During puberty, 90% of boys and over 80% of girls will have some acne lesions. There are many types of acne, as many as fourteen different kinds, affecting newborns to the elderly. So if you’re one of the lucky few who hasn’t has acne by the time you graduate from high school, it’s no guarantee you won’t run into trouble.
While most people recover from acne without any permanent effects, some are left with permanent acne scarring. Fortunately, there are numerous topical and oral acne medications on the market today that can improve the appearance of acne scars. However, most larger, deeper scars will likely require treatment with a surgical technique followed by skin resurfacing treatment.
Once an acne outbreak has healed, it often leaves a red or darker (hyper-pigmented) mark on the skin. This is not considered a scar but rather part of the skin’s normal healing and remodeling process. It usually takes about 6-12 months to complete. If no more acne develops in this area of the skin, it can heal normally. Any color change or skin defect remaining after one year is normally considered a permanent scar or defect.
Acne medication comes in two forms: Over-The-Counter (OTC) and Prescription.
OTC medication treatments often provide reasonable results for mild to medium cases of acne. They are also considered effective at reducing pore blockages.
Benzoyl Peroxide
Is one of the most frequently used acne treatments for both over-the-counter and prescription medications. Popular over-the-counter products include such trusted names as Proactiv
Things to keep in mind when using benzoyl peroxide medications:
◊ Use a Moisturizer – it can dry out your skin.
◊ Handle Carefully – it can bleach things like: clothes, bedding, towels, hair etc.
◊ Always Wear Sunscreen – it can make your skin more photo-sensitive.
Salicylic Acid
Is a mild acid cleanser that encourages the sloughing of dead skin cells on the top layer of your skin and in the opening of plugged follicles. It does not have any effect on oil (sebum) production or the P. acnes bacteria. Its effects stop when you discontinue use so it must be used even after your outbreak has stopped. Salicylic acid is available in many over-the-counter acne lotions
Glycolic Acid
These acids belong to the family of alpha-hydroxy acids, which are natural chemicals derived from fruit (citric acid is also an alpha-hydroxy acid). High acidity gives glycolic acid natural exfoliant properties. It is also considered a natural moisturizer. When applied to the skin, glycolic acid penetrates below the surface layers and breaks up the glue that prevents the release of dead skin cells. Its use is said to provide a smoother skin surface with a more youthful ‘glow’. The majority of glycolic acid skin care products do not contain it in concentrations higher than 10%.
Try to find glycolic acid products with a concentration ranging from 8 to 10% such as Joesoef Face Cream
Prescription Acne Medications:
Adapalene
Adapalene (trade name Differin) is a topical retinoid-type compound used primarily in the treatment of mild to moderate acne. It also regulates oil production in the skin to prevent acne and contains an exfoliant that helps to remove dead and damaged skin.
Adapalene is normally applied once daily at bedtime only on the affected areas. Prior to applying it is important to wash your face with a mild cleanser. In cases of skin irritation usage may be decreased to once every other day until the condition improves.
Since Adapalene is a topical acne medication, many people tend to overuse this drug thinking they may get faster results. However, this may lead to a worsening of their condition. On initial usage your acne condition may appear to worsen. It may take as many as eight to twelve weeks before you begin to see the best results.
There are no known serious side effects for Adapalene. However, mild side effects such as redness or drying of the skin, mild burning or itchiness may be experienced.
There are certain precautions that patients must adhere to while using Adapalene, they include:
- Avoid putting the medication near your eyes, nose or lips
Avoid using on dry, chapped, windburned or sunburned skin. Using Adapalene on currently irritated skin may worsen the condition. - It is not recommended for patients with eczema or in combination with alpha hydroxy and glycolic acids.
- Be sure to use mild, un-perfumed skin cleansers and avoid abrasive soaps, harsh shampoos and conditioners while using Adapalene.
- Use a sunscreen as this acne medication can increase photo-sensitivity.
Clindamycin
Clindamycin is an antibiotic used for treating only serious bacterial infections. The drug is usually used for treating anaerobic (without the presence of oxygen) bacteria. It works by inhibiting the growth of bacteria and is a very common topical treatment for acne.
