Acne

Acne medications work in different ways, by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring.

The treatment regime recommended will depend on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use most oral prescription medications for acne.

We will discuss with you,  the risks and benefits of medications and other treatments we recommend.

Topical medications

The most common topical prescription medications for acne are:

• Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin and adapalene (Differin). They may be combined with topical antibiotics (Treclin) or Benzoyl Peroxide (Epiduo). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
• Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Duac,) and erythromycin with benzoyl peroxide (Benzamycin).
• Salicylic acid and azelaic acid. Azelaic acid is a naturally occurring acid which has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many conventional acne treatments when used twice a day for at least four weeks. It's even more effective when used in combination with erythromycin. Prescription azelaic acid (Finacea) is an option during pregnancy and while breast-feeding. Side effects include skin discolouration and minor skin irritation.

Salicylic acid may help prevent plugged hair follicles and is available as both wash-off and leave-on products.

Oral medications

• Antibiotics. 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 lymecycline, minocycline or doxycycline — or a macrolide.

Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance.

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.

• Combined oral contraceptives. Combined oral contraceptives are often used for acne therapy in women who also wish to use them for contraception. They are products that combine estrogen and progestin. 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.

• Spironolactone. The drug spironolactone may be considered for women and adolescent girls if oral antibiotics aren't helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness and painful periods.
• Isotretinoin. Isotretinoin is a powerful drug for people whose severe acne doesn't respond to other treatments or who are developing scarring.

Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug.  In the UK and Europe, women of childbearing age who start isotretinoin may need to start the Pregnancy Prevention Programme. The usual length of treatment is between 4 and 6 months.

Therapies

These therapies may be suggested in select cases, either alone or in combination with medications.

• Lasers. A variety of light-based therapies have been tried with some success.  We use laser/intense pulsed light predominantly to treat acne scarring.
• Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid, glycolic acid or retinoic acid.  See more about chemical peels
• Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This therapy has resulted in rapid improvement and decreased pain. Side effects may include thinning in the treated area.