How Is Acne Treated?
Acne is often treated by dermatologists
(doctors who specialize in skin problems). These doctors
treat all kinds of acne, particularly severe cases.
Doctors who are general or family practitioners, pediatricians,
or internists may treat patients with milder cases
The goals of treatment are to heal
existing lesions, stop new lesions from forming, prevent
scarring, and minimize the psychological stress and
embarrassment caused by this disease. Drug treatment
is aimed at reducing several problems that play a
part in causing acne:
- abnormal clumping of cells in the follicles
- increased oil production
All medicines can have side effects.
Some medicines and side effects are mentioned in this
booklet. Some side effects may be more severe than
others. You should review the package insert that
comes with your medicine and ask your health care
provider or pharmacist if you have any questions about
the possible side effects.
Depending on the extent of the problem,
the doctor may recommend one of several over-the-counter
(OTC) medicines and/or prescription medicines. Some
of these medicines may be topical (applied to the
skin), and others may be oral (taken by mouth). The
doctor may suggest using more than one topical medicine
or combining oral and topical medicines.
Treatment for Blackheads, Whiteheads,
and Mild Inflammatory Acne
Doctors usually recommend an OTC
or prescription topical medicine for people with mild
signs of acne. Topical medicine is applied directly
to the acne lesions or to the entire area of affected
There are several OTC topical medicines
used for mild acne. Each works a little differently.
Following are the most common ones:
- Benzoyl peroxide – destroys
P. acnes, and may also reduce oil production
- Resorcinol – can help break
down blackheads and whiteheads
- Salicylic acid – helps break
down blackheads and whiteheads. Also helps cut
down the shedding of cells lining the hair follicles
- Sulfur – helps break down blackheads
Topical OTC medicines are available
in many forms, such as gels, lotions, creams, soaps,
or pads. In some people, OTC acne medicines may cause
side effects such as skin irritation, burning, or
redness, which often get better or go away with continued
use of the medicine. If you experience severe or prolonged
side effects, you should report them to your doctor.
OTC topical medicines are somewhat
effective in treating acne when used regularly; however,
it may take up to 8 weeks before you see noticeable
Treatment for Moderate to Severe
People with moderate to severe inflammatory
acne may be treated with prescription topical or oral
medicines, alone or in combination.
Prescription Topical Medicines
Several types of prescription topical
medicines are used to treat acne. They include:
- Antibiotics – help stop or
slow the growth of bacteria and reduce inflammation
- Vitamin A derivatives (retinoids)
– unplug existing comedones (plural of comedo),
allowing other topical medicines, such as antibiotics,
to enter the follicles. Some may also help decrease
the formation of comedones. These drugs contain
an altered form of vitamin A. Some examples are
tretinoin (Retin-A), adapalene (Differin), and
- Others – may destroy P.
acnes and reduce oil production or help stop
or slow the growth of bacteria and reduce inflammation.
Some examples are prescription strength Benzoyl
peroxide, sodium sulfacetamide/sulfur-containing
products, or Azelaic acid (Azelex).
Like OTC topical medicines, prescription
topical medicines come as creams, lotions, solutions,
gels, or pads. Your doctor will consider your skin
type when prescribing a product. Creams and lotions
provide moisture and tend to be good choices for people
with sensitive skin. If you have very oily skin or
live in a hot, humid climate, you may prefer an alcohol-based
gel or solution, which tends to dry the skin. Your
doctor will tell you how to apply the medicine and
how often to use it.
For some people, prescription topical
medicines cause minor side effects, including stinging,
burning, redness, peeling, scaling, or discoloration
of the skin. With some medicines, such as tretinoin,
these side effects usually decrease or go away after
the medicine is used for a period of time. If side
effects are severe or don't go away, notify your doctor.
Brand names included in this booklet
are provided as examples only, and their inclusion
does not mean that these products are endorsed by
the National Institutes of Health or any other Government
agency. Also, if a particular brand name is not mentioned,
this does not mean or imply that the product is unsatisfactory.
As with OTC medicines, the benefits
of prescription topical medicines are not immediate.
Your skin may seem worse before it gets better. It
may take from 4 to 8 weeks to notice improvement.
Prescription Oral Medicines
For patients with moderate to severe
acne, doctors often prescribe oral antibiotics. Oral
antibiotics are thought to help control acne by curbing
the growth of bacteria and reducing inflammation.
Prescription oral and topical medicines may be combined.
Common antibiotics used to treat acne are tetracycline
(Achromycin V), minocycline (Dynacin, Minocin), and
doxycycline (Adoxa, Doryx, and Monodox).
