Acne treatment consists of reducing sebum and keratin production, encouraging the shedding of dead skin cells to help unclog the pores and killing or limiting bacteria. Treatment choice depends upon whether the acne is mild, moderate, or severe.

Complicated cases are referred to a dermatologist or an endocrinologist, who treats diseases of the glands and the hormones. Counseling may be necessary to clear up misconceptions about the condition and to offer support regarding the negative effect of acne on the physical appearance.

Treatment for mild acne consists of reducing the formation of new comedones with over-the-counter acne medications containing benzoyl peroxide (e.g., Clearasil, Fostex), salicylic acid (Stridex), sulfur (Therac lotion), or resorcinol (Acnomel cream).

Treatment with stronger medications requires a doctor’s supervision. Such medications include comedolytics, which are agents that loosen hard plugs and open pores. Adapalene (Differin), the vitamin A acid tretinoin (Retin-A), and concentrated versions of salicylic acid, resorcinol, and sulfur are in this group.

Topical antibiotics, such as erythromycin, clindamycin (Cleocin- T), and meclocycline (Meclan), may be added to the treatment regimen. Drugs that act as both comedolytics and antibiotics, such as benzoyl peroxide, azelaic acid (Azelex), or benzoyl peroxide plus erythromycin (Benzamycin), are also used.

After washing with a mild soap, the acne medications are applied alone or in combination, once or twice a day over the entire affected area of skin. It may take many months to years to control the condition with these medications.

Possible side effects include mild redness, peeling, irritation, dryness, and an increased sensitivity to sunlight that requires use of a sunscreen.

When acne is severe and the lesions are deep, oral antibiotics may be taken daily to reduce the spread of bacteria. Tetracycline is the medication most often used. Minocycline, however, may be preferable because it has fewer side effects.

Erythromycin and doxycycline are also used, and they also have side effects, including dizziness, photosensitivity, gastrointestinal problems, and darkening of the skin. Other possible side effects include allergic reactions, yeast infections, dizziness, tooth discoloration, and folliculitis.

It is necessary for antibiotics to be used for up to three months to clear up the condition. Isotretinoin (Accutane) can be used in cases of very severe acne or if antibiotic therapy proves unsuccessful. It may clear up resistant cysts and nodules in up to 90% of people and prevent scarring.

Some do require a second course of treatment before this happens, however. Although the medication can be quite helpful, women who might become pregnant should use it with care. Isotretinoin can cause birth defects up to a month after it has stopped being used.

Therefore, strict attention is paid to pregnancy tests and contraceptive requirements for women of child-bearing age who take this medication. The course of treatment with isotretinoin lasts about four to five months. If dosage is kept low, a longer course of therapy is needed.

Isotretinoin is a strong medication. Side effects are very common, mostly dryness of the eyes, genital mucosa, and lips. Other effects may include increases in cholesterol, triglycerides, and abnormal liver enzymes. Blood tests taken each month should be monitored during the course of treatment to ensure that the medication is not causing serious harm.

Anti-androgens, drugs that inhibit androgen production, are used to treat women who are unresponsive to other therapies. Oral contraceptives such as norgestimate/ethinyl estradiol (Ortho-Tri-Cyclen) have been shown to improve acne.

In late 2001, a clinical trial demonstrated that ultra low-dose birth control pills (Alesse) prove as effective in treating acne as do pills with higher doses of estrogen. Improvement may take up to four months.

Other drugs, such as spironolactone and corticosteroids, may be used to reduce hormone activity in the adrenal glands, reducing production of sebum. This is the treatment of choice for an extremely severe, but rare type of acne called acne fulminans, found mostly in adolescent males.

Acne conglobata, a more common form of severe inflammation, is characterized by numerous, deep, inflammatory nodules that heal with scarring. It is treated with oral isotretinoin and corticosteroids.

Several surgical or medical treatments are available to alleviate acne or the resulting scars:

• Comedone extraction. The comedo is removed from the pore with a special tool.
• Chemical peels. Glycolic acid is applied to peel off the top layer of skin to reduce scarring.
• Dermabrasion. The affected skin is frozen with a chemical spray and removed by brushing or planing.
• Punch grafting. Deep scars are excised and the area repaired with small skin grafts.
• Intralesional injection. Corticosteroids are injected directly into inflamed pimples.
• Collagen injection. Shallow scars are elevated by collagen protein injections.
• Laser treatments. Two types of laser treatments are used in treating acne scars. Laser-treated skin heals in three to 10 days, depending on the treatment chosen.