Over the counter (OTC) acne medicines are a good first choice in mild acne, and can be fairly effective. Most all of these contain one of three ingredients, and despite what advertising and television stars may tell you, they work about the same. These ingredients are:
- benzoyl peroxide (an excellent germ killer, but can be irritating)
- salicylic acid (a chemical exfoliant), and
- sulfur (the least commonly used of the 3 because of its unpleasant smell.
For moderate to severe acne, or acne that is persistent/resistant to OTC treatment, seek the help of a board-certified Dermatologist. We are the experts in the evaluation and management for diseases of the skin, hair and nails, and have access to a large arsenal of weapons to attack your acne. Prescription therapy for acne is vastly more potent than any of the OTC options.
A good dermatologist first should initially examine your acne closely to make sure that you do, in fact, have acne! There are a number of conditions that may mimic acne, many of which may not be easily identified by your general physician.
Secondly, it is important to assess for conditions, medicines or exposures that may effect your acne. Examples could include hormonal conditions, steroid exposure, or prescription medicines such as lithium. Knowing and evaluating for these problems will impact not only your acne care, but also your general health.
Third, is developing an individualized plan for your acne. Again, this is where expertise is so critical- Dermatologist simply have more "arrows in our quiver" to treat your acne.
Acne treatments generally fall into 6 categories:
- Comedolytics (whitehead/blackhead removers)
- topical antibiotics
- oral antibiotics
- systemic retinoids (like Accutane® (Isotretinoin)
- hormonal therapies
- physical modalities.
As acne has 4 root causes (increased oil, sticky pores, overgrowth of germs, and inflammation), most acne requires a combination of treatments for maximum results.
Comedolytics remove the clogged up pores (comedone= whitehead/blackheads) that are initial formation of all acne bumps. The most effective are the retinoids, such as Retin-A®, Differin®, and Tazorac®.
Topical antibiotics kill the germs associated with acne, that result in inflammation. Prescription therapies offer more options and increased effectiveness over their OTC counterparts.
Oral antibiotics not only assist in germ killing, but also decrease the inflammatory response in acne. There are many options, often with subtle differences and differing side effects. Your dermatologist will be able to choose the appropriate one for your personalized care.
Other, more advanced and powerful treatments, are generally solely used by dermatologists. These include systemic retinoids (isotretinoin/accutane), hormonal therapy, and physical modalities (acne surgery, chemical peels, laser or light based therapies).
Be sure to aggressively pursue appropriate treatment for acne. Acne scarring is extremely difficult to improve and the social impact of severe acne should not be ignored. With all the options available today, your acne your be well controlled."
Over the counter (OTC) anti-acne therapies do have their place in acne control.
Typically containing benzoyl peroxide, salicylic acid, or astringent -- ingredients which have proven safe and effective through the years -- nonprescription acne medications can be especially useful for those suffering from minor, scattered acne breakouts.
On the other hand, for those plagued by persistent and widespread flares or deep, cystic, painful, and potentially scarring outbreaks, there can be no substitute for a consultation with a dermatologist to tailor the use of prescription medications in order to treat the specific problems of the patient.
Fortunately, we have the relatively recent introduction of a variety of topical prescription preparations that have proven quite effective for controlling and suppressing acne. These include combinations of topical antibiotics and retinoids, topical antibiotics and benzoyl peroxides, as well as new delivery systems to increase the penetration and efficacy of the individual ingredients while minimizing their potential for causing skin dryness or irritation.
There is also a next generation set of oral antibiotics that offer the advantages of potentially fewer side effects and even the convenience of once-per-day dosing.
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Last updated : 2/10/2023