Treatment. If you've tried over-the-counter (nonprescription) acne products for several weeks and they haven't helped, your doctor can. How is acne treated? WebMD offers a comprehensive guide to prescription and nonprescription treatments for this skin condition, along with. Read about acne treatment, home remedies, medication side effects, and learn what causes and what prevents pimples. Plus, get information on how to get rid.
Treatment Acne 4 –
Antiandrogen therapy alone may be successful, but in less than half of women; 36 the acne may recur when it is discontinued. Combination therapy with topical agents or oral antibiotics provides substantially more benefit. An association with severe skin reactions, such as erythema multiforme, Stevens—Johnson syndrome and toxic epidermal necrolysis, has been reported.
Before a patient starts oral isotretinoin therapy, baseline blood work is recommended. In women of childbearing age, two forms of birth control should be used during and for one month after therapy, unless the patient has had a hysterectomy or is sexually abstinent. Cutaneous side effects of isotretinoin include dry eyes, nose and lips, and dermatitis. Patients should use artificial tears, and generous amounts of moisturizer on the nose, lips and skin.
Herbal therapies such as tea tree oil, and topical and oral ayurvedic compounds seem to be well tolerated; however, there are limited data about their efficacy and safety in treating acne.
Physical treatments for acne include comedone extraction, chemical peels and microdermabrasion, intralesion cortico-steroid injection for acne cysts, and high-intensity, narrow-band blue light photodynamic therapy, as well as injectable fillers and laser resurfacing for acne scarring. However, there is limited evidence in peer-reviewed literature to support such treatments.
The treatment of acne in children is similar to that in adults. Because topical therapies may be more irritating in children, initiation with low concentrations is preferred. Systemic treatments should be reserved for more extensive cases.
Erythromycin is preferred over tetracyclines for children under nine years of age, because tetracyclines can affect growing cartilage and teeth. Although treatment with isotretinoin has numerous potential minor side effects in patients of all ages, an uncommon complication in young patients is premature epiphyseal closure. Selecting appropriate treatment in pregnant women can be challenging because many acne therapies are teratogenic; all topical and especially oral retinoids should be avoided.
Topical and oral treatment with erythromycin may be considered. Trials are being conducted with currently available therapies, in different strengths and combinations. Combining an allylamine antifungal agent with benzoyl peroxide may prove to enhance the effectiveness of benzoyl peroxide in treating acne while preventing antibiotic resistance. More studies are needed to resolve the long-standing controversy about the role of diet and acne. As well, further direct treatment comparison and long-term trials are needed to determine the optimal sequence of treatment selection as well as to establish the effects on quality of life and long-term efficacy.
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Open in a separate window. Grade I mild acne showing comedones with few inflammatory papules and pustules. Grade Severity Clinical findings I Mild Open and closed comedones with few inflammatory papules and pustules II Moderate Papules and pustules, mainly on face III Moderately severe Numerous papules and pustules, and occasional inflamed nodules, also on chest and back IV Severe Many large, painful nodules and pustules.
Is there an underlying cause? How well do topical treatments work? Antimicrobials Topical antimicrobials, including benzoyl peroxide and antibiotics, are effective in treating inflammatory disease. Combination therapy Combination therapy, for example with retinoids and antibiotics, is more effective than either agent used alone.
Over-the-counter therapy Before seeing a physician, patients frequently use over-the-counter therapies for their acne. When should systemic therapy be started? Antibiotics When topical agents are insufficient or not tolerated, or in cases of moderate to severe acne, especially when the chest, back and shoulders are involved, systemic antibiotics are often considered the next line of treatment Table 3.
Antibiotic, dose Notes Tetracycline — mg twice daily Inexpensive. Hormonal therapies Hormonal agents provide effective second-line treatment in women with acne regardless of underlying hormonal abnormalities. What about alternative therapies?
What physical treatments are available? How should children and pregnant women be treated? Key points Effective therapies for acne target one or more pathways in the pathogenesis of acne, and combination therapy gives better results than monotherapy.
Topical therapies are the standard of care for mild to moderate acne. Systemic therapies are usually reserved for moderate or severe acne, with a response to oral antibiotics taking up to six weeks. Hormonal therapies provide effective second-line treatment in women with acne, regardless of the presence or absence of androgen excess.
Psychological sequelae of acne vulgaris: Can Fam Physician ; Haider A, Shaw JC. Treatment of acne vulgaris. Guidelines of care for acne vulgaris management. J Am Acad Dermatol ; N Engl J Med ; American Association of Clinical Endocrinologists Polycystic Ovary Syndrome Writing Committee American Association of Clinical Endocrinologists position statement on metabolic and cardiovascular consequences of polycystic ovary syndrome.
