If you google the words acne treatment, it’ll yield 187,000,000 results in 1.16 seconds. Now, as proud as we are of Google for doing a great job on finding information for us, working our way through 187,000,000 results seems like a task straight from hell. Plus, all those results are teeming with different advice, information and recommendations. Thus, when it comes to how to treat our acne, we wonder, what’s the truth, the whole truth, and nothing but the truth?
So, instead of scouring the list to find the truth, we decided to curate the truth. That means a comprehensive list of acne treatments, who they work for, and their side effects all in one convenient place— right here. We talked to board-certified dermatologist Purvisha Patel, MD, founder of Visha Skincare, to get the official word(s) on acne and the seemingly never-ending laundry list of treatments.
A topical acne treatment means it’s something you’re applying directly to the skin. This can come in the form of a gel, lotion or pad, depending on what’s prescribed (or bought at the drugstore) to you. Dr. Patel says topicals work for “people throughout the acne spectrum from comedonal [whiteheads, blackheads, and micro-bumps] to cystic [big, red bumps that can hurt and itch].”
Retinoids (Tretinoin, Retin-A, Tazorac)
What Are They?: These are all vitamin A derivatives that help the skin exfoliate/peel the skin and shrink oil glands. This opens clogged pores and reduces oil production to help decrease acne.
Side Effects: Skin peeling and irritation. Make sure you make clear to your dermatologist what kind of skin you have on a daily basis—oily, dry, T-zone oily. Just in case the day you see them is not a typical day for you, as this can affect the strength of topical prescribed.
Antibiotics (Doxycycline, Minocycline)
What Are They?: They are mostly used for their anti-inflammatory effects. Inflammation occurs when the follicles get clogged, and there is overgrowth of bacteria/fungus in the follicle.
Side Effects: None reported. Check with your doctor.
Salicylic Acid and Azelaic Acid
What Are They?: Salicylic acid is usually prescribed to exfoliate the skin to decrease clogged pores. Azelaic acid is a naturally produced acid that is in the prescription treatment Finacea. It helps exfoliate the skin and lighten skin darkening.
Side Effects?: Skin peeling and inflammation as above.
What Are They?: A topical antibiotic that is used to help with neutrophils, or white blood cells that come to areas of inflammation—this helps decrease redness.
Side Effects: No topical side effects unless the patient is sensitive to the vehicle. Make sure you tell your dermatologist if you have a known allergy to topical meds or ingredients such as propylene glycol, a common ingredient of topical medication vehicles.
What Are They?: Washes such as sulfa [sulfacetamide sodium suspension], BPO [benzoyl peroxide] and acid washes—these exfoliate the skin.
Oral treatments are administered by mouth. Dr. Patel suggests going on oral medication “when there is a deeper cystic component [the follicle is not coming to a head].”
What Are They?: Antibiotics are no longer the cornerstone of acne treatment. They mostly work by decreasing the inflammatory response in the skin and help make deeper inflammatory papules smaller.
Side Effects: They are not safe to take over a long period of time, and the most common, cyclines (such as doxycycline and minocycline), make you more sun sensitive. This can result in the scars of acne appearing more apparent after being in the sun and more sunburns. There can also be gastrointestinal distress and even nausea. Ask your doctor if there are any foods to avoid when taking these medications.
Combined Oral Contraceptives
What Are They?: Oral contraceptives help with the oil-production component of acne. Typically oil production peaks during a cycle with a progesterone spike—this causes more oil production and hence more acne as there are progesterone receptors in the skin. Once a pore is clogged, oil in combination with bacteria/fungus can create growth then inflammation. High-dose estrogen is found to suppress oil production as well, but the risks and side effects prohibit use.
Side Effects: Spotting, bloating and weight gain. Ask your doctor which pill will be a good fit for you given your cycle, lifestyle and weight.
What Are They?: Spironolactone is a common combination ingredient used in OCPs (oral contraceptive products) that is a diuretic but also helps decrease oil production. It is important to measure blood potassium levels with use and stop if too high. There are other anti-androgen agents as well, but the risks and side effects prohibit use.
Side Effects: Increased potassium levels and low blood pressure/dizziness. Your doctor will check your labs and blood pressure before starting medication.
What Is It?: This is a high-dose vitamin A medication that is chemotherapy for the sebaceous glands of the skin. It causes gland shrinkage, leading to decreased oil production and causes the top layer of the skin to shed, or peel.
Side Effects: This can result in very dry peeling skin. This drug is considered a teratogen—it is toxic to a forming fetus, so pregnancy testing and close monitoring is required during treatment. It is also associated with increasing triglyceride levels in the blood as well as increasing the prevalence of mood disorders such as depression and suicidal ideation.
These are the treatments you see celebrities doing in their Instagram stories. They’re almost always done by a professional and are beneficial for “expedit[ing] treatment and help[ing] with scaring.”
Lasers and Photodynamic Therapy
What Are They?: Lasers are typically used in conjunction with topical agents to help speed up the treatment or treat scars. Lasers can be used to resurface the skin to peel the top clogged layer and to treat scarring as well as redness. PDT, or photodynamic therapy, is a targeted light treatment where a chemotherapy medication is placed on the skin and left to sit to be absorbed by P. Acnes, the most common bacteria causing acne. The medicine is taken up by the bacteria and then a blue light is used to activate the medication. This results in killing of the bacteria in a very controlled fashion. It is very effective, but is generally not covered by insurance companies and can get very expensive.
Side Effects: Skin darkening and inflammation may occur at the site of treatment. Your physician will teach you how to take care of your skin after the treatment.
What Is It?: Chemical peels are most commonly performed in the doctor’s office to peel off the top layer of skin to open pores, reveal new smoother skin, and help with scarring. Light chemical peels can be performed at home with low-dose salicylic acid and glycolic acid—they should result with some skin flaking. Medium-depth peels should be performed in a doctor’s office using stronger concentrations of acids such as glycolic, salicylic, lactic and malic acid. They usually result in peeling over a few days. Deeper peels should be performed by a dermatologist/physician only as they require medical monitoring. The deeper the peel, the deeper the layers of skin that slough. This is both helpful for acne and scarring.
Side Effects: There should be sun avoidance after a peel to prevent pigmentation and scarring of the skin.
Extraction of Whiteheads and Blackheads
What Is It?: This is a manual procedure either done at home with an extractor or by an experienced health professional. The clogged pore is extracted of the oil to decrease the acne. It is important to wash with a good exfoliating wash such as Visha Skincare Advanced Purifying Cleanser before and after extracting to dissolve the oil and clean the skin.
Side Effects: It is important to either get a professional or learn how to use a comedone extractor or there can more inflammation that can result in scarring.
What Is It? This should be reserved for emergency pimples only and done only by an experienced dermatologist. A dilute steroid solution is injected directly into the pimple to give immediate anti-inflammatory benefits, this generally helps the pimple go down and not be painful and resolves the lesion within 24 hours.
Side Effects: Skin thinning and lightening as well as atrophy (the skin gets so thin it sinks down under the surface) may occur. This is truly something to be done a few days before an important event such as prom or a wedding and is not recommended as a regular treatment strategy.