Provided by:Dermatology Associates

Acne Treatment
Almost all cases of acne can be effectively treated. The goal of treatment is to promote the
healing of existing acne lesions, stopping new lesions from forming, and preventing the
formation of acne scars.
Acne treatment aims to control one or more of the underlying causes of acne. For instance,
topical retinoids unclog sebaceous glands and keep pores open, while antibiotics are used to
fight the P. acnes bacteria. Isotretinoin (Accutane) and hormonal agents, such as birth control
pills, are used to reduce sebum (oil) production.

What is the best acne treatment plan?

Your doctor will recommend an acne treatment plan based on these factors:

Severity of your acne. Mild acne may respond well to the use of benzoyl peroxide or
a topical retinoid only. Moderate acne may require a combination of acne
medications, such as topical retinoid with an antibiotic. Severe acne with scarring may
require treatment with an oral retinoid (Accutane, Sotret).

Results of previous acne treatments. Stronger acne medications may be added to the
treatment plan if previous medication do not bring acne under control.

Degree of acne scarring. More aggressive therapies may be started earlier if acne
scars have already started developing.

Gender. Some treatments are available only for females, such as birth control pills.

Whatever your treatment plan, it is important that you give it enough time to work. This may
mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the

medication is hard at work keeping new lesions from forming. Staying on your medication is
the most important step to getting acne under control.

Acne Medications
Many people will first attempt to treat their acne with an over-the-counter acne medication.
Many brands of acne treatment share the same active ingredients. For instance, benzoyl
peroxide is the active ingredient of both ProActiv and Clearasil.
However, even some cases of mild acne may require prescription-strength medications for
effective treatment. If no improvement is seen after 6 to 8 weeks of using a non-prescription
medication, see your doctor about starting other medications. Relying on an ineffective
treatment simply means enduring acne for weeks longer than necessary and increases the
chances of developing permanent acne scars.

Over-the-Counter Acne Medications

Benzoyl peroxide
Benzoyl peroxide was one of the first medications found to be effective in treating mild acne
and has been used safely for decades. It is found in many over-the-counter formulas, as well
as in combination with prescription medications. Benzoyl peroxide is available in different
concentrations. Its primary side effect is dry skin and higher concentrations are more likely to
irritate the skin.
Benzoyl peroxide may be used in combination with other prescription acne medications. For
instance, your doctor may recommend that benzoyl peroxide be used along with an oral or
topical antibiotic.
Sulfur and salicylic acid
These medications have some mild ability to break down whiteheads and blackheads and are
found in many non-prescription acne medications. Like benzoyl peroxide, salicylic acid must
be used continuously. Once these medications are stopped, acne lesions are likely to reappear.
Herbal or natural remedies
Over-the-counter products labeled "herbal," "organic" or "natural" are marketed as acne
treatments but their effectiveness has rarely been tested in clinical trials. The value of these
alternative acne treatments is not known.

Prescription-Strength Acne Medication

Topical Retinoids

Topical retinoids are among the most effective and commonly used prescription acne
medications. Topical retinoids are unique in their ability to unclog swollen pores. They may
be used alone for mild acne or combined with other medications for moderate to severe acne.
Different topical retinoids are found in a variety of branded acne medications, include:

Adapalene (Differin, Epiduo)

Tazarotene (Tazorac)

Tretinoin (Retin A Micro, Tretin-X, Veltin, Ziana)

Topical Antibiotics
Antibiotics applied to the skin, such as clindamycin and erythromycin, kill the P. acnes
bacteria that leads to inflammation.
Oral Antibiotics
Antibiotics, such as tetracycline, doxycycline, and minocycline, may be prescribed for oral
use. This allows the medication to reach bacteria in the deep layers of the dermis. They are
also prescribed for their ability to reduce skin inflammation.
Dapsone
Dapsone is a medication that that may be applied to the skin to reduce the inflammation of
acne.
Oral Contraceptives
For women who experience hormonally triggered acne, birth control pills may be prescribed
to reduce sebum production.
Isotretinoin
Isotretinoin remains the most effective treatment for severe acne or acne that does not
respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged
pores, bacterial overgrowth, and inflammation. Most patients take the medicine for periods of
15 to 20 weeks that may be repeated if necessary. Treatment requires monthly office visits,
monthly lab tests, and strict contraception. It is critical that women of childbearing age do not
get pregnant while taking isotretinoin because of the serious risk of birth defects. The iPledge
program was developed to reduce the likelihood of birth defects and other side effects.
Anti-androgen drugs
Some drugs used for other medical conditions are known to reduce androgen levels, such as
spironolactone (Aldactone). These may be used in some cases of acne.

