Acne Treatments That Work

From the WebMD Archives

You listen to every infomercial and read every magazine article you find. Still, you can't find an acne treatment that works.

Or maybe you found your acne solution - only to discover that 3 months into treatment it suddenly stopped working.

"Everyone's skin is a little bit different and sometimes it takes more than one type of treatment to get a good result - but there is absolutely a solution for every acne patient," says Charles E. Crutchfield III, MD, clinical associate professor of dermatology, University of Minnesota Medical School and medical director of Crutchfield Dermatology.

If you're having trouble finding an effective acne treatment, you've come to the right place. WebMD consulted three skin experts to learn more about the latest acne treatment options - including a fresh, new approach that makes every acne treatment work better.

Acne Treatments: What Causes Acne?

Experts at the American Academy of Dermatology say acne develops when hormonal shifts (like the kind that occur during puberty and, for women, before a menstrual cycle, and prior to menopause) cause an overproduction of oil and cells inside a skin follicle. Together, they form a kind of biological traffic jam that plugs the opening of the pore and causes the follicle beneath to swell.

Crutchfield says this causes an overgrowth of bacteria normally found on the skin, which in turn produce irritating chemical substances that fuel inflammation. The end result is whiteheads, blackheads, hard tiny pimples, or pus-filled lesions.

Indeed, because doctors now believe that inflammation plays such a key role in acne, many say the future of treatment will involve drugs that specifically target the inflammatory response in skin.

"We're not there yet, but the future of acne treatments will definitely be medications that focus on the inflammatory aspect - and that is where the real solution might lie," says dermatologist Doris Day, MD, associate professor at NYU School of Medicine in New York City and author of 100 Questions and Answers About Acne

Acne Treatments: What Works Right Now

Meanwhile, there are many acne treatment options to choose from right now. These treatments fit one of two categories: "pore cleansers" that suppress acne by preventing the "traffic jam" inside the pores; and products that target the production of either oil or hormones, which are thought to trigger breakouts.

Pore-cleaners are over-the-counter medications that contain benzyl peroxide and/or salicylic acid, and usually are very effective, Day says. "For many patients, this might be all the treatment that's needed, particularly if breakouts are not causing scarring."


Pore-cleansers are even more effective if you find two or three products you like and rotate them every two to three months, Crutchfield says.

"You can actually build a resistance to treatment. Essentially, the acne outsmarts the medicine and the breakout begins again, but rotating products can often solve that problem," he says.

What about the pre-packaged acne treatment products often sold on infomercials, the Internet and shopping channels? Day says these products usually contain benzyl peroxide or salicylic acid or both - the same ingredients in the acne medications sold in drugstores.

Crutchfield says that what gives these products an edge is the fact that they come with a recommended regimen. This, he says, increases compliance, which is a essential to the effectiveness of any product. "If they have any 'magic', that's it," Crutchfield says.

For occasional breakouts - or to keep skin clear after ending a regimen - you may want to skip the topicals altogether and go high-tech with Zeno, an FDA approved heated electronic "zit zapper." It uses the body's "heat shock response" to kill bacteria and clear pimples.

While the company claims Zeno can clear each pimple with just a few 2 1/2-minute long treatments spread over 24 hours, Crutchfield says it does so for only about 60-70% of patients - and it works best only on mild breakouts.

"This is not for severe acne - it's good for maintenance once your acne is under control or if you have an occasional pimple, but that's all," says Crutchfield.

Acne Treatments: How Your Doctor Can Help

When over-the-counter acne treatments just don't seem to do the job, don't despair - your local dermatologist has another bag of tricks that can help. Often, the first line of prescription defense is antibiotics - both topical and oral, and sometimes both.

"Antibiotics work fast, so they can bring about a quick result," says Day. This, she says, is particularly true when used in conjunction with a benzyl peroxide product and a good cleansing regimen.

One of the newest soldiers in the antibiotic army is Solodyn, an extended release drug which offers a continuous but very low dose of the antibiotic minocycline. Another is MinocinPac - the first prescription treatment package that combines minocycline withskin calming topical products designed to work together.