Other oral medicines less commonly
used are clindamycin (Cleocin), erythromycin, or sulfonamides
(Bactrim). Some people taking these antibiotics have
side effects, such as an upset stomach, dizziness
or lightheadedness, changes in skin color, and increased
tendency to sunburn. Because tetracyclines may affect
tooth and bone formation in fetuses and young children,
these drugs are not given to pregnant women or children
under age 14. There is some concern, although it has
not been proven, that tetracycline and minocycline
may decrease the effectiveness of birth control pills.
Therefore, a backup or another form of birth control
may be needed. Prolonged treatment with oral antibiotics
may be necessary to achieve the desired results.
Treatment for Severe Nodular or
People with nodules or cysts should
be treated by a dermatologist. For patients with severe
inflammatory acne that does not improve with medicines
such as those described above, a doctor may prescribe
isotretinoin (Accutane), a retinoid (vitamin A derivative).
Isotretinoin is an oral drug that is usually taken
once or twice a day with food for 15 to 20 weeks.
It markedly reduces the size of the oil glands so
that much less oil is produced. As a result, the growth
of bacteria is decreased.
Advantages of Isotretinoin (Accutane)
Isotretinoin is a very effective
medicine that can help prevent scarring. After 15
to 20 weeks of treatment with isotretinoin, acne completely
or almost completely goes away in most patients. In
those patients where acne recurs after a course of
isotretinoin, the doctor may institute another course
of the same treatment or prescribe other medicines.
Disadvantages of Isotretinoin
Isotretinoin can cause birth defects
in the developing fetus of a pregnant woman. It
is important that women of childbearing age are not
pregnant and do not get pregnant while taking this
medicine. Women must use two separate effective
forms of birth control at the same time for 1 month
before treatment begins, during the entire course
of treatment, and for 1 full month after stopping
the drug. You should ask your doctor when it is safe
to get pregnant after you have stopped taking isotretinoin.
Some people with acne become depressed
by the changes in the appearance of their skin. Changes
in mood may be intensified during treatment or soon
after completing a course of medicines like isotretinoin.
There have been a number of reported suicides and
suicide attempts in people taking isotretinoin; however,
the connection between isotretinoin and suicide or
depression is not known. Nevertheless, if you or someone
you know feels unusually sad or has other symptoms
of depression, such as loss of appetite, loss of interest
in once-loved activities, or trouble concentrating,
it's important to consult your doctor.
Other possible side effects of isotretinoin
- dry eyes, mouth, lips, nose, or skin (very common)
- muscle aches
- sensitivity to the sun
- poor night vision
- changes in the blood, such as an increase in
fats in the blood (triglycerides and cholesterol)
- change in liver function.
To be able to determine if isotretinoin
should be stopped if side effects occur, your doctor
may test your blood before you start treatment and
periodically during treatment. Side effects usually
go away after the medicine is stopped.
Treatments for Hormonally Influenced
Acne in Women
In some women, acne is caused by
an excess of androgen (male) hormones. Clues that
this may be the case include hirsutism (excessive
growth of hair on the face or body), premenstrual
acne flares, irregular menstrual cycles, and elevated
blood levels of certain androgens.
The doctor may prescribe one of several
drugs to treat women with this type of acne:
- Birth control pills – to help
suppress the androgen produced by the ovaries
- Low-dose corticosteroid drugs, such
as prednisone (Deltasone) or dexamethasone (Decadron,
Hexadrol) – to help suppress the androgen
produced by the adrenal glands
- Antiandrogen drugs such as spironolactone
(Aldactone) – to reduce the excessive
Side effects of antiandrogen drugs
may include irregular menstruation, tender breasts,
headaches, and fatigue.
Other Treatments for Acne
Doctors may use other types of procedures
in addition to drug therapy to treat patients with
acne. For example, the doctor may remove the patient's
comedones during office visits. Sometimes the doctor
will inject corticosteroids directly into lesions
to help reduce the size and pain of inflamed cysts
Early treatment is the best way to
prevent acne scars. Once scarring has occurred, the
doctor may suggest a medical or surgical procedure
to help reduce the scars. A superficial laser may
be used to treat irregular scars. Dermabrasion (or
microdermabrasion), which is a form of "sanding down"
scars, is sometimes used. Another treatment option
for deep scars caused by cystic acne is the transfer
of fat from another part of the body to the scar.
A doctor may also inject a synthetic filling material
under the scar to improve its appearance.
How Should People With Acne Care
for Their Skin?
Clean Skin Gently
If you have acne, you should gently
wash your face with a mild cleanser, once in the morning
and once in the evening, as well as after heavy exercise.
Wash your face from under the jaw to the hairline
and be sure to thoroughly rinse your skin.
Ask your doctor or another health
professional for advice on the best type of cleanser
Using strong soaps or rough scrub
pads is not helpful and can actually make the problem
worse. Astringents are not recommended unless the
skin is very oily, and then they should be used only
on oily spots.