Side Effects of Acne Medications

Many of these acne medications have side effects, such as burning, redness, and irritation.
With some medicines, such as topical retinoids, these side effects usually decrease or go away
after the medicine is used for a period of time. Tell your doctor if side effects are severe or
don't go away.
While the older acne lesions are healing, the medication is hard at work keeping new acne
lesions from forming. Staying on your acne medication is the most important step to getting
acne under control.

Procedures to Treat Acne.

For persistent acne lesions that are inflamed or unresponsive to medications, some doctors
recommend additional methods, including extraction, photodynamic therapy, or
corticosteroid injections.

Talk to your Doctor

It is important to talk to your doctor about the best acne treatment for you.
Ongoing use of your acne medicine may be required for several months, even after the initial
acne lesions cleared up, to keep acne under control.
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Antibiotics (Topical) for Acne

Antibiotics applied to the skin may be prescribed for the treatment of acne.
Antibiotics help control acne by killing the bacteria that cause the acne lesions to become
inflamed. The sebum (oil) within the hair follicles can become infected by p. acnes bacteria,
resulting in swelling and redness of the acne lesion. Killing the bacteria reduces the
inflammation and reduces the severity of the acne flare. Unfortunately, the p. acnes bacteria
that can develop resistance to antibiotics. When this occurs, that particular antibiotic is no
longer effective in treating acne. If antibiotic resistance is suspected, a different antibiotic or
different type of acne medication may be prescribed.
Antibiotic resistance is more likely to develop following the use of a topical antibiotic. The
risk of developing resistance increases if a topical antibiotic is used for long periods, and
without any other acne treatments. For this reason, topical antibiotics are usually prescribed
for just a few weeks or months, and used in combination with other acne medications. Oral
antibiotics, on the other hand, may be prescribed for longer periods of time.

Types of Topical Antibiotics Used for Acne

Azelaic acid (Azelex). In addition to killing p. acnes, azelaic acid can be helpful for
treating the dark spots that develop in some acne patients with skin of color (postinflammatory hyperpigmentation). Azeleic acid is well tolerated by most people and
can be safely used for long periods of time. Side effects may include skin dryness and
lightening of the skin where applied.

Benzoyl peroxide. Benzoyl peroxide is not typically thought of as an antibiotic, but it

can help to slow down the growth of the P. acnes bacteria. Studies have also shown
that benzoyl peroxide can increase the effectiveness of other acne medicines and
reduces the likelihood of developing antibiotic resistance. However, benzoyl peroxide
does not have anti-inflammatory effects. Benzoyl peroxide formulations included
lotions, gels and washes. It may be prescribed for use alone or in combination with a
topical retinoid (Epiduo).

Clindamycin. Topical clindamycin reduces p. acnes bacteria and decreases

inflammation. Several branded formulations combine clindamycin with other acne
medications, including benzoyl peroxide (Acanya, Benzaclin, Duac) or a topical
retinoid (Ziana). When applied to the skin, clindamycin has proven safe and is well
tolerated. Possible side effects include skin dryness and irritation.

Erythromycin. Erythromycin, also available for oral use, is broad spectrum antibiotic
with anti-inflammatory properties. It may be combined with benzoyl peroxide
(Benzamycin). Like topical clindamycin, erythromycin may cause skin dryness and
possible irritation.

Take your acne medication exactly as directed by your doctor. Do not take more or less of it
or take it more often than prescribed. Read the medication guide that you receive with the
medication for a complete list of possible side effects
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Antibiotics (Oral) for Acne

Antibiotics are commonly prescribed for the treatment of acne. Antibiotics may be used on
the skin (topical preparations) or taken by mouth (oral preparations).
Antibiotics help control acne by killing the bacteria that cause the acne lesions to become
inflamed. The sebum (oil) within the hair follicles can become infected by p. acnes bacteria,
resulting in swelling and redness of the acne lesion. Killing the bacteria reduces the
inflammation and reduces the severity of the acne flare.

Oral Antibiotics for Acne

Oral antibiotics are usually prescribed for cases of moderate or severe acne. Oral antibiotics
are usually started at a relatively high dosage that is reduced over time as the acne is brought
under control.
Oral antibiotics for acne include:

Erythromycin. Erythromycin is prescribed for a wide variety of bacterial infections,

and is effective against P. acnes on the skin. The most common side effects are GI
upset, including nausea and stomach pain.

Minocycline (Dynacin, Solodyn). Minocyline has been shown to be effective in

treating acne that has not responded to other oral antibiotics. Studies suggest that
antibiotic resistance is less likely to develop against minocycline.

Tetracycline and Doxycline (Adoxa, Doryx). Tetracycline and its derivative,

doxycycline, are effective against the inflammatory lesions of acne. These
medications should not be taken by children younger than 8 years of age because they
can affect growth and stain teeth. They should also not be taken by women who are
pregnant or breastfeeding. People are advised to avoid sun exposure when taking
these medications because they can increase sensitivity to sunlight.