But perhaps the most exciting new approach involves the off-label use of Oracea, an oral medication originally approved to treat rosacea, another inflammatory skin condition. It features an ultra low dose of the antibiotic doxycycline in a novel new configuration

"They dropped the antibiotic component of this drug extremely low, but at the same time they dramatically increased the anti-inflammatory component," says Crutchfield. The end result is a drug that targets the inflammation and, says Crutchfield, works extremely well for many acne patients, including middle aged women who also have rosacea symptoms.

Day often takes another "off label" approach when acne strikes women in middle age. Her solution involves use of the anti-androgen drug Aldactone.

"The results are incredible - the skin clears, there is no drying, and if you use the brand name and not the generic, there are almost no side effects and the women feel great - most say their skin never looked so good," says Day.

Crutchfield also prescribes Aldactone, and says it not only works for middle-aged women, but also for teenaged girls and young women, particularly when acne develops on the chin and jaw line.

"Acne is all basically hormonally driven, so in some young women anti-androgens are the answer," he says. Some women also find acne relief in birth control pills, which help regulate the cycle and control hormonal swings linked to many breakouts.

Acne Treatments: The Really ' Big Guns'

In the event that your acne is stubborn - or you are developing scars - doctors say there are several "big guns" available to help. Unlike topicals and antibiotics, which work to suppress breakouts, these treatments go to the root of the problem by shutting down oil production.

"When I see a patient whose skin is already scarring I don't mess around - I go right for the most aggressive treatment - and for me that's isotretinoin, otherwise known as Accutane," says Crutchfield.

As he explains, this oral prescription drug impacts oil production. Once the "oil faucet" is turned off, he says, you eliminate the traffic jam inside the pores, and the breakouts stop.


But use of Isotretinoin is not without hazards. It significantly increases the risk of birth defects and has been linked to episodes of aggressiveness and violent behavior. It may also cause a decrease in bone mineral density if used over a long period of time. (Doctors say all of these -risks are rare).

Still, if you're concerned about risks, you may want to pursue acne treatments that use lasers and other light devices. Though costly, doctors say some of these treatments have effects similar to Accutane. and can turn off the oil without the risks.

"One type of laser works like an antibiotic to inhibit growth of bacteria linked to acne, and the other type helps to actually shrink the oil glands for that 'Accutane-like' effect," says David Goldberg, MD director of Skin Laser and Surgery Specialists of New York and New Jersey.

Together, he says, they form the core of long lasting treatment. Moreover, since both acne treatments also have anti-aging benefits, Goldberg says they can be a particularly good choice for midlife acne.

For dermatologist Bruce Katz, MD the treatment that does wonders when all others fail is PDT or photodynamic therapy. In his regimen, this laser-like light source is combined with a topical drug called "Levulan," applied during treatment. He says this combination gives skin a one-two punch that kills bacteria, shrinks oil glands and can offer permanent acne relief in just a few weeks of treatments.

"So far, we are experiencing three years plus of clear skin - and as our follow-up continues it's likely we will find even longer lasting results," says Katz, director of the JUVA Skin and Laser Center in New York City.

Since many dermatological treatments can be costly and insurance coverage of acne treatments is often thin, be sure to check with your insurer before your dermatologist appointment, so you know what you can afford.

WebMD Feature Reviewed by Cynthia Dennison Haines, MD on March 01, 2007


SOURCES: Charles E. Crutchfield III, MD, clinical associate professor of dermatology, University of Minnesota Medical School; medical director, Crutchfield Dermatology. Doris J. Day, MD, clinical assistant professor, NYU School of Medicine; author, 100 Questions and Answers About Acne and Forget The Face Lift.David J. Goldberg, MD, director, Skin Laser and Surgery Specialists of New York and New Jersey; Bruce Katz, MD, director, Juva Skin and Laser Center, New York City. American Academy of Dermatology.

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