"This type of treatment is focused on teenagers, who usually have a period of a year to four years when they’re breaking out because of changing hormone levels and increased oil production, and in some cases, genetics," says Amy Taub, MD, founder and medical director of Advanced Dermatology in Lincolnshire, IL. Taub is also an assistant clinical professor of dermatology at Northwestern University’s Feinberg School of Medicine.
Each of the antibiotics has its own set of side effects -- doxycycline causes sun sensitivity, for example, and tetracycline can cause yellowing of teeth in children -- so dermatologists will work with their patients to help choose an antibiotic that works best for them.
Mild to moderate comedonal acne can often be aggravated by external triggers, like hair gels and makeup. "Some of these makeups and gels are so occlusive that when the person stops using them, the acne goes away," Alexiades-Armenakas says.
Treating ‘Hormonal’ Acne
Many cases of inflammatory acne are "hormonal" in nature -- that is, they occur in teenage girls and women, and are aggravated by hormonal fluctuations like those that occur during the menstrual cycle. For these women, dermatologists often choose to prescribe either oral contraceptive pills or another medication called spironolactone.
There are now three oral contraceptives that are specifically approved by the FDA for the treatment of acne in women: Yaz, Estrostep, and Ortho Tri-Cyclen. Only pills that combine the female hormone estrogen with the synthetic version of the male hormone progesterone, progestin, can stabilize hormonal fluctuations in a way that can treat acne.
Oral contraceptives are a very effective treatment for acne in many women, but you have to give them time to work, says Bethanee Schlosser, MD, assistant professor and director of the women’s skin health program in the department of dermatology at Northwestern University’s Feinberg School of Medicine. "I ask patients to give the pills at least three months of use before judging their impact. That’s when the studies found a notable difference between placebos and oral contraceptives. Many patients went on to get further benefit at about 6 months out. This is not an overnight process."