Acne vulgaris is the world’s most common skin disease. Anyone of any age can get it, but teens and young adults are most likely to suffer acne outbreaks. In fact, 80 percent of people ages 11-30 have acne outbreaks at least occasionally. Oil glands are small in children, but puberty (and testosterone in particular) causes these glands to grow larger. They secrete oil and cellular debris in a substance called sebum. Sebum keeps the skin flexible and acts as a protective barrier against water evaporation on the skin’s surface. It also keeps hair shiny and soft. Sometimes skin cells clog up these follicles, also known as pores. With the pores clogged, sebum gets trapped inside. Skin bacteria called Propionibacterium acnes (P. acnes) starts to grow inside the pores, too. The bacteria cause inflammation. When the clogged pore bursts open, all the sebum and P. acnes bacteria spill onto the surface of the skin, causing breakouts.
Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks. It can take many months or years for your acne to clear up completely. The treatment regimen your doctor recommends depends on your age, the type and severity of your acne, and what you are willing to commit to. For example, you may need to wash and apply medications to the affected skin twice a day for several weeks. Often topical medications and drugs you take by mouth (oral medication) are used in combination. Pregnant women will not be able to use oral prescription medications for acne.
The most common topical prescription medications for acne are as follows:
For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Oral antibiotics should be used for the shortest time possible to prevent antibiotic resistance. Oral antibiotics are best used with topical retinoids and benzoyl peroxide. Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin's sun sensitivity.
Four combined oral contraceptives are approved by the FDA for acne therapy in women who also wish to use them for contraception. You may not see the benefit of this treatment for a few months, so using other acne medications with it the first few weeks may help.
The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren't helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Isotretinoin. Isotretinoin is a powerful drug for people whose severe acne doesn't respond to other treatments. Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug.
Isotretinoin is a powerful drug for people whose severe acne doesn't respond to other treatments. Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug.
These therapies may be suggested in select cases, either alone or in combination with medications.