Over-The-Counter (OTC) Topical Creams and Washes

Topical medicine is applied directly to pimples or acne lesions or to the entire affected area. Common over-the-counter or OTC creams that are available without prescriptions include those containing benzoyl peroxide, salicylic acid, resorcinol, or sulfur.

Benzoyl peroxide is an antiseptic that kills P. acnes, the bacteria that causes acne infection. Salicylic acid, resorcinol, and sulfur help breakdown whiteheads and blackheads. Salicylic acid can also reduce the shedding of follicle and sebaceous gland cells.

OTC acne creams are usually recommended to those with mild acne conditions and may take up to 8 weeks to show improvement. In some people, these creams can cause side effects such as skin irritation, burning, and redness. Fortunately, the side effects are usually temporary and disappear by themselves once the medicine is no longer used.

Some ingredients, such as salicylic acid and benzoyl peroxide, have also been made available as daily washes for those with mild acne.

Prescription Topical Creams

For more moderate cases of acne, topical medicines containing antibiotics, adapalene, azelaic acid, benzoyl peroxide, and tretinoin are often used.

Antibiotics and azelaic acid are used to help get rid of bacteria and reduce inflammation. Tretinoin and adapalene are a form of vitamin A called retinoids, which work by reducing the formation of acne lesions (comedones) and opening up existing comedones to allow other topical medicines to enter the follicles.

Prescription topical creams often have side effects such as stinging, burning, peeling, discoloration, scaling, redness, and severe dryness of the skin. In some people, skin may look worse before improvement can be seen within 4 to 8 weeks.

Prescription Oral Medicines

For patients with severe forms of acne, doctors often prescribe oral antibiotics - sometimes in combination with topical creams. Common oral antibiotics include tetracycline, minocycline, doxycycline, clindamycin, and erythromycin.

Although generally safe, oral antibiotics sometimes can have side effects such as dizziness and lightheadedness, upset stomach, increased susceptibility to sunburn, and changes in skin color. For pregnant women and children, tetracycline is not prescribed as it may cause teeth discoloration. Tetracycline and minocycline may also decrease the effectiveness of birth control pills.

If their acne conditions do not improve with the antibiotics above, dermatologists may prescribe isotretinoin - a strong form of retinoid or vitamin A that can reduce the size of oil glands and diminish oil and sebum production.

While effective, isotretinoin can have serious side effects, including birth defects, dryness in the eye, mouth, lips, nose, and skin; itching, nosebleeds, susceptibility to sunburn, muscle aches, and poor night vision. Isotretinoin can also cause changes in liver function and in triglyceride and cholesterol levels, thus requiring regular blood checks before and during treatment.

Because of these potential side effects, isotretinoin should never be used without proper dermatologist supervision.

Hormone Therapy

Some acne in women are caused by hormonal changes. These acne can be caused by elevated hormone levels prior to menstruation or by excessive androgen (male sex hormone - yes, women do normally produce small amounts of these hormones) production.

For these acne, doctors can prescribe specific drugs. Low-dose estrogen birth control pills can help reduce the androgens produced by the ovaries, whereas low-dose corticosteroids can be used to suppress androgens produced by the adrenal glands. Anti-androgen drugs, such as spironolactone, can be used to reduce excessive oil and sebum production. Such drugs, however, have the potential side effects of irregular period, breast tenderness, fatigue, and headache.

Other Treatments for Acne

Some dermatologists may offer other treatments of acne, including popping the pimple (under very specific and sterile conditions) during office visits and cortisone injections to reduce the size and pain of inflammed acne lesions.

Treatment of Acne Scars

Although prevention of acne scars is the goal of all acne treatment methods, once scarring has occured, there are a couple of possible treatments:

Laser Treatment
Laser is often used either to smooth the skin layer or to tighten the underlying tissue and "push" out depressed scars.

Dermabrasion
Dermabrasion is a surgical procedure where scars are "sanded" by rotary abrasives. It can be performed by qualified doctors to reduce the appearance of acne, but may not be very effective for ice-pick and deep scars.

In a small percentage of people, dermabrasion actually makes their skin worse and may cause temporary or permanent discoloration.

Microdermabrasion
In microdermabrasion, instead of a hand held machine, aluminum oxide crystals are used to remove skin. This procedure is gentler than dermabrasion and takes only the surface layer of skin. However, multiple procedures may be needed before improvement can be seen.

Dermaplaning
Deep acne may require dermaplaning, where skin is "shaved" by use of an oscillating blade.

Collagen Injection
Collagen can be used to "fill out" and stretch certain types of acne scars. The effect of collagen injection is temporary, lasting about 3 to 6 months, and are usually not effective for ice-pick and deep scars.

Skin surgery
In this procedure, deep ice-pick scars are excised or "punched" out, and the resulting hole is filled by either a skin graft or just sutured. In certain cases, skin grafts are needed to replace an area badly affected by acne.

Vitamin A

There is evidence that when taken orally, vitamin A can successfully treat severe acne. However, large quantities of this vitamin is required. Vitamin A derivatives, such as isotretinoin and retinoid creams, have also been successfully used for acne treatment.

Vitamin B3

Vitamin B3 or niacinamide gel has been shown to be an effective acne treatment. In a double-blind clinical study, a treatment of 4% niacinamide gel applied twice daily was shown to be as effective as antiobiotic clindamycin in acne treatment.

Vitamin B5

Studies have suggested that vitamin B5 or panthotenic acid can reduce the amount of oily sebum in your skin. It has been suggested that vitamin B5 is required by your body's natural enzymes to break down oil.

Other studies have also suggested that deficiency in vitamin B5 can also cause acne.

Zinc

Clinical studies have shown that an oral zinc supplement is as effective in clearing acne as antibiotics. In one study, 30 mg of zinc taken twice a day was shown to reduce acne conditions within 12 weeks of treatment.

In cream form, zinc can also be used in concert with the antibiotic erythromycin or by itself to treat acne breakouts (see below).

Tea Tree Oil

Tea tree oil is a solution derived from the leaves of the Australian tea tree plant (Melaleuca alternifolia). The leaves of the tea tree plant have traditionally used as an antiseptic.

Studies have shown that tea tree oil has antibacterial and antifungal properties, and that it can be successfully used to treat acne and fungal infections, as well as to promote wound healings.

In a single-blind, randomized clinical trial on 124 patient, 5% tea-tree oil application on mild to moderate acne was found to be just as effective as 5% benzoyl peroxide lotion. Both were shown to reduce the numbers of inflamed and non-inflamed acne lesions. Tea tree oil, however, was found to have fewer side effects, such as skin irritation and dryness, than benzoyl peroxide.

Zinc

Topical zinc cream has been shown to reduce oily sebum production and may help the body's immune system in warding off bacterial infections in acne.

Zinc is also a required element in tissue repair and rebuilding. It helps your skin heal after acne and contributes to the elimination of red spots often left by acne. Zinc can also help prevent scarring.