Because many skin conditions can resemble acne, the initial examination and diagnosis is important. Conditions that resemble acne include rosacea, allergic reactions, and basal cell carcinoma, each of which has differing degrees of severity. By obtaining an accurate diagnosis from a dermatologist, patients can achieve the peace of mind that comes with knowing their skin is otherwise healthy. Once the diagnosis is confirmed, the next step to acne treatment involves an evaluation of the skin to determine the type, severity and recalcitrance of the acne.
There are a number of possible approaches to acne management. Topical medications are often the first approach. Retinoids are creams and lotions that primarily target comedonal (blackhead and whitehead) acne. These tend to be irritating to the skin, so often the patient applies three times per week increasing to daily applications as the skin adjusts. Because all acne begins with comedones, retinoids are a component of nearly all acne regimens. For more inflammatory acne, topical antibiotics (most commonly clindamycin), benzoyl peroxide, and topical dapsone are added to the regimen to help eliminate the bacteria that contribute to red, inflammatory acne.
Oral medications tend to be a highly effective form of acne treatment when topical applications are insufficient, or when used in conjunction with topical medications. Oral antibiotics help eliminate bacteria and control inflammation that characterizes moderate to severe acne. Although there are theoretical side effects of oral antibiotics, including nausea and an increase in sun sensitivity, it is important to remember that there are many low dose formulations that significantly minimize these risks. Female patients may also benefit from oral contraceptives and/or spironolactone, which regulate the hormones and their effects on the hair follicles, respectively, that often cause acne breakouts. Patients with severe cases of acne might utilize isotretinoin, which does come with the risk of potentially serious side effects, requiring patients to be monitored by the dermatologist while taking it. However, it is important to know that when used correctly, isotretinoin is a very safe option—and sometimes the only option to stop or prevent scarring.
Light therapy, chemical peels, and localized steroid injections are three viable acne treatment options for patients who need adjuvant treatments to achieve or retain clarity with medications alone.
