Topical retinoids are derived from vitamin A and work by unclogging pores. They are the treatment of choice for blackheads and closed comedones. They work by stimulating collagen production and exfoliating the top layers of skin cells. Side effects of using retinoids include redness, dryness, itching and stinging. Doctors will guide you on how to introduce them into your skincare routine, and which skincare products to combine them with to improve tolerability. It may result in increased sensitivity to sunlight, so always apply your sunscreen during the day.
Topical benzoyl peroxide like Benzac or Duac should be applied directly onto spots. It simply works by killing the bacteria on the skin that causes acne. By neutralising acne-causing bacteria, flare-ups are reduced. It also dries out large spots relatively quickly. You only need to apply a small amount to affected areas, as redness and peeling are likely to occur.
Topical antibiotics, such as clindamycin and metronidazole, are effective acne treatments. It is recommended not to use topical antibiotics on their own, due to the risk of developing bacterial resistance. Instead, they work better when combined with benzoyl peroxide to reduce this risk and to improve results as they tackle bacteria in different ways.
Spironolactone is an oral medication that was initially developed for blood pressure and heart failure, but also seems to work in female adult acne by acting on hormones in the skin. It helps reduce acne significantly because it has anti-androgen effects to block male hormone testosterone and excessive oil production, which can both cause spots. At higher doses, it may also prevent excessive facial and body hair growth and hair loss on the head.
Birth control pills contain female hormones that work by counteracting the effect of male hormones (such as testosterone) on acne. Their use is limited to female patients. The maximum benefit of oral contraceptives on acne occurs in three to four months.
Oral anti-inflammatory antibiotics often used are doxycycline and minocycline, all of which are quite effective in many cases of acne. Antibiotics do not address other causative factors in acne and may take several weeks or months to clear it up. They are often used in combination with other drugs that “unclog” follicles. Many oral antibiotics for acne should not be used during pregnancy.
Chemical peels will improve mild to moderate acne. This involve application of a chemical peeling agent, which include AHAs (like glycolic acid – an acid that reduces spots and inflammation) and BHAs (salicylic acid – an anti-inflammatory that helps exfoliate the outer layer of skin, to exfoliate). Peels can not only be used to treat active acne but hyperpigmentation (skin discoloration left behind by spots) and superficial acne scars.
For single, isolated stubborn, large inflammatory acne lesions such as cysts, a small steroid injection can be used directly on the spot. Steroid injections are useful if you want to bring down a spot as soon as possible because they reduce swelling and dry them out. The cyst usually flattens within 48 hours. They are safe, but in some cases, they can leave behind an indentation in the skin where the cyst once was and may cause skin thinning and pigmentation change.