Have you tried treating your acne with no luck? You might simply be using the wrong product for the type you have. Whether you have periodic breakouts or more stubborn cystic acne, there's a solution. We asked Dr. Neal Schultz, an NYC dermatologist, to share the best treatments for every type of acne. Read on for his expert product recommendations, along with some editor favorites, that'll give you clear skin in no time.
The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.
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Topical antibiotics deemed safe during pregnancy include clindamycin, erythromycin, and metronidazole (all category B), due to negligible systemic absorption. Nadifloxacin and dapsone (category C) are other topical antibiotics that may be used to treat acne in pregnant women, but have received less study. No adverse fetal events have been reported from the topical use of dapsone. If retinoids are used there is a high risk of abnormalities occurring in the developing fetus; women of childbearing age are therefore required to use effective birth control if retinoids are used to treat acne. Oral antibiotics deemed safe for pregnancy (all category B) include azithromycin, cephalosporins, and penicillins. Tetracyclines (category D) are contraindicated during pregnancy as they are known to deposit in developing fetal teeth, resulting in yellow discoloration and thinned tooth enamel. Their use during pregnancy has been associated with development of acute fatty liver of pregnancy and is further avoided for this reason.
If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” says Linkner. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.
Antibiotics for acne, both topical and oral, used to be the top prescriptions for getting clear skin, but research has revealed that they aren’t the best option for most people today due to something called antibacterial resistance. This is where bacteria mutate, become immune to certain antibiotics, then reproduce offspring that are also immune, creating entire colonies of bacteria that can’t be killed by certain antibiotics.
Alternative and integrative medicine approaches used in the treatment of acne include fish oil, brewer's yeast, probiotics, oral zinc and topical tea tree oil. More research is needed to establish the potential effectiveness and long-term safety of these and other integrative approaches, such as biofeedback and traditional Chinese medicine. Talk with your doctor about the pros and cons of specific treatments before you try them.
The earliest pathologic change is the formation of a plug (a microcomedone), which is driven primarily by excessive growth, reproduction, and accumulation of skin cells in the hair follicle. In normal skin, the skin cells that have died come up to the surface and exit the pore of the hair follicle. However, increased production of oily sebum in those with acne causes the dead skin cells to stick together. The accumulation of dead skin cell debris and oily sebum blocks the pore of the hair follicle, thus forming the microcomedone. This is further exacerbated by the biofilm created by P. acnes within the hair follicle. If the microcomedone is superficial within the hair follicle, the skin pigment melanin is exposed to air, resulting in its oxidation and dark appearance (known as a blackhead or open comedo). In contrast, if the microcomedone occurs deep within the hair follicle, this causes the formation of a whitehead (known as a closed comedo).
Hypertrophic scars are uncommon, and are characterized by increased collagen content after the abnormal healing response. They are described as firm and raised from the skin. Hypertrophic scars remain within the original margins of the wound, whereas keloid scars can form scar tissue outside of these borders. Keloid scars from acne occur more often in men and people with darker skin, and usually occur on the trunk of the body.
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