Retinoids: Retin-A (tretinoin) has been in use for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. Adapalene 0.1% is now available without a prescription. With proper sun protection, however, they can be used even during sunny periods. The combination medication known as Epiduo gel -- which contains the retinoid, adapalene, along with the antibacterial, benzoyl peroxide -- is applied once a day.
Isotretinoin has a high risk of inducing birth defects if taken by pregnant women. Women of childbearing age who take isotretinoin need two negative pregnancy tests (blood or urine) before starting the drug, monthly tests while they take it, and another after they are done. Those who are sexually active must use two forms of contraception, one of which is usually the oral contraceptive pill. Isotretinoin leaves the body completely when treatment is done; women must be sure to avoid pregnancy for one month after therapy is stopped. There is, however, no risk to childbearing after that time.
“After sweating, immediately use an exfoliating cleanser to help keep your pores clear and remove excess oil,” says Dr. Zein Obagi of ZO Skin Health. Try keeping Neutrogena Rapid Clear Treatment Pads in your gym bag or locker for those times you need an on-the-go cleanse. These will remove any leftover dirt while treating your skin with acne-fighting salicylic acid.
Your dermatologist may prescribe Accutane®, if other treatments have not worked. This is a strong medicine that can help prevent scarring and treat active disease. But, Accutane also can cause birth defects. It is important that you are not pregnant and do not plan to get pregnant while taking this medicine. You must use two methods of birth control at the same time. This is done for one month before treatment begins, during treatment, and for a full month after stopping the drug. Talk with your dermatologist about when it's safe to get pregnant. Other side effects of this drug may include dry eyes, itching, mood changes, and changes in the blood and liver. You and your dermatologist can decide whether this medicine is right for you based on the pros and cons. Use any prescribed medicine exactly as you are advised. Taking more medicine than you are supposed to take may make acne or your general health worse. Ask your doctor what to do if you miss a dose.
Try sipping spearmint tea. According to Dr. Carl Thornfeldt, dermatologist and founder of Epionce Skincare, having two cups a day could reduce acne by 25%! Dr. Levin explains this is because spearmint tea has been shown to have anti-inflammatory and reduction in testosterone levels in some limited studies. "While it's unclear how it works, and it's important to note that there are no standardized studies, it is encouraging data that spearmint may have potential as a natural adjunct treatment for hormonal acne," she says.
There are a number of mild chemical peels available over the counter, but acne scar removal requires a stronger peel typically administered by a doctor or dermatologist. Trichloroacetic acid (TCA) peels are slightly stronger than alpha hydroxy acid (AHA) peels and may be used for acne scar treatment. The strongest type, phenol peels, may cause significant swelling and require up to two weeks of recovery time at home. Neither are recommended for people with active severe acne.
Acne treatment that you apply to the skin: Most acne treatments are applied to the skin. Your dermatologist may call this topical treatment. There are many topical acne treatments. Some topicals help kill the bacteria. Others work on reducing the oil. The topical medicine may contain a retinoid, prescription-strength benzoyl peroxide, antibiotic, or even salicylic acid. Your dermatologist will determine what you need.
Even if battling zits is a distant memory, filed away with high-school gym class and algebra tests, acne marks and scars can annoyingly linger long after pimples are gone. “If someone gets a very large pimple or cyst, the natural healing process of the skin will create a scar,” says David Avram, M.D., of Heights Dermatology and Laser. “The more intense the inflammation, the more likely it will leave a scar.”
Extractions: An extraction is the physical unclogging of a clogged pore. The aesthetician pushes a tool called an extractor around each acne lesion, forcing the pus, bacteria, and sometimes blood up through the clogged follicle opening. It is an aggressive procedure that should only be performed by an experienced aesthetician or dermatologist as it can damage your pores if done incorrectly.
If you wear tight clothing when working out or don heavy equipment for sporting purposes, you may have experienced Acne Mechanica. This type of acne is prevalent among athletes, students, and soldiers, and is directly caused by excessive heat, pressure, and covered skin. It also may be triggered by consistent rubbing of different materials against the skin. This type of acne can be alleviated by changing out of sweaty gear and clothing and showering immediately after a workout. It’s also important to clean gear of acne bacteria and prevent friction by ensuring a comfortably tight fit. If you believe your acne flare up has been caused by a tight or heavy uniform, wearing a clean, cotton t-shirt underneath can help absorb the sweat and keep your skin protected.
Many over-the-counter lotions and creams containing salicylic acid or benzoyl peroxide are available to help prevent acne and clear it up at the same time. You can experiment with these to see which helps. Be sure to follow the instructions exactly — don't use more than you're supposed to at one time (your skin may get too dried out and feel and look worse) and follow any label directions about allergy testing.
You can help keep rosacea under control by keeping a record of things that cause it to flare up. Try to avoid or limit these triggers as much as you can. Antibiotic lotions or gels can also help. Sometimes, you may need to take antibiotic pills. Your dermatologist may treat you with laser surgery. If you think you have rosacea, talk with your doctor about these treatments.
True acne scars — as in indentations in the skin like ice-pick scars — can only be erased with professional procedures like microneedling or lasers. Fortunately, what most of us refer to as “scars,” according to Julia Tzu, M.D., founder and medical director of Wall Street Dermatology, are actually marks caused by post-inflammatory hyperpigmentation (brown spots) or post-inflammatory erythema (red spots), that will fade over several months or years. Fortunately, there are products that can speed up the process.
Treatment of acne scars: For those patients whose acne has gone away but left them with permanent scarring, several options are available. These include surgical procedures to elevate deep, depressed acne scars and laser resurfacing to smooth out shallow acne scars. Newer forms of laser resurfacing ("fractional resurfacing") are less invasive and heal faster than older methods, although results are less complete and the procedures may need to be repeated three or more times. These treatments can help, but they are never completely successful at eliminating acne scars.