1) Dear Alice,

What is the best treatment for acne?

— Zit-city

2) Dear Alice,

I would like to know something about acne. I am a high school student, and have gotten acne. I got it for more than two years, and would like to find a way to cure it. I currently use Neutrogena's Acne face wash, Neutrogena's overnight acne treatment, and some face washers. They have decreased, but I really want them to be gone.

I also read that fatty foods don't contribute to acne, but any case, I still eat low-fat foods for healthy reasons.

I hope you can help me. Thanks a lot for your help.

— Anxious about Acne

3) Dear Alice,

What medications do you recommend for acne?

— Pimples

Dear Zit-city, Anxious about Acne, and Pimples,

Acne is a skin disorder that can affect people at any age, from infancy to older adulthood. The years from adolescence to middle age tend to be the most bothersome as far as acne is concerned. There are a number of treatment options available that aim to clear up existing acne and prevent future breakouts from developing. These options vary based on the severity of the acne, which is a measure of the type and quantity of blemishes, and can include over-the-counter products (meaning no prescription is needed) to options prescribed by a health care provider. As for diet, there is limited evidence about the ways in which diet and acne are associated, but you may find the question Greasy foods lead to acne and gallbladder problems? to be helpful. Before diving in and trying these treatment options, it might be good to talk with your health care provider to help identify the cause of your acne and the best approach to both treat and prevent future breakouts.

It might be helpful to start by going over what causes acne in the first place. The three main acne culprits are hormones, bacteria, and inflammation. Therefore, treatment usually aims to address these three factors. With the onset of adolescence and its accompanying increase in hormonal secretion, the body is bombarded with changes. One of those changes is the increase in the size of sebaceous glands, which are the glands that produce and excrete sebum, a fluid that helps keep the skin lubricated. The enlarged glands make it more likely for the body to overproduce sebum, which then can clog the glands on the face, shoulders, chest, and back. Before you know it, a pimple or blackhead, that’s referred to as a comedone in the medical world, is formed. The enlarged pores that result from the increased hormone secretion offer ideal environments for bacteria, specifically Propionibacterium acnes (P. acne, for short) to live. P. acne thrive in the over productive sebaceous gland where they set up shop, only to further aggravate skin troubles. The third factor, inflammation, is the body's response to clogging of the gland and subsequent bacterial invasion. As the body tries to fight the bacteria, inflammation starts, and anti-inflammatory cells are sent to the site — this leads to the formation of a cyst or pustule.

To answer your questions about the “best” treatment option, it's good to mention that there’s no one-size-fits all remedy out there. Not only that, what works for you at one point in time may need to be adapted later. Acne medications tend to affect people differently depending on skin type, classification, and severity of acne. You may, therefore, need to experiment with a few treatments before finding the formula that works best for you. Treatment options come in many formulations — such as creams, lotions, and gels — and vary in active ingredients and strength based on the severity of acne:

  • Over-the-counter products: For those with mild-to-moderate acne, or those with only a couple of blemishes, over-the-counter products may be sufficient to control their acne. These topical products are applied to the skin and often contain benzoyl peroxide or salicylic acid. They work by reducing the skin’s oil production to prevent clogged pores or by killing the bacteria that may lead to acne. Generally, these products come in limited strengths or dosages. Typically, these products need to be used regularly to see results, and while they may control acne for a while, there’s a chance that they won’t have sustained results over time. It’s also worth noting that some of these treatments may have side effects (though typically mild), such as dryness or irritation where the topical product was applied if used for an extended period of time.
  • Prescription topical products: If someone has severe acne, many blemishes, or over-the-counter products don’t seem to work, they could consider talking with a health care provider (such as a dermatologist, a medical doctor who treats skin conditions) about stronger medications that may be available. These include topical products with prescription-strength active ingredients, such as benzoyl peroxides, salicylic acid, and retinoids, which are a form of vitamin A. It’s good to keep in mind that some people may experience side effects such as skin peeling and drying where the product was used.
  • Prescription oral medications: Other treatment options include antibiotics, which can be used to fight off excess bacteria and then minimizes any inflammation you’re experiencing. However, oral antibiotics typically can’t be used for an extended period of time since they could cause antibiotic resistance. Some other medications target the hormonal causes of acne. For individuals assigned female at birth, the use of certain birth control pills could help because they prevent excess secretion of androgen hormones. These work to decrease the effects hormones have on the sebaceous gland. In really severe cases, isotretinoin may be prescribed. For some people, isotretinoin may permanently clear acne after one course, which lasts on average about five months. However, due to the serious side effects, such as potential miscarriage, severe drying throughout the body, and sun sensitivity, it’s critical to work closely with a health care provider to see if it’s a fit for you.  
  • Surgery: If none of these medications work, there are options such as dermatologic surgery, which uses an incision and drainage or freezing.

Remember that it may take several tries, and even multiple visits with your health care provider, to find the treatment that works best for you. For more information about acne — types, causes, home treatments, and preventive measures — you may want to check out the Go Ask Alice! General Health archives. Additionally, you can visit the American Academy of Dermatology website for more information about acne.

Alice!

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