Acne Treatment

Graphical Abstract

What is acne and what causes it?

Acne is a chronic skin condition involving inflammation (redness, swelling, pain) of skin on the face, neck, chest, or back. It can take many forms, including whiteheads, blackheads, pimples, deep nodules, and cysts. Acne may be caused by decreased skin turnover and shedding, increased production of sebum (an oily, waxy substance produced by glands to lubricate the skin), and by certain types of skin bacteria. Other factors that contribute to acne include genetics, hormones, mechanical stimulation (friction, rubbing, picking, squeezing), certain drugs (such as corticosteroids), and skin care products and cosmetics. Untreated acne can lead to skin color changes, scars, and psychosocial and emotional distress.

Which medications are used to treat acne?

Mild acne is treated with topical (applied to the skin) medications, some of which are available without a prescription. Topical treatments are often used in combination with each other. Side effects may include skin dryness, redness, and irritation. Patients with acne should discuss treatment options with their primary care physician or with a dermatologist. [AU:OK to add?]

• Topical antimicrobials target certain types of skin bacteria. Examples include benzoyl peroxide, clindamycin, erythromycin, and azelaic acid.

• Topical retinoids increase skin cell turnover and shedding, and decrease sebum production and other causes of inflammation. Examples include adapalene, tretinoin, tazarotene, and trifarotene.

• Other acne therapies include topical dapsone, sulfur, and salicylic acid

Moderate and severe acne, along with mild acne that does not respond to the above treatments, can be treated with stronger types of medications, many of which are taken by mouth (oral).

• Antibiotics target certain types of skin bacteria and are available in topical (minocycline) and oral (doxycycline, minocycline, sarecycline) forms.

• Hormonal therapies target hormone receptors and reduce sebum production. They are available in topical (clascoterone) and oral (spironolactone, certain birth control pills) forms.

• Oral retinoids (isotretinoin) are reserved for the most severe and treatment-resistant forms of acne.

In general, oral medications have more side effects than topical treatments. Many acne treatments cannot be used while breastfeeding or pregnant, and some such as isotretinoin require blood tests to monitor for harmful side effects.

Basic skin care can also be helpful for acne management, including gentle skin cleansers, non-comedogenic (non-pore blocking) skin care products, and avoidance of skin scrubbing and picking.

What other acne treatments are available?

Select physical skin treatments can be used for all stages of acne, although there is less evidence for these compared with topical and oral medications.

• Chemical peels

• Microdermabrasion (exfoliation of the outer layer of skin)

• Laser or light-based therapy

What is expected after treatment?

Treatment success involves both resolution of current acne lesions and prevention of new flares. Two to three months of consistent treatment is usually needed to assess treatment response. Because everyone responds differently to medications, acne treatment plans can change over time, may involve different combinations of therapy, and may require different treatment strategies for acute flares vs long-term maintenance of clear skin.