Guidelines for use:
- Clindamycin is usually taken every six hours 4 times a day.
Make sure to consume at least a full glass of water when taking this medication. - Try to keep your body upright for at least 30 minutes after taking Clindamycin and avoid lying down immediately after consuming.
- Don’t stop using it prior to completing the entire cycle even if your symptoms have disappeared.
Clindamycin is a semi-synthetic antibiotic and is considered very effective as a topical acne treatment. It helps destroy the P Acnes bacteria that causes acne. It also works as an anti-inflammatory agent and reduces skin redness. When using Clindamycin, it is important to use as directed as bacteria may develop resistance to it.
Erythromycin
Erythromycin is an antibiotic that helps kill or reduce the growth of bacteria in the body. This medication can be used to treat various bacterial infections including acne. It is often prescribed to people with an allergy to penicillin.
Erythromycin works by reducing the proteins that are essential for the survival of bacteria in the body. This reduces the microbial activity in your system.
Use the following guidelines when using erythromycin:
- Always consume erythromycin along with at least 8 ounces of water.
- Erythromycin can be consumed with or without food, milk or water.
- For oral suspensions shake well before using.
- If you are using a chewable tablet make sure to chew it well before swallowing.
Doxycycline
Is a tetracycline antibiotic that helps treat various bacterial infections. The product works by reducing the growth of a variety of bacteria. This antibiotic is used to treat various health conditions such as acne, infections of the urinary tract, gonorrhea, chlamydia among several others.
Isotretinoin (Accutane)
Is a retinoid which means its chemical structure is derived from vitamin A. It was first approved in the US in 1982 and is often prescribed as an alternative to oral antibiotics for the treatment of unresponsive, severe outbreaks of nodular acne or acne vulgaris.
It has a combined effect on several of acne’s contributing factors. This distinguishes it from the more conventional topical acne medications (benzoyl peroxide, adapalene…).
It is usually prescribed after other acne treatments fail to produce results and is known to cure approximately 35-38% of patients from acne after a single course of treatment (usually about 20 weeks), 70% of patients experience long-term remission. This medication can also reduce the risk of acne scarring.
Isotretinoin’s exact biochemical interactions are unknown, however it has proven to assist the sebaceous (oil) glands in reducing sebum output in several ways. Testosterone causes the oil gland to produce various oils that affect the hair follicle lining. Isotretinoin reduces these types and levels of oil so your pores will not remain blocked. It also makes the cells that are sloughed off in your follicles less sticky, this inhibits the formation of comedones (blackheads and whiteheads).
For many suffering from severe cystic acne, Accutane has proven to be nothing short of a miracle. But, it has a number of possible serious side effects similar to those resulting from large doses of vitamin A. Among Accutane’s potential side effects are: dry, peeling skin; a sudden inability to see in the dark (so night driving can be dangerous); intra-cranial pressure, which can lead to permanent loss of sight, or in rare instances death. More about Isotretinoin side effects.
Concerns regarding this medications teratogenic effects led to the introduction of the iPLEDGE program.
Tetracycline
Is an antibiotic that has been used successfully to suppress the symptoms of acne. It cannot cure acne, but can be effective at high doses for very severe acne, or low doses for less severe acne. Because this acne treatment only suppresses symptoms, treatment is often done on a longer term basis – possibly months or even years.
Women who are pregnant or breast feeding should avoid tetracyclines as they have been proven to permanently stain teeth in children as well as inhibit their bone growth. Its use can lead to skeletal defects in a fetus. Children under twelve years should not use it for the same reasons. A common alternative for pregnant women and younger children is oral erythromycin.
Like all antibiotics, tetracycline throws off your intestinal flora by killing the good bacteria (along with the bad) in your bowel. Your body requires these good bacteria for proper metabolisation of nutrition in your diet. Therefore, it is often recommended that patients taking antibiotics also take a pro-biotic to replenish the good bacteria.