Take your acne medication exactly as directed by your doctor. Do not take more or less of it
or take it more often than prescribed.

Read the medication guide that you receive with the medication for a complete list of
possible side effects.
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Provided by:Dermatology Associates

Benzoyl Peroxide for Acne

Benzoyl peroxide was found to be effective in treating mild acne over 80 years ago and has
been an important component of acne treatment since.
Benzoyl peroxide is the active ingredient in many of the most common non-prescription acne
medicines, such as Clearasil, PanOxyl, Proactiv, and Stridex. It is also the active
ingredient some prescription-strength medications, such as Acanya Gel and Benzac.
Benzoyl peroxide may also be formulated with other acne medications to create a
combination product. For instance, Epiduo combines benzoyl peroxide with adapalene, a
topical retinoid. Benzoyl peroxide works by removing dead skin cells that can clog the pores
and acting as an antibacterial agent that reduces the P. acnes bacteria on the skin.
Benzoyl peroxide is available in a variety of concentrations ranging from 2.5% to 10%.
Research suggests that 5% and 10% concentrations are not significantly more effective than
lower concentrations, and that lower concentration may be better tolerated.
Benzoyl peroxide commonly causes dry and irritated skin, but these side effects often lessen
after use for a week or two. Generally people with dry or sensitive skin may wish to start with
the lower concentration and build up the concentration over time as tolerance develops.
Benzoyl peroxide can bleach hair, sheets, towels and clothing so delicate clothing should not
be worn after applying benzoyl peroxide on the back or chest (truncal acne).
Benzoyl peroxide may be recommended for use even after acne clears to prevent new acne
lesions from forming.
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Provided by:Dermatology Associates

Acleara Acne Clearing System

The Acleara Acne Clearing System uses a light technology used to treat mild to moderate
inflammatory acne.

The system combines a vacuum system and filtered broadband light. The vacuum clears the
pores of the skin by extracting dirt, dead skin cells and sebum (natural oil produced by the
sebaceous glands). Along with the targeted heating of sebaceous glands, the light heats the
sebaceous gland, causing them to shrink and destroys acne-causing bacteria called p. acnes.

What to Expect from Treatment with Acleara

A single treatment session with the Acleara Acne Clearing System can often be completed
in as little as 10 minutes. The actual time required for an individual depends on the size of the
treatment area.Multiple treatments may be required to achieve best results.
Your doctor will recommend a treatment plan based on the severity of your acne, its location
and past medical history.
The procedure is non-invasive. Most people feel little or no discomfort during the procedure
and you can immediately resume your regular daily activities.

Before and After Acleara Treatment

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image

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After treatment, you may notice that your skin is drier, less oily, and feels fresher. Acne
outbreaks present prior to treatment, start to clear up over the next 2-3 days.
Most people will experience a mild, sunburn sensation on the skin that may be accompanied
by some minor swelling or bruising. This usually clears after 12 to 24 hours.
Ask your doctor to discuss other possible side effects post-care instructions.
Images courtesy of Palomar Medical.
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Isolaz Acne Light Treatment

Isolaz is a unique treatment for acne that combines a vacuum that extracts sebum from the
skin and a broadband light that helps to kill the bacteria (P. Acnes) that can cause acne lesions
to become inflamed.

Isolaz is the first system indicated to treat severe forms of acne, such as pustular and
comedonal acne as well as mild to moderate inflammatory acne.
All skin types, light and dark, can be treated using Isolaz acne treatment.

What to Expect from Isolaz Treatment

Isolaz is a quick, easy and painless way to treat acne.

The treatment time depends on the area of the body being treated. Treatments on the face may
take 15-20 minutes, whereas treatments for truncal acne (acne on the chest or back) may take
a little longer.
You can go right back to your normal activities immediately after Isolaz acne treatments.
Images courtesy of Solta Medical, Inc.
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Provided by:Dermatology Associates

Isotretinoin for Acne

Isotretinoin is an oral medication used to treat severe acne when other acne treatments have
failed to bring acne under control. It is available by prescription only.
Despite concerns about side effects, isotretinoin remains an important treatment option for
those with severe acne. It can clear up acne that resists all other forms of treatment, including
oral antibiotics.
Isotretinoin is commonly known by the former brand name Accutane, but Accutane is no
longer available. Other brand names of isotretinoin include Amnesteem and Sotret.

How is Isotretinoin Used?

A course of isotretinoin treatment typically lasts 15-20 weeks, though it may be prescribed
for longer periods if lower doses are used.
Most people require only one course of isotretinoin treatment, though an additional course of
treatment may be recommended in some cases. A person's acne may continue to improve for
several weeks or months after stopping isotretinoin.

