.
  • Isotretinoin (Amnesteem®, Claravis®, Sotret®), an oral retinoid, is an especially effective drug used only for the most severe cases of acne. Isotretinoin shrinks the size of oil glands, which contributes to acne formation. The most common side effect is dryness, but can also cause birth defects. Some evidence suggests a possible increased risk of ulcerative colitis and depression. Because of these risks, anyone using the drug must take part in a Food and Drug Administration-approved risk management program known as iPledge.

Other therapies:

Depending on your condition, your healthcare provider might suggest one of these specialized therapies, possibly combined with medication.

  • Steroids. Rarely, steroids can be used to treat severe acne or injected into large nodules to reduce inflammation.
  • Lasers. Currently, lasers are primarily used to treat acne scars. A laser delivers heat to the scarred collagen under the skin, this relies on the body’s wound healing response to create new, healthy collagen. This encourages the growth of new skin to replace it. There are different types of laser resurfacing—ablative and non-ablative. Your dermatologist will determine which type is best for your skin type and nature of acne scars.
  • Chemical Peels. This treatment uses special chemicals to remove the top layer of old skin. Typically whenever the top layer is removed, the new skin that grows in is smoother and can lessen acne scars.

Do I need to see a specialist?

Your acne can be managed by your general healthcare provider. However, when acne does not improve or is severe you should see a board certified dermatologist.

What should I do while waiting to see a dermatologist?

Continue washing your face at least daily with lukewarm water and a mild facial cleanser that you can buy over the counter. Products containing benzoyl peroxide and salicylic acid are effective. You can also now purchase the topical retinoid, Differin®, over the counter and use as directed.

Last reviewed by a Cleveland Clinic medical professional on 09/01/2020.

References

  • National Institute of Arthritis and Musculoskeletal and Skin Diseases. Questions and Answers about Acne. Accessed 8/31/2020.
  • American Academy of Dermatology. Acne: Overview. Accessed 8/31/2020.
  • Di Landro A, Cazzaniga S, Parazzini F, et al. Family history, body mass index, selected dietary factors, menstrual history, and risk of moderate to severe acne in adolescents and young adults. J Am Acad Dermatol. 2012;67(6):1129–1135. Accessed 8/31/2020.

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