DIAGNOSIS
When you see a doctor about acne, you’ll have a physical exam, and your doctor will ask about your medical history. Women may be asked questions about their menstrual cycles. This information can help your doctor find out if hormones are playing a role in acne flare-ups. Most often, you won’t have any special tests to diagnose acne.
RECOMMENDED MEDICATIONS
Medicines can help manage the severity and frequency of acne outbreaks. A number of medicines are available. Your treatment will depend on the type of acne you have (pimples, whiteheads, blackheads, or cystic lesions).
Treatment of acne depends on whether inflammation or bacteria are present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). Topical creams and lotions work best for this type of acne. But if bacteria or inflammation is present with open sores, oral antibiotics or isotretinoin may work better.
Topical medications
These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling.
The most common topical prescription medications for acne are:
- Retinoids. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage).
- Antibiotics. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
- Dapsone (Aczone).
Oral medications
- Antibiotics. Choices for treating acne include tetracyclines, such as minocycline and doxycycline
- Combined oral contraceptives. The Food and Drug Administration approved three products that combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz).
- Anti-androgen agent. The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren’t helping.
- Isotretinoin. This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn’t respond to other treatments.
Therapies
These therapies may be suggested in select cases, either alone or in combination with medications.
- Light therapy. Light therapy targets the bacteria that cause acne inflammation. Some types of light therapy are done in a doctor’s office. Blue-light therapy can be done at home with a hand-held device.
- Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids.
- Extraction of whiteheads and blackheads. Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven’t cleared up with topical medications.
- Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction.
Treating children
If your child has acne, you may want to consult 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.
