Treatment for Acne

Over-the-Counter Treatment

Topical Retinoid

Adapalene 0.1% (Differin gel) is now available over-the-counter and currently the only prescription strength retinoid product available OTC.

How it works: Topical retinoid products effectively work by breaking down whiteheads, blackheads, increasing skin cell turnover, and reducing inflammation. Apply a pea-sized amount. Results may be noticeable in as little as 2 weeks but may take 8—12 weeks for full effect.

Benzoyl Peroxide

Available as various formulations (wash, lotion, etc.) of varying strengths (2.5%-10%).

How it works: Antibacterial properties allow it to kill Propionibacterium Acnes, a bacteria that contributes to non-comedonal or pustular acne. For acne on the back, chest, or shoulders, use PanOxyl 10 % body wash. Apply in the shower, leave on for 5-10 min before rinsing. Caution: Benzoyl Peroxide may bleach or stain clothes and pillowcases.

Studies suggest that a 2.5% strength product is effective without increasing risk of skin irritation.

Salicylic Acid

Available in various formulations (wash, lotion, gel, pads, etc.) of varying strengths (0.5%-2%).

How it works: Dissolves the skin debris that clogs pores which can cause acne and also provides mild anti-inflammatory properties.

Expectations and Precautions

How long before my acne gets better?

Results may vary. Reduction in acne may be noticed in a week but may take up to 8-12 weeks for maximal reductions in acne. Sometimes acne can get worse before it gets better due to an increase in cell turn over. Good habits and adherence help maximize effects.

What should I be worried about when using these products?

Side effects include dryness, peeling, redness and irritation. Some products may increase sun sensitivity. Reducing frequency of application, such as using a topical retinoid every other night, or benzoyl peroxide for spot treatment may decrease side effects. Washing with gentle cleansers, using non-comedogenic moisturizers, and using sun protection will minimize side effects and damage to the skin.

I have tried these products according to instructions for an appropriate amount of time. What if I am not satisfied with the results of treatment?

Talk to your primary care provider or dermatologist. They can prescribe a stronger topical retinoid or may add oral medications such as a short course of antibiotics, spironolactone, or oral contraceptives. Providers or dermatologists may also recommend Isotretinoin (Accutane) for resistant, severe or cystic acne.

Since I have oily skin, should I really use a moisturizer?

Many products used to treat acne can strip the skin of natural oils causing drying of the skin. Especially when using a retinoid product, moisturizing and using sun protection promotes healthier skin.

Prescription Treatments

The following treatments require a prescription written by a provider and must be filled at a pharmacy. Always let your provider and pharmacist know about all topical and oral medications (including non-prescription) you are using or taking.

Topical medications:

• Antibiotics (Clindamycin, Erythromycin)
• Retinoids (Tretinoin “Retin-A”, adapalene “Differin”, tazarotene “Tazorac”)
• Benzoyl peroxide
• Combo products (adapalene + benzoyl peroxide, clindamycin or erythromycin + benzoyl peroxide)

Oral medications:

• Isotretinoin (Accutane, Absorica)
• Antibiotic (Doxycycline or Minocycline)
• Spironolactone
• Oral Contraceptives

Sun Protection

A broad spectrum sunscreen protects against damaging UVA and UVB rays of the sun from reaching the dermis, a deeper layer of the skin.

Facial Moisturizers may also include Sunscreen. Look for “SPF” or “Broad Spectrum Sunscreen” on the labels.

Recommended sunscreens contain physical blockers like Zinc Oxide or Titanium Dioxide to block UV rays.

Using sunscreen can promote healing of postinflammatory hyperpigmentation (PIH).