There are so many acne treatment options available today to get your acne breakouts under control. Acne treatments can be divided into three categories: topical (medications you put on your skin, either over-the-counter products or prescription), systemic (oral medications by prescription), and procedural (treatments done at the salon or dermatology office). Which is the best treatment is determined by the type and stage of your acne.
Over-the-counter acne treatments are those products you can get at the drug store, grocery store, skin spa, or cosmetic store. The most effective OTC acne treatment products contain at least one of these ingredients:
- Salicylic acid
- Benzoyl peroxide
- Glycolic acid
Over-the-counter acne treatments are a good choice for mild acne and blackheads, but rarely effective for anything more.
Prescription Topical Medications
For acne that isn’t getting better with over-the-counter products, prescription topical medications are a great option. These medications can be used to treat mild breakouts to severe acne, and everything in between. The most common topical prescription medications for acne are as follows:
Retinoids and retinoid-like drugs. You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance.
Salicylic acid and azelaic acid. Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products. Studies showing its effectiveness are limited. Azelaic acid is a naturally occurring acid found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It’s even more effective when used in combination with erythromycin.
Dapsone. Dapsone (Aczone) 5 percent gel twice daily is recommended for inflammatory acne, especially in adult females with acne. Side effects include redness and dryness.
Oral acne medications work internally. These medications are typically prescribed for severe breakouts or cystic acne. They’re also used for less severe types of acne when topical treatments aren’t giving good enough results. Oral acne treatments are available by prescription only and include:
Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation.
Combined oral contraceptives. Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin (Ortho Tri-Cyclen, Yaz, others).
Anti-androgen agents. The drug spironolactone may be considered for women and adolescent girls if oral antibiotics aren’t helping. It works by blocking the effect of androgen hormones on the sebaceous glands.
Isotretinoin. Isotretinoin is a powerful drug for people whose severe acne doesn’t respond to other treatments. Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug
Procedural treatments are therapies performed by a dermatologist, healthcare practitioner, or esthetician in the office or salon. They can be used to treat mild to severe acne, depending on the procedure. Some professional acne treatment procedures you may want to try:
Comedo extractions. Your doctor may use special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications. This technique may cause scarring.
Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid. Any improvement in acne is not long lasting, so repeat treatments are usually needed.
Lasers and photodynamic therapy. A variety of light-based therapies have been tried with some success. But further study is needed to determine the ideal method, light source and dose.
Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This therapy has resulted in rapid improvement and decreased pain. Side effects may include thinning in the treated area.
Procedural therapies aren’t meant to be used as the sole acne treatment. Instead, consider these add-ons to help boost your current acne treatment medication.