Treatment of acne aims to get rid of it fast and to avoid subsequent scarring. In its mild form, you could start the treatment by using over-the-counter facewash for cleaning the affected part and topical creams for local application.

You should wash your face a number of times every day with an acne anti-bacterial soap and water. You could apply an over-the-counter topical cream on the affected part/s after your face has dried completely.

Give it 20 minutes after the face wash. If you have back acne, take the help of your family members to wash your back and apply the cream or lotion.

If over-the-counter products have not improved your acne, you should consult the skin specialist. This happens when you have a severe acne breakout, or acne cysts or nodules.

The dermatologist will put you on prescription oral drugs and topical creams. With this advanced therapy, improvement will be seen but you have to be patient for a complete cure. With treatment too, it can take weeks to a few months for the acne to clear up.

The treatment consists of medications such as oral antibiotics and applying topical acne skin creams, which are available over the counter, while some are prescribed by the dermatologist  Acne cleansers, soaps, face wash, and lotions are available, which should be used after consulting your dermatologist.

You have to persist with the line of treatment until your acne is cured. Many people give up treatment because they feel it is not working due to the long period it takes for the condition to clear up. Treatment to cure acne vulgaris is a painfully slow process and you must be patient about it.

Washing should be gentle and not the scrubbing type. Vitamin A supplements can be taken. Do not attempt to squeeze or extract the pimples as this may lead to scarring. The application of oil or an oily gel on the hair should be avoided.

Treatment of acne consists of the following options:

  • Topical creams and applications
  • Oral drugs
  • Other therapies

Topical preparations for local relief

Treatment to cure acne usually starts with the application of topical skin creams. This cream may be an antibiotic cream to kill the bacteria and reduce infection and additionally other creams to reduce the oil on the skin and clear the blocked pores may be prescribed. These contain retinoids and a higher concentration of benzoyl peroxide, or salicylic acid.

Topical preparations should be applied evenly all over the affected area and not just on the pimple spots. Mild acne responds well to topical treatment and may not require oral drugs.

Benzoyl peroxide

Benzoyl peroxide is the commonly recommended topical cream for acne. It is an over-the-counter product and does not require a prescription. There are various brand names available and comes in strengths of 2.5%, 4%, 5%, and 10%. It is best to start using benzoyl peroxide at a lower concentration, because of the skin irritation it may cause.

Always wash your face well with mild soap and pat it dry with a clean towel. Do not rub the towel on the face as it may inflame the acne. After twenty minutes, apply a thin layer of benzoyl peroxide cream all over the affected area.  This topical preparation will help control the infection by its anti-bacterial effect, reduce inflammation, and clear the blocked pores.

Initially use it only once a day and after a few days, you can start applying it twice a day, once you know your skin can tolerate it.

Azelaic acid

The topical azelaic acid gel is used to clear the inflammation and the blocked pores in the treatment of acne. It belongs to a class of medications called dicarboxylic acids.

It has antimicrobial and anti-inflammatory properties, but its anti-inflammatory action is not as strong as benzoyl peroxide. However, it causes less skin irritation and can be used in patients whose skin is sensitive to benzoyl peroxide.

Retinoids

Retinoids are available only under prescription. They are available as creams, gels, and lotions and should be applied to the affected part thrice a week. Once your skin tolerates it and there is no skin irritation, you can start applying it daily.

Retinoids act by clearing up the blocked skin pores and their mild anti-inflammatory action helps in treating the blackheads and the whiteheads, which occur early on before the pimples onset.

Topical antibiotics

Topical antibiotics creams for acne help in killing the bacteria and controlling inflammation. You will need a prescription for obtaining this product.

Since they do not have any action on the blocked skin pores, they are of no use in removing the blackheads and the whiteheads. They are, therefore, often used in combination with benzoyl peroxide. This also helps in preventing antibiotic resistance.

You apply the antibiotic cream in the evening and the benzoyl peroxide in the morning. Take care to wash your face, mop it dry and give it 20 minutes to dry before applying the cream.

Combinations of cream are available that have a synergistic effect on acne treatment. Topical preparations, having a combination of an antibiotic with retinoids or an antibiotic with benzoyl peroxide are available and effective.

Oral treatment to cure acne vulgaris

Oral antibiotics

Oral antibiotics, especially tetracycline-based, are used to treat acne. They are required in moderate to severe forms of acne and when topical antibiotic creams do not control the infection. In acne cysts and nodules, oral antibiotics are started at the outset. Oral antibiotics will kill the bacteria, thereby reducing infection and inflammation.

Tetracycline is the antibiotic of choice. Other antibiotics from the same family include oxytetracycline, doxycycline, minocycline, and lymecycline. Erythromycin or trimethoprim may be advised if the above-mentioned antibiotics do not work or you are sensitive to them.

It may take up to six weeks for some improvement to be seen and up to four months for the acne to clear up.

Oral contraceptives

The Food and Drug Administration (FDA) of the United States has approved the estrogen and progestin combination in the treatment of acne in women and adolescent girls. These are taken only on advice from your doctor because of side effects and certain contraindications.

Spironolactone (Aldactone)

Spironolactone is a potassium-sparing diuretic used in congestive heart failure, cirrhosis of the liver, and kidney disease. It removes the excess fluid from the body.

It is due to the action of the male sex hormones, androgens that acne develops because of the excessive secretion of sebum from the sebaceous glands. Spironolactone blocks the action of the androgens and prevents the sebaceous glands from secreting excessive sebum.

Isotretinoin

Isotretinoin is a form of vitamin A that is used to treat severe nodular acne, which has not responded to other treatments, including antibiotics.

Isotretinoin, available only by prescription, is very effective and is used only in very severe forms of acne (cystic acne) or in those that do not respond to other lines of treatments.

85% of acne cases clear up after one course of its treatment, which takes 4 to 5 months. This period may vary slightly and the dermatologist will decide when to stop the treatment.

Regular follow-up visits to the dermatologist are required when taking this drug, because of the potential side effects that this drug has. Your doctor may, therefore, ask you to sign a consent form.

Side effects of isotretinoin include ulcerative colitis, depression, and congenital birth defects. It is contraindicated in pregnancy.

Other therapies to treat acne

Light therapy

Light therapy is used to kill bacteria and reduce inflammation. However, this therapy needs further study to optimize the line of treatment.

Chemical peels

Chemical peels are used in the treatment of blackheads and papules. It involves repeated applications of salicylic acid in the affected areas. This is done by the dermatologist.

It is also used in conjunction with other acne treatments to increase the efficacy of the treatment. It is however not combined with retinoids either topical or oral due to fear of it causing skin irritation.

Acne extraction

Acne extraction is performed by the dermatologist through a procedure called “drainage and extraction” to remove a large acne cyst, not responding to regular treatment. This procedure will help to reduce swelling and pain. However, there are chances that it may leave a scar.

The various options in the treatment to cure acne vulgaris have to be followed when indicated. This will be decided by your dermatologist to get the best results fast. Moreover, treatment prevents new breakouts.

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