It is also important to shampoo your
hair regularly. If you have oily hair, you may want
to wash it every day.
Avoid Frequent Handling of the
Avoid rubbing and touching skin lesions.
Squeezing, pinching or picking blemishes can lead
to the development of scars or dark blotches.
Men who shave and who have acne should
test both electric and safety razors to see which
is more comfortable. When using a safety razor, make
sure the blade is sharp and soften your beard thoroughly
with soap and water before applying shaving cream.
Shave gently and only when necessary to reduce the
risk of nicking blemishes.
Avoid a Sunburn or Suntan
Many of the medicines used to treat
acne can make you more prone to sunburn. A sunburn
that reddens the skin or suntan that darkens the skin
may make blemishes less visible and make the skin
feel drier. However, these benefits are only temporary,
and there are known risks of excessive sun exposure,
such as more rapid skin aging and a risk of developing
Choose Cosmetics Carefully
While undergoing acne treatment,
you may need to change some of the cosmetics you use.
All cosmetics, such as foundation, blush, eye shadow,
moisturizers, and hair-care products should be oil
free. Choose products labeled noncomedogenic (meaning
they don't promote the formation of closed pores).
In some people, however, even these products may make
For the first few weeks of treatment,
applying foundation evenly may be difficult because
the skin may be red or scaly, particularly with the
use of topical tretinoin or benzoyl peroxide.
What Research Is Being Done on Acne?
Medical researchers are working on
new drugs to treat acne, particularly topical antibiotics
to replace some of those in current use. As with many
other types of bacterial infections, doctors are finding
that, over time, the bacteria that are associated
with acne are becoming resistant to treatment with
certain antibiotics, though it is not clear how significant
a problem this resistance represents.
Scientists are also trying to better
understand the mechanisms involved in acne so that
they can develop new treatments that work on those
mechanisms. For example, one group of NIAMS-supported
researchers is studying the mechanisms that regulate
sebum production in order to identify ways to effectively
reduce its production without the side effects of
current medicines. Another group is trying to understand
how P. acnes activates the immune system
in order to identify possible immunologic interventions.
Other areas of research involve examining the effects
of isotretinoin on an area of the brain that might
lead to depression and developing a laser system to
treat acne and acne-related scars without damaging
the outer layers of the skin.
Researchers in Germany, funded by
German institutions, have taken P. acnes
and identified its genetic information (genome). This
information may help researchers develop new treatments
to target the bacteria.
Where Can People Find More Information
National Institute of Arthritis
and Musculoskeletal and Skin Diseases (NIAMS)
National Institutes of Health
1 AMS Circle
Bethesda, MD 20892-3675
Toll Free: 877-22-NIAMS (226-4267)
NIAMS provides information about
various forms of arthritis and rheumatic disease
and bone, muscle, joint, and skin diseases. It
distributes patient and professional education
materials and refers people to other sources of
information. Additional information and updates
can also be found on the NIAMS Web site.
American Academy of Dermatology
P.O. Box 4014
Schaumberg, IL 60168-4014
Toll Free: 888-462-3376
This national organization can
provide referrals to dermatologists. It also publishes
a brochure on acne for adults and a fact sheet
for young people. These are available on the organization's
Web site or can be obtained by calling or writing
to the academy.
NIAMS gratefully acknowledges the
assistance of Laurence H. Miller, M.D., Chevy Chase,
MD; Kenneth A. Katz, M.D., M.Sc., University of Pennsylvania
School of Medicine, Philadelphia; Edward W. Cowen,
M.D., National Cancer Institute, NIH; and Alan Moshell,
M.D., NIAMS, NIH, in the preparation and review of
The mission of the National Institute
of Arthritis and Musculoskeletal and Skin Diseases
(NIAMS), a part of the Department of Health and Human
Services' National Institutes of Health (NIH), is
to support research into the causes, treatment, and
prevention of arthritis and musculoskeletal and skin
diseases; the training of basic and clinical scientists
to carry out this research; and the dissemination
of information on research progress in these diseases.
The National Institute of Arthritis and Musculoskeletal
and Skin Diseases Information Clearinghouse is a public
service sponsored by the NIAMS that provides health
information and information sources. Additional information
can be found on the NIAMS Web site at http://www.niams.nih.gov/default.asp.
For Your Information
This publication contains information
about medications used to treat the health condition
discussed here. When this publication was printed,
we included the most up-to-date (accurate) information
available. Occasionally, new information on medication
For updates and for any questions
about any medications you are taking, please contact
the U.S. Food and Drug Administration at:
U.S. Food and Drug Administration
Toll Free: 888-INFO-FDA (888-463-6332)
NIH Publication No. 06-4998