A popular pro-biotic supplement is ‘DDS-1 Lactobacillus Acidophilus’ (the most common good bacteria found in your gut). It can usually be found in most pharmacies and health food stores. Other foods containing natural pro-biotics include: Kefir (a fermented milk drink), Raw Milk, REAL Yogurt or Kambucha (a type of sweetened, fermented tea).
Tetracycline has derivative (related) acne medications such as: minocycline and doxycycline.
Minocycline
Is a broad spectrum tetracycline antibiotic that’s been in use since the 1970’s and is considered one of the most effective and stronger acne medications. The drug works by boosting the power of the immune system allowing it to destroy and limit the growth of various causative organisms.
Dosage is normally one 100 mg pill taken twice daily. This is easier for patients than the 4 times a day required with tetracycline and tetracycline. It also has an anti-inflammatory effect which reduces redness and swelling whether it eliminates the acne or not. A topical acne cream is often used along with minocycline pills.
When taking it try to follow these guidelines:
- Avoid skipping any doses
- This medication should be consumed with at least 8 ounces of water and notconsumed with milk or dairy products
- The tablet should be swallowed as a whole, never crushed or chewed since it is meant to be released slowly into the body.
Sodium Sulfacetamide
Is an antibacterial agent that interferes with the growth of certain bacteria on the skin that can lead to acne. It belongs to a class of drugs known as topical sulfa antibiotics. To get the most benefit from this medication you should use it regularly at the same time each day.
Be sure to not increase your dosage of this medication or use it more often than prescribed as this will not cause your acne to improve any faster and your risk for side effects will increase. Typically it is applied in a thin film 1-3 times a day onto clean, dry skin.
Sodium Sulfacetamide side effects
Tazarotene
Is a prescription topical retinoid acne medication. This drug is similar to vitamin A and encourages quick cell growth. It also improves the appearance and texture of the skin. Since Tazarotene is a topical medication, it should always be applied with clean hands so remember to wash your hands thoroughly before applying. Cleanse your face with a mild soap prior to applying Tazarotene and pat your skin dry gently.
Once the skin is clean and dry, apply a thin layer of the medication onto only the affected area. If the medication accidentally gets on these areas you should always wash it off.
Tazarotene should be used as instructed by your doctor. Using the medication any more or any less could do more harm than good. This medication is normally applied once during bedtime unless otherwise instructed.
Tazarotene side effects can include:
- Worsening of acne
- Dry skin
- Itchiness
- Redness
Also seen in some cases is a more extreme drying and cracking of the skin. For most patients these side effects will diminish markedly after 2–4 weeks of continuous use.
Tretinoin
Is the acid derivative form of vitamin A and is most commonly used as a treatment for comedonal acne (whiteheads and blackheads). It works by irritating the skin causing an increase in the turnover of skin cells, they grow (divide) and die more rapidly. It also works to eliminate plugged material from hair follicles while preventing the formation of new comedones.
It is available as a cream or gel under the brand names: Retin-A, Aberela, Renova, Avita, or Stieva-A. Most patients experience tremendous amounts of inflammation during the first few weeks of therapy. This causes some people to stop taking it, believing it’s not working or making it worse. However, it can often take 6-9 weeks to see a noticeable improvement.
Patients may also experience reactions such as: redness, scaling itching or burning.
A gradual increase in use is the best approach with this acne medication, this will allow your skin time to adjust to the drug.
Spironolactone
Is an off-label acne medication effective in treating hormonally influenced breakouts. It is normally only prescribed to treat cases of acne in women. It is referred to as ‘off-label’ because the United States FDA doesn’t recognize spironolactone as an treatment for acne.
It is in a group of drugs known as anti-androgens. Well known androgens, like testosterone, are usually thought of as male-only hormones but they are also present in females, although in lower levels.
In women who produce more androgen hormones than they need anti-androgens can be prescribed to block their absorption and thereby regulate acne-causing hormonal fluctuations. Spironolactone is only considered effective in fighting acne outbreaks
caused by hormonal changes. It isn’t normally considered a first line of defense against acne breakouts.
The most common daily dosage is between 50 to 100mg. Many doctors often begin treatment with this acne medication at 25 mg and work up to the target dosage over a period of several weeks.
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