Precautions When Using Isotretinoin

IIsotretinoin is prescribed in a very controlled manner to reduce the risk of developing side
effects.
Isotretinoin must not be used by female patients who are or may become pregnant.
There is an extremely high risk that severe birth defects will result if pregnancy occurs while
taking this medication in any amount, even for short periods of time.
People using isotretinoin must agree to the strict terms of the iPLEDGE program before
starting isotretinoin. Those participating in the iPledge program commit to the following:

Seeing the dermatologist every 30 days while taking isotretinoin

Taking necessary tests, such as blood tests or pregnancy tests

Isotretinoin is dispensed in quantities to last only 30 days. A prescription refill is required for
the next 30 days. A doctor must have assurances that ALL patients are following the iPledge
program before approving the refill. This includes the requirement that all women have two
(2) negative pregnancy tests before the approving the refill.

Taking Isotretinoin
Take Isotretinoin exactly as directed by your doctor. Do not take more or less of it or take it
more often than prescribed by your doctor.
Swallow the capsules whole with a full glass of liquid. Do not chew or suck on the capsules.

Your doctor will probably start you on an average dose of isotretinoin and increase or
decrease your dose depending on how well you respond to the medication and the side effects
you experience.

Side Effects of Isotretinoin

Isotretinoin may cause side effects. Call your doctor if you have any unusual problems
while taking this medication.

Dry Eyes. Isotretinoin may cause your eyes to feel dry and make wearing contact
lenses uncomfortable during and after your treatment.

Sun Senstivity. Avoid unnecessary or prolonged exposure to sunlight and wear

protective clothing, sunglasses, and sunscreen during daylight hours. Do not use
indoor tanning booths or tanning lights.

Increased Risk of Scars. Isotretinoin increases the risk that you will develop scars
from procedures that traumatize the skin. Do not plan skin care procedures, such as
waxing, laser hair removal, or dermabrasion, while you are taking isotretinoin and for
6 months after stopping treatment. Ask your doctor when you can safely undergo
these treatments.

Other more serious reported side effects include depression and inflammatory bowel disease
(IBD).
There is not enough evidence to determine whether isotretinoin can cause depression and
other mental health conditions. Studies have shown that severe acne is itself associated with
depression and can impact a person's self esteem. Nonetheless it is important to remain
cautious. If a person taking isotretinoin has any symptoms of depression or another mental
health condition, the person must contact their doctor and stop taking isotretinoin right away.
Similarly, if a person taking isotretinoin develops any of the following signs or symptoms of
inflammatory bowel disease (IBD), the person must stop taking isotretinoin and contact their
doctor.

Severe abdominal pain

Diarrhea

Bleeding from the rectum

Jaundice. Yellowing of the skin or eyes

Dark urine

Take isotretinoin exactly as directed by your doctor. Do not take more or less of it or take it
more often than prescribed.

Read the medication guide that you receive with the medication for a complete list of
possible side effects
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Laser and Light Therapies for Acne

New, state-of-the-art lasers and other light treatments have revolutionized the treatment of
acne. Lasers and light therapies emit an intense beam of light at a specific wavelength that
acts upon particular components of the skin.
Some laser and light systems are designed to damage the sebaceous glands so that they
produce less sebum (oil). Other laser and light therapies are designed to damage the P. acnes
bacteria that infect the sebaceous glands and cause them to become inflamed.
Most laser and light-based therapies reach the deeper layers of skin where acne lesions start
without harming the skin's surface. Laser and light therapies also improve the skin's texture
and lessen the appearance of acne scars.

Types of Laser and Light Treatments for Acne

Pulsed light therapy. Pulsed light destroys the P. acnes bacteria and shrinks
sebaceous glands by creating heat in the deep tissue. Side effects include temporary
redness in the treated areas.

Blue light therapy. This painless treatment exposes the skin to a low-intensity blue
light that is believed to destroy the P. acnes bacteria after multiple treatments.
Ongoing treatment is necessary for best results. Possible side effects of blue light
therapy include temporary redness and dryness in the treated areas.

Diode laser therapy. Diode lasers can destroy sebaceous glands. Side effects of diode
laser therapy include temporary redness and swelling of the treated areas.

Photodynamic therapy (PDT). PDT uses a light that is shone upon skin that is pretreated with a special medication that sensitizes the skin to light. This is followed by
blue, red, pulsed light or another type of light therapy. Side effects can include
redness, swelling, crusting of the skin.

Photopneumatic therapy. Photopneumatic therapy uses suction to "vacum up" the

oil and dead skin cells from within the sebaceous glands. The targeted area is then
treated with blue and red light therapy to destroy P. acnes and reduce inflammation.

Side Effects and Safety

There are rarely any permanent problems with laser therapy. Occasionally some lightening of
the skin occurs that usually resolves.

Some laser treatments can be painful, however the pain is well controlled. Other treatments,
such as blue light therapy, cause no pain.
Because lasers produce an intense bright beam of light, everyone in the treatment room is
required to wear protective eyewear.
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