Medications commonly used for acne treatment include the following:
- Benzoyl peroxide kills the skin bacteria that cause inflammation and helps open the ducts through which sebum passes to the skin surface. It is available without a prescription in 2.5, 5, and 10percent strengths in several forms. Liquids and creams are better for dry skin, while gel forms are more helpful for oily skin. Benzoyl peroxide can be applied once or twice daily after washing the affected area with mild soap and water. It will improve the majority of acne cases if used consistently. If using benzoyl peroxide for one or two months doesn’t help, a doctor should be consulted. A family physician or pediatrician can manage most cases of acne, but for more severe outbreaks, a dermatologist may be needed.
- Tretinoin (Retin-A in various forms and strengths) is extremely effective in unplugging pores and even causing comedones (blackheads) to be expelled from the skin. This can be alarming at first, because the new appearance of comedones on the surface will suggest that the medication is making the acne worse. But this effect is only temporary. Tretinoin typically causes some redness and peeling of the skin. Skin treated with tretinoin sunburns more easily, no avoiding the sun or using a strong sunscreen is important. The combination of tretinoin applied at bedtime (thirty minutes after washing and drying the face) and benzoyl peroxide every morning should control 80 to 85 percent of acne in adolescents.
- Antibiotics applied topically or taken orally some-times help acne treatments by reducing the population of bacteria on the skin. Oral forms of tetracycline or erythromycin are particularly helpful when inflammation is intense. Tetracycline and similar drugs cannot be given to pregnant women or the teeth of a developing fetus or a child.
- Isotretinoin (Accutane), an extremely potent derivative of vitamin A, is used in the most severe cases of acne. Isotretinoin acts essentially like an enhanced version of tretinoin, and 90 percent ofeven the worst cases of acne will respond to treatment over a four to five-month period.
This drug has a number of potential side effects, including dry skin, itching, and changes in liver function. Most important, it can cause significant deformities in a developing fetus if taken during pregnancy. Any woman who plans to take iso-tretinoin must consider this fact very carefully. Some physicians will not prescribe isotretinoin to an adolescent or adult female unless she agrees to take oral contraceptives.
- Azelaic acid (Azelex) is a newer topical medication that is unrelated to the others listed above. Derived from cereal grains, it inhibits skin bacteria, decreases the sebum that blocks pores, and reduces inflammation. It is applied twice daily to skin that has just been washed and should be continued for four weeks before deciding whether or not it is helpful.
Whatever approach is taken, it is important to remember that (1) treatment can only control acne, not cure it. For most people, this problem will fade away before adulthood. (2) Once treatment is started, it might be several weeks before there is a visible change for the teenager who is agonizing over the latest crop of facial bumps, this news may bring little comfort. Parents (and a physician, when appropriate) will need to be empathetic and supportive. Sometimes support will involve a gentle reminder to be consistent with treatment.