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Treatment

There are a number of effective treatments for acne. Dermatologists recommend treatments singly or in various combinations, depending on the individual's condition.

Topical Treatments

These lotions, creams, and gels are applied to the surface of the skin. Topical antibiotics (drugs designed to destroy bacteria) can help reduce acne. Types of topical antibiotics include erythromycin, clindamycin, and sulfa drugs. The topical approach is effective because the medication is applied directly to the lesions. Also, because the patient does not swallow the drugs, they do not travel through the body and are less likely to cause side effects. A disadvantage to antibiotic treatment is that bacteria often develop tolerance and resistance to the medication over time, and thus become difficult to eradicate.

Blackheads and whiteheads respond well to treatments with retinoids (Retin A®, Avita®, Differin®, Tazorac®), which are chemically similar to vitamin A. Retinoids break up the mixture of oil and dead cells that blocks the follicle and causes the lesion. Once the follicle is unclogged and oil flow is restored, the lesion begins to heal. It may take weeks to see improvement with these treatments. In fact, the acne may get worse before it gets better.

A side effect of retinoids is increased sun sensitivity. Doctors usually recommend covering the skin or using sunscreens to minimize this problem. Sunlight also breaks down retinoids, rendering them less effective. Some researchers have found that mixing yellow pigment with the retinoids reduces this problem.

Benzoyl peroxide is a familiar medication for acne. Over-the-counter and prescription benzoyl peroxide products may be recommended by dermatologists, depending on the severity of the acne.

Benzoyl peroxide kills the bacteria that cause acne. Doctors often use benzoyl peroxide along with topical antibiotics to reduce the likelihood of antibiotic resistance.

A side effect of benzoyl peroxide is local irritation, especially with the higher strengths such as 10 percent gels.

Mild acid solutions of fruit origin, including salicylic and glycolic acids, can be effective on acne. These solutions encourage the peeling of the top layer of skin and the opening of blocked follicles, which helps reestablish the normal skin-cell replacement cycle.

Tea tree oil is a natural oil with antibiotic properties. Research is ongoing to determine whether it can be an effective acne treatment.

Oral Medications

A medication that is taken orally is carried throughout the bloodstream to all of the body's systems; thus, it is a systemic treatment. Oral medication can be useful when acne affects the skin on multiple areas of the body.

Antibiotics kill the bacteria that have colonized the follicles. This reduces inflammation. Tetracyclines are the most frequently prescribed oral antibiotics. Because bacteria tend to develop resistance, doctors use systemic antibiotics for short-term treatments. Common side effects of tetracyclines are few, but they have been known to cause increased sensitivity to the sun and decreased efficacy of birth control pills in some cases.

Minocycline and doxycycline are tetracyclines that, despite their high cost, have two advantages: they require less frequent dosage and can be taken with food.

Another oral treatment is isotretinoin, or retinoic acid (Accutane®). It is chemically similar to vitamin A. Accutane is effective in about two-thirds of the patients who use it to treat more severe cystic acne or acne that is unresponsive to other treatments. It reduces production of oil. Its main side effect is body dryness.

Hormone therapy involves the use of medications that restore the normal balance of hormones in both women and men. Another hormone-related treatment is cortisone injection, which can reduce the inflammation of deeper acne nodules.

Other Treatments

Acne surgery is an option for people who have a severe condition that fails to respond to other treatments. In this procedure, the dermatologist extracts blackheads and whiteheads with a special tool called a comedo extractor. Sometimes a deep nodule is injected with a cortisone solution to reduce inflammation.

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