How is acne treated?
The choice of treatment depends upon the severity of the acne. All acne should be treated as it will not improve if left untreated and could become worse. Mild acne is usually treated with a topical lotion, cream or gel (applied directly to the skin). Many of these products contain an ingredient called benzoyl peroxide, which has an antibacterial effect and needs to be used daily over a period of months before improvement occurs. Benzoyl peroxide is found in many acne preparations that can be purchased over the counter, but is also available on prescription in different concentrations. Azelaic acid (Azelex) is less irritating than benzoyl peroxide and also fights bacteria, but it may take many months to produce an improvement, particularly in moderately severe acne. It is used when there are large numbers of blackheads present.

Topical antibiotics such as erythromycin and clindamycin (Clindagel, Evoclin) may be prescribed for mild acne and are often given in combination with benzoyl peroxide. In moderate acne, topical treatments containing substances known as retinoids, such as tretinoin (Avita, Atralin, Retin-A), or retinoid-like substances, such as adapalene (Differin) may be used. These products increase sebum drainage, reduce plug formation on the skin surface and increase skin renewal. They should not be used in pregnancy.

Isotretinoin (Amnesteem, Claravis, Sotret) can also be given in tablet form for severe acne. This drug is prescribed when antibiotics and other treatments have not been effective and must not be taken during pregnancy. Because of their high risk of causing birth defects in unborn children, these drugs falls under a restricted distribution program, approved by the FDA, in order to minimize fetal exposure. The program is called iPLEDGE. Only prescribers and pharmacies registered in the program may prescribe or dispense these drugs.

Combination products for topical use are also available (clindamycin and benzoyl peroxide [Duac], adapalene and benzoyl peroxide [Epiduo]). In moderate and severe acne, topical treatments are usually given in combination with oral antibiotics (eg, doxycycline [Monodox, Vibramycin], erythromycin [Ery-Tab], minocycline [Dynacin, Solodyn], tetracycline). Treatment needs to be continued for at least three months. Little improvement may be noticed during the first month of antibiotic treatment. Around 75% of people with acne will see an improvement with antibiotic therapy. Side effects that may be caused by antibiotics include thrush, sensitivity to sunlight, and a decrease in the effectiveness of oral contraceptives. Hormone treatments such as oral contraceptives may significantly improve acne.