How do I treat my acne?

Acne is a very common problem, and despite commonperceptions, can last long past adolescence. Many patients try to treat acne themselves, but are unsure of which products will help.  This quick guide will help explain the types, over the counter treatments, and when is a good time to see your dermatologist. First, let’s go over the types of acne.
  1. Comedonal – small bumps called comedones that are either open to the skin surface (blackheads) or closed (whiteheads)
  2. Inflammatory – red, inflamed bumps often with white center that can be “popped”
  3. Cystic – deep acne with no opening to the surface; often painful and can lead to scarring.
Often times, patients have a combination of these above types.  The most effective medications depend upon the predominant acne type. Many are even combined for synergistic effects.  Below is a list of the most common acne medications and what they work best for. Keep in mind, many over the counter products contain the SAME active ingredients.  Make sure you read the labels for a good, cost effective option that has the ingredient you need.
  1. Salicylic acid – good for comedonal acne as it helps dissolve blackheads.  Is likely the MOST drying acne medication, so its use can be difficult for those with dry skin
  2. Benzyol peroxide – likely the most effective OTC for inflammatory acne.  Effective against the bacteria P. Acnes, which is associated with this type of acne.  Can also be drying, especially when combined with other products.
  3. Adapalene – only over the counter retinoid.  OTC form is low strength, but retinoids as a whole are the ideal treatment for comedonal acne as they slowly force blackheads out.
  4. Alpha hydroxyl acids – these include lactic and glycolic acids.  These help to remove the top layer of skin cells and can also lead to fewer black and white heads.
  5. Sulphur – likely the most gentle of all products.  Can help with inflammatory acne
When treating acne, it is important to use a non-comedogenic(non-acne forming) moisturizer.  All acne products can be drying, so moisturizing twice a day during treatment can help to reduce redness.  Face washing is also important as it removes excess oil that can lead to acne.   It should be done 1-2x a day.  Multiple therapies work best, but start slowly to let your skin adapt.  Many of these therapies have different strengths/percentages of the active ingredient.  It is good to start low and work up if needed.  Also note, no acne treatments help treat active acne, but also prevent new acne formation.  Thus, they should be used for the full face ,and not as spot treatment. A good example patient with an optimized treatment regimen is noted below: Suzie is 16.  She has multiple blackheads on her forehead and nose and also gets 5-10 red, “puss” filled bumps a month.  She states her skin is very oily and rarely dry.
  1. Morning – Salicylic wash to help with blackheads; substitute with gentle facewash if dryness occurs
  2. Evening – Benzoyl Peroxide Wash 5% followed by a pea sized amount of Differin to the whole face, excluding eyelids.
When should you see a dermatologist?  When over the counter products, or if you have severe acne. Scarring is a reason to be seen immediately, as acne scars are often permanent.  Also, note the lack of over the counter options for cystic acne. This and moderate to severe inflammatory acne are best treated