Almost everyone (90% of people!) gets acne, and almost everyone can significantly improve their acne.
Acne can occur on the face, chest, shoulders, upper arms, and back. Multiple factors contribute to acne: genetics, age, consumption of dairy (for some people), clogged pores, hormones, occlusion (such as hair gels that get on the forehead), and progesterone-only birth controls (like Mirena). Combined (progesterone and estrogen) birth control pills usually help acne, particularly Yaz, Yasmin, and Ortho-Tri-Cyclen.
Skin Acne Types
(medical term: open comedones)
(medical term: closed comedones)
(large bumps that form under the skin and can cause pain)
If an “acne bump” persists for more than 4 weeks in the same location, it should be evaluated by a dermatologist — rarely other serious conditions can mimic acne.
For mild acne, a topical retinoid (like Retin-A, tretinoin, adapalene, or tazorac) and benzoyl peroxide are usually the most effective treatments.
These are topical treatments (not pills) that can be incredibly effective. It usually takes a month to see improvement–the most improvement is usually seen after 3 months.
Retinoids can cause significant dryness, peeling, and pinkness of the skin. However, this can almost always be avoided by using a minimal amount of retinoid and starting gradually. Use a pea-sized amount of retinoid for your entire face. Always start retinoids every other night for the first two weeks, and then after two weeks progress to every night if you are doing well. If you get too dry or irritated, take a night off. Note that retinoids are contraindicated during pregnancy.
For moderate acne, a topical retinoid, benzoyl peroxide, and low dose antibiotics pills (like doxycycline 20mg twice a day) are a good treatment option.
Low dose antibiotic pills are much better tolerated (with a significantly lower chance of causing antibiotic resistance) than higher dose antibiotic pills.
For severe acne, the most effective treatment is isotretinoin (Accutane). Isotretinoin is the only treatment that permanently improves acne.
Isotretinoin is a pill taken every day for 5-6 months. Blood work is required (before and during treatment), pregnancy is absolutely contraindicated, and both the patient and dermatologist must sign up for the iPledge program (a government-managed program to help prevent pregnancies while on isotretinoin).
Most people who go on isotretinoin do very well with no serious side effects. Most people will get dry lips and or noses that can be treated with Vaseline, Aquaphor, or bland lip balms.
Very rarely, patients can get severe headaches and or vision changes from isotretinoin–if this happens immediately stop the medication and contact your dermatologist or go to an urgent care or emergency room. You will need to have your eyes checked to see if there is pressure building up behind them, which can very rarely be caused by isotretinoin.
Other treatment options for acne include:
A pill for hormonal acne (female patients only).
This is the fastest way (usually within a day or two) to improve large acne cysts. It improves only the cysts that are injected.
Good for all types of acne and acne scars, as well as for rejuvenating the face. Note that this is a cosmetic treatment not usually covered by medical insurance policies.
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