Acne affects almost every teenager to some degree. Some are lucky to escape teenagerhood with mild acne consisting only of blackheads and whiteheads, which dermatologists call comedones (comb-ee-dones). Most people though have inflammatory lesions like papules and pustules. A few people have one of the more severe types of acne with nodules and cysts that go on to severe scars.
To understand the treatment for acne it helps to know what causes it. In a nutshell, skin cells that are normally shed from inside pores become "sticky" for reasons we don't entirely understand. Behind this sticky plug of skin cells oil (also known as sebum) builds up. Hormones increase the production of this sebum. This sets up an environment where bacteria grow and create inflammatory byproducts that cause acne.
From that description you can see some of the "targets" where we can start to treat acne. To break up the plugs of skin cells we often give people Vitamin A-derived medications. Probably the best-known medication of this kind is Retin-A (also called tretinoin). Retin-A breaks up these plugs and prevents new comedones from forming. Accutane (isotretinoin) is the oral cousin of Vitamin A that treats all of the known causes of acne. It increases the turnover of skin cells to clear out the comedones, decreases sebum production, and has been shown to decrease the types of bacteria that cause acne. Accutane, like all medications, has the potential to cause side effects, and some of them are potentially serious. For many people with severe acne, however, it remains the treatment of choice today even after decades on the market.
Antibiotics, both topical and oral, play a role in treating all kinds of acne. Topically your doctor might prescribe clindamycin or erythromycin. Oral antibiotics for acne range from a class of medications called tetracyclines (including doxycycline and minocycline), to another class called sulfonamides. It would take too long to mention all the details of antibiotics used to treat acne, but suffice it to say that they do a fantastic job at treating acne--particularly inflammatory acne--for many patients.
So far I've talked about prescription medications for acne, but some of the best medications are readily available over the counter. Benzoyl peroxide is a topical medication available as a face wash and in bar form in various strengths up to 10%. It is also found in many prescription products alone and as a combination with antibiotics and Vitamin-A derivatives. The two big downsides to benzoyl peroxide are irritation and bleaching. It will bleach any clothes and towels it comes into contact with. The 10% formulations are irritating to most people if you use it for extended periods (like overnight). To combat these to problems my recommendation is to use 10% benzoyl peroxide (my favorite is Oxy brand face wash) in the shower. Put a small amount on your face for 5-10 minutes and then wash it off well before drying your face. Moisturize with a good non-comedogenic (non-pore-clogging) sunblock after the shower.
Another great over-the-counter product is salicylic acid 2%. Two percent salicylic acid is available from many brands. I like the formulation that Neutrogena makes in their Oil-Free Acne Wash. It decreases inflammation and breaks up the formation of comedones like many other acne products. Like benzoyl peroxide and Retin-A some people may find it irritating so it is important to use face moisturizers and/or alternate with a gentler wash like Cerave.
Unfortunately there is no perfect combination for everybody. If the over-the-counter products are not working well enough for you then it may be time for a visit to the dermatologist. Often you can get things under control with a few months of an oral medication and then go back to topicals only.
To recap, here are some of my favorite products for acne available over the counter: Neutrogena Oil-Free Acne Wash, Oxy Face Wash (with 10% benzoyl peroxide), and Cerave foaming face cleanser.
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