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Acne vulgaris, the most common form of acne, is an inflammatory condition prevalent in both adolescents and adults. Without appropriate acne treatment, the open or closed lesions — commonly referred to as blackheads or whiteheads — can result in permanent scarring and pigment changes. Patients may experience a range of acne presentations, from mild to severe and in different locations on the body depending on root cause of the condition and genetics. Mild and moderate acne sufferers will primarily encounter acne on the face. Mild acne typically results in open and closed comedones with relatively few pustules and papules; more severe cases result in numerous inflammatory papules, pustules, and nodules.
In the most severe cases of acne, patients experience many large, inflamed pustules and nodules. It’s not uncommon for patients with severe acne to even report physical pain from their acne. And, beyond the physical toll patients must also be aware of the potential effects on mental health.
The right acne treatment is essential to controlling the severity of the condition – and helping patients feel more comfortable and confident in their skin. Treatments for acne vulgaris, then, should help to reduce the frequency and severity of symptoms and improve physical appearance.
When it comes to the treatment of acne, however, there is no one-size-fits-all approach. The best treatment for acne for you may depend on several factors.
Still, treatments generally fall into one of a few categories: topical retinoids, topical antibacterials, oral antibiotics, hormone therapies, or an oral retinoid.
In deciding on the best course of action, a dermatologist will take into account the patient's age, the severity of the condition, their response to previous treatments, and other underlying or causative medical conditions. Ultimately, topical therapies, oral antibiotics, and hormonal therapies all aim to interrupt the formation of acne at an early stage, counteracting the critical inflammation, hormonal causes, and sebum production, while reducing the risk of long-term scarring or physical alteration.
The standard of care for treating mild to moderate acne is a topical therapy. Topical treatments and therapies typically fall into four categories:
Over-the-counter or OTC products are generally the first approach patients take on their own. These affordable and readily available remedies will typically use an antimicrobial but at a lower potency than a prescription — benzoyl peroxide 2.5% or salicylic acid 2%, for example. While OTC products are popular DIY options, evidence is still relatively thin when compared to prescription-strength formulations.
Retinoids are effective treatments against acne. Retinoids work by accelerating the skin cell turnover process, helping to heal scars and smooth wrinkles more quickly. They can help to restore collagen and elastin, and they’re a go-to ingredient in many beauty products. They’re not all the same, however, with some, like retinol and retinaldehyde, available in over-the-counter serums, and others available only by prescription, like tretinoin.
The primary application for retinoid therapy is against the microcomedone phase — the early acne phase when spent skin cells accumulate in the pores, causing blockages rather than flowing to and sloughing off the skin's surface. Despite retinoid efficacy — 40-70% reduction in comedones and inflammatory lesions — these medications can cause some skin irritation and sensitivity.
A dermatologist can help patients find the right retinoid and potency for use on their acne.
Antimicrobials include antibiotics and benzoyl peroxide. A bactericidal, benzoyl peroxide helps stave off the effects of cutibacterium acnes that strengthen resistance to antibiotic therapies. The topical is effective and relatively fast-acting, but it can cause irritation in some people. While available in several potencies, starting with more mild concentrations (2.5%) is likely better than starting with more aggressive options (10%) because the more potent versions tend to be more irritating and may not be any more effective.
In addition, topical forms of erythromycin and clindamycin are effective at reducing inflammation and lesions by as much as 70%. Still, these therapies also come with a warning: routine use can lead to resistance within one month when these treatments are used alone. Combination therapy can limit the likelihood of such results.
Combination therapy, using retinoids and antibiotics applied at separate times — depending on compatibility — is typically more beneficial to a patient than using either treatment alone. The reason for spacing each medication's use is to avoid oxidation of the retinoid. Benzoyl peroxide prevents the growth of a key ace-forming bacteria, P. acnes, allowing retinoids to do their job more effectively without risking future resistance.
Systemic therapies are taken orally and target specific physiologic pathways to relieve acne symptoms.
Systemic options are often the next stage in acne treatment when topical agents do not work or when acne is more severe. Standard treatment options include one or a combination of treatments, including:
When patients experience moderate to severe acne on their chest, back, and shoulders, and topical agents are not effective or tolerated, dermatologists might recommend using one of several oral antibiotics, including tetracycline, minocycline, doxycycline, erythromycin, or trimethoprim and sulfamethoxazole. Each option has its pros and cons.
While some topical treatments have been shown to be more effective, oral antibiotics can have a similar inflammatory reduction response, up to 67%. Additionally, dermatologists can prescribe varying or higher doses of many medications to provide more control and improved results. It’s best to allow the drug at least six weeks to see results.
Hormonal therapies can be effective treatments for women experiencing moderate to severe acne. While excess androgen production was once thought to be the cause of hormonal acne, leading to the development of antiandrogen therapies, that is no longer believed to be the case. However, antiandrogen therapy may still be a beneficial treatment for some people, regardless of hormonal abnormalities.
Some of the most effective hormonal therapies for acne are oral contraceptives; however, a patient should focus on estrogen-containing oral contraceptives because those containing only progesterone can make acne worse. A licensed doctor can help make this determination.
Isotretinoin is typically the last option for acne treatment because it is the most aggressive and potentially volatile option. There is no denying the benefits of this retinoid: it decreases sebum production, P. acnes colonization, abnormal follicular keratinization, and is an anti-inflammatory. Unfortunately, the medicine carries several risks, such as pancreatitis. A dermatologist will want to monitor isotretinoin patients closely to reduce the likelihood of adverse reactions. Because of the risks associated with isotretinoin, dermatologist typically only prescribe it in severe cases or those instances where patient history or history with topical or oral therapies indicate it may be necessary. Patients will also need to submit to a battery of tests, including thorough bloodwork, before being prescribed the medication; a dermatologist may repeat these tests monthly or quarterly.
Acne patients should recognize the uniqueness of their condition. While we all share biological traits, of course, your condition and complexion are unique. Don’t assume that one therapy will work for you just because it worked for your friend.
A professional can help you understand the specifics of your condition and design or select a custom acne treatment plan specific to your needs. Dermatologists are trained and experienced in treating acne and similar skin conditions, and their guidance can do wonders to accelerate the process for treatment-seeking acne sufferers. It's not just about prescription meds – they can select the right combinations and potencies, too.
Telemedicine is making it easier than ever to get help from a licensed clinician. Virtual visits from Nava MD are an affordable, convenient way for patients to avoid the common stressors and cost associated with going to a doctor's office while still receiving the care they need. In fact, leading-edge dermatologists have been using telemedicine and video conferencing platforms for years, allowing patients to receive fast, credible, and effective care from the comfort of their homes.
Now, with Nava MD, custom acne treatments are easier than ever. Nava MD connects you with a licensed professional for access to prescription ingredients typically reserved for in-office visits. It’s the fast, convenient, and affordable way to get acne help from the comfort of home, with medications delivered to your door and ongoing care from your clinician when needed.
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