Dapsone is a topical gel medicine sold under the brand name Aczone for treating severe acne, and it’s perfect for people who want a low-maintenance acne treatment plan. Unlike many of the best acne medications, dapsone only needs to be applied once daily, and it is the only medications most people will need, though it’s always good to include a face wash and moisturizer in your skin care routine if possible. Dapsone can function on its own because it is both antibacterial and anti-inflammatory10, effectively taking care of two of the biggest causes of acne.
Contrary to the marketing promises of “blemish banishers” and “zit zappers,” immediate results are not the trademark of acne treatments — a frustrating truth to anyone suffering through a breakout. And while pimples are personal (your stress-induced spots will look and act differently than your best friend’s breakout), the best acne treatments will include a regimen of products to hit all of acne’s root causes. We tested 43 kits to find the most well-rounded breakout-fighting solutions on the market.
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In severe cases, oral isotretinoin may be considered. This medication can be very effective but can also cause serious side effects including severe birth defects. Strict protocols must be followed. Monthly appointments with the treating doctor must be kept throughout the treatment period to monitor for any side effects. In females of child-bearing age, protocol includes two forms of birth control. The treatment period is usually five months.
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).
^ Hay, RJ; Johns, NE; Williams, HC; Bolliger, IW; Dellavalle, RP; Margolis, DJ; Marks, R; Naldi, L; Weinstock, MA; Wulf, SK; Michaud, C; Murray, C; Naghavi, M (October 2013). "The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions". The Journal of Investigative Dermatology. 134 (6): 1527–34. doi:10.1038/jid.2013.446. PMID 24166134.
In 2015, acne was estimated to affect 633 million people globally, making it the 8th most common disease worldwide. Acne commonly occurs in adolescence and affects an estimated 80–90% of teenagers in the Western world. Lower rates are reported in some rural societies. Children and adults may also be affected before and after puberty. Although acne becomes less common in adulthood, it persists in nearly half of affected people into their twenties and thirties and a smaller group continue to have difficulties into their forties.
Medical conditions that commonly cause a high-androgen state, such as polycystic ovary syndrome, congenital adrenal hyperplasia, and androgen-secreting tumors, can cause acne in affected individuals. Conversely, people who lack androgenic hormones or are insensitive to the effects of androgens rarely have acne. An increase in androgen and oily sebum synthesis may be seen during pregnancy. Acne can be a side effect of testosterone replacement therapy or of anabolic steroid use. Over-the-counter bodybuilding and dietary supplements are commonly found to contain illegally added anabolic steroids.
Sulfur – Not to be confused with irritating sulfates that can be found in some cleansers and treatments, sulfur is an element that can be quite good for your skin. It removes the dead skin cells and excess oils that clog your pores. But just like any chemical ingredient, too much of it can dry your skin out. You’ll likely find it coupled with other ingredients in your cleanser, like benzoyl peroxide, salicylic acid, and resorcinol.
However, salicylic acid isn’t just for those of us with sensitive skin. It can also help those of you with tougher skin, through higher concentrations. Over-the-counter, you can find salicylic acid in concentrations up to 2 percent, but if you want something even more intense, many spas and dermatology offices offer salicylic acid chemical peels with 20-30 percent salicylic acid. Beware, these peels will likely leave your face very photosensitive for a few days, but they have been known to significantly reduce sebum for a few weeks at a time.
Antiandrogens such as cyproterone acetate and spironolactone have been used successfully to treat acne, especially in women with signs of excessive androgen production such as increased hairiness or skin production of sebum, or baldness. Spironolactone is an effective treatment for acne in adult women, but unlike combined birth control pills, is not approved by the United States Food and Drug Administration for this purpose. The medication is primarily used as an aldosterone antagonist and is thought to be a useful acne treatment due to its ability to additionally block the androgen receptor at higher doses. Alone or in combination with a birth control pill, spironolactone has shown a 33 to 85% reduction in acne lesions in women. The effectiveness of spironolactone for acne appears to be dose-dependent. High-dose cyproterone acetate alone has been found to decrease symptoms of acne in women by 75 to 90% within 3 months. It is usually combined with an estrogen to avoid menstrual irregularities and estrogen deficiency. The medication has also been found to be effective in the treatment of acne in males, with one study finding that a high dosage reduced inflammatory acne lesions by 73%. However, the side effects of cyproterone acetate in males, such as gynecomastia, sexual dysfunction, and decreased bone mineral density, make its use for acne in this sex impractical in most cases. Hormonal therapies should not be used to treat acne during pregnancy or lactation as they have been associated with birth disorders such as hypospadias, and feminization of the male babies. In addition, women who are sexually active and who can or may become pregnant should use an effective method of contraception to prevent pregnancy while taking an antiandrogen. Antiandrogens are often combined with birth control pills for this reason, which can result in additive efficacy.
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