Endocr Pract ; J Am Acad Dermatol ; 49 Suppl 1: S1—37 [ PubMed ]. A multicenter, double-blind, randomized comparison study of the efficacy and tolerability of once daily tazarotene 0. Cutis ; 69 Suppl: A comparison of the efficacy and tolerability of adapalene 0.
Br J Dermatol ; suppl A double-blind evaluation of topical isotretinoin 0. Clin Exp Dermatol ; Int J Dermatol ; The effect of antimicrobial agents on leukocyte chemotaxis. J Invest Dermatol ; Clin Ther ; Br J Dermatol ; The combined use of topical benzoyl peroxide and tretinoin in the treatment of acne vulgaris. Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: S—7 [ PubMed ]. Cutis ; 67 Suppl 2: Effective over-the-counter acne treatments.
Semin Cutan Med Surg ; Treatment of acne vulgaris without antibiotics: Fam Pract ; Oprica C, Nord CE. European surveillance study on the antibiotic susceptibility of Propionibacterium acnes. Clin Microbiol Infect ; Arch Intern Med ; Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: Erythromycin resistant propionibacteria in antibiotic treated acne patients: Sequential antibiotic therapy for acne promotes the carriage of resistant staphylococci on the skin of contacts.
J Antimicrob Chemother ; Induction of proinflammatory cytokines by a soluble factor of propionibacterium acnes: Infect Immun ; Tetracyclines inhibit connective tissue breakdown by multiple non-antimicrobial mechanisms.
Adv Dent Res ; Is antibiotic resistance in cutaneous propionibacteria clinically relevant? Implications of resistance for acne patients and prescribers.
Am J Clin Dermatol ; 4: An accurate photographic method for grading acne: The role of androgens in determining acne severity in adult women. A randomized controlled trial of second-versus third-generation oral contraceptives in the treatment of acne vulgaris.
Am J Obstet Gynecol ; ACOG practice bulletin no. Obstet Gynecol ; Side effects include skin discoloration and minor skin irritation. 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. Evidence is not strong in support of using zinc, sulfur, nicotinamide, resorcinol, sulfacetamide sodium or aluminum chloride in topical treatments for acne.
For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Usually the first choice for treating acne is tetracycline — such as minocycline or doxycycline — or a macrolide. Oral antibiotics are best used with topical retinoids and benzoyl peroxide. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance. Antibiotics may cause side effects, such as an upset stomach and dizziness.
These drugs also increase your skin's sun sensitivity. 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. You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help. The most common side effects of these drugs are weight gain, breast tenderness and nausea.
A serious potential complication is a slightly increased risk of blood clots. Isotretinoin Amnesteem, Claravis, Sotret 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.
Potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects. In fact, isotretinoin carries such serious risk of side effects that all people receiving isotretinoin must participate in a Food and Drug Administration-approved risk management program.
These therapies may be suggested in select cases, either alone or in combination with medications. Most studies of acne drugs have involved people 12 years of age or older. Increasingly, younger children are getting acne as well. In one study of girls ages 9 to 10, 78 percent of them had acne lesions. If your child has acne, consider consulting a pediatric dermatologist. Ask about drugs to avoid in children, appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.
Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this disease. You can try to avoid or control mild acne with nonprescription products, good basic skin care and other self-care techniques:. Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with a mild soap and warm water. If you tend to develop acne around your hairline, shampoo your hair every day.
And be gentle if you're shaving affected skin. Avoid certain products, such as facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne.
Excessive washing and scrubbing also can irritate the skin. Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide as the active ingredient. You might also try products containing salicylic acid, glycolic acid or alpha hydroxy acids, which may help with mild and moderate acne.
It may take a few weeks before you see any improvement. Nonprescription acne medications may cause initial side effects — such as redness, dryness and scaling — that often improve after the first month of using them. Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil.
More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them. Acne and acne scars can cause anxiety and may affect your social relationships and self-image.
Sometimes it can help to talk with your family, a support group or a counselor. Stress can worsen acne. Try to manage stress by getting enough sleep and practicing relaxation techniques. If you have acne that's not responding to self-care and over-the-counter treatments, make an appointment with your doctor. Early, effective treatment of acne reduces the risk of scarring and of lasting damage to your self-esteem.
After an initial examination, your doctor may refer you to a specialist in the diagnosis and treatment of skin conditions dermatologist.
Below are some basic questions to ask your doctor about acne. If any additional questions occur to you during your visit, don't hesitate to ask. Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth.
Your doctor may ask:. Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission. This content does not have an English version.
Management of acne
Current consensus recommends a combination of topical retinoid and antimicrobial therapy as first-line therapy for almost all patients with acne. Using the right acne treatment is vital for clear skin. Learn about a variety of treatment options, ranging from topical ointments to oral treatments. Oral antibiotic treatment, hormonal therapies and Table 3: Oral antibiotic therapy for acne vulgaris.