Most mild cases of acne can be treated with over-the-counter remedies, such as benzoyl peroxide creams and cleansers. Mild breakouts, while inconvenient, don’t usually lead to scarring or persistent problems. Moderate-to-severe cases of acne, on the other hand, typically require stronger treatments, a combination of treatments, and the help of a dermatologist. Severe cases, in particular, can lead to permanent scarring and involve difficult to treat cysts.
A dermatologist can not only assess what type of acne a patient has but also prescribe a treatment plan that is most likely to be successful. While there is no known cure for acne, prescription medications and experimental regimens can reduce the severity and frequency of breakouts. Dermatologists will also advise patients where to get more information on the side effects of medications and what to avoid. Severe and cystic acne often has underlying genetic or hormonal causes, but here are some of the most common treatments dermatologists recommend.
Retinoids are vitamin A-based creams and lotions that help fight acne by accelerating the rate at which the skin’s cells shed and renew. These types of treatments include Retin-A topical cream, which can be prescribed in three different strengths. Higher strengths aren’t usually prescribed at first, as they can be too harsh on the skin. Over-the-counter retinol creams are a lower strength of retinoid that can be used for milder cases of acne.
The advantages of retinoids are that they help the skin’s cells turn over faster while also encouraging the skin to produce more collagen. This helps prevent the formation of blackheads and whiteheads, as faster skin turnover reduces the chance that dead skin cells will mix with oils and clog the pores. Retinoids can also keep the skin from aging faster and reduce the appearance of fine lines or wrinkles.
Some of the disadvantages of using retinoids are increased sun sensitivity, peeling, redness, and irritation. Skin can also dry out or become noticeably drier when using these products. Sunscreen should be used during the day to help protect the skin, as it will be more likely to burn faster and more severely. A light moisturizer can be used to help combat some of the dryness and peeling, although moisturizers with scents or certain ingredients may need to be avoided due to increased skin sensitivity.
A dermatologist may prescribe oral or topical antibiotics to treat acne. Oral antibiotics, such as doxycycline and tetracycline, are common medicines that reduce the amount of p. acnes bacteria. Topical antibiotic treatments like clindamycin are applied locally to the problem areas to reduce the bacteria. Antibiotics are often used alongside other treatments like retinoids since acne is thought to be caused by a number of factors.
The advantages of antibiotics include the reduction of bacteria that leads to the development of acne. Without the presence of enough p. acnes bacteria, breakouts are less likely to occur. If they do occur, the severity can be reduced, as the body’s inflammatory response to that bacteria is linked to severity.
The cons of antibiotics include the development of bacteria resistance. This means that antibiotics become less effective at killing p. acnes bacteria over time. With oral antibiotics, there is also the risk of developing systemic bacteria resistance, meaning the patient is less likely to respond to any type of antibiotic treatments related to other conditions. Furthermore, taking oral antibiotics for an extended period can lead to the reduction of “good bacteria” in the body, making the patient more susceptible to digestive issues and yeast infections.
Isotretinoin is an oral retinoid treatment and is usually reserved for the most severe cases of acne. Patients who have not responded successfully to other treatments are good candidates for isotretinoin. The treatment works by targeting multiple causes or sources of acne, including excess oil production.
This treatment can have a dramatic effect on a patient’s acne, especially if it is severe, persistent, or cystic. Isotretinoin not only reduces oil gland activity, but it increases the rate at which skin cells turn over. The medication also reduces the amount of p. acne bacteria present in the body and on the skin.
However, there are several cons involved in using this product. First, birth defects can occur from their use, and female patients must agree to prevent pregnancy with two forms of birth control when using isotretinoin. Some dermatologists and doctors may be more hesitant to prescribe isotretinoin to females because of this. Second, the medication can produce dry, cracked lips, and peeling skin. Patients must be careful to avoid prolonged exposure to UV rays and sunlight. Third, blood tests must be periodically taken to monitor liver function and cholesterol.
Isotretinoin has also been linked with psychological symptoms, such as depression. Patients taking the drug must be closely monitored by a doctor or dermatologist throughout treatment. While some patients only need one course of treatment, others need two or more to significantly reduce their acne.
This topical treatment is most effective in women who experience hormonal acne. Cases of acne-related to hormonal issues usually result in breakouts along the jawline and chin, and these women may also be simultaneously diagnosed with polycystic ovary syndrome. This condition causes the body to produce more male hormones or androgens, leading to the excess body and facial hair, oily skin and acne, and hair loss from the scalp.
Spironolactone is commonly prescribed as an oral treatment that targets excess androgen production. The reduction in these hormones improves patients’ appearance by reducing excess body hair, oily skin, and acne. It can also stop the loss or thinning of hair from the head.
The drawbacks of this treatment include irregular periods and the need to postpone pregnancy. Since the medication can result in adverse effects on a developing fetus, pregnancy should be avoided. Spironolactone can also lead to increased urination and the need to stay hydrated.
Other common acne treatments include laser and light therapy, benzoyl peroxide, and chemical peels. These treatments can reduce p. acne bacteria, reduce scarring, and encourage skin cell turnover. However, they are all likely to lead to increased skin sensitivity and irritation. Seeking out the advice and aid of a dermatologist is the best way to combat troublesome acne, especially if it persists, does not respond to over-the-counter treatments, or appears to be cystic. A dermatologist will give advice on how to manage the cons of treatments while leveraging the pros that can result in improved skin appearance and increased self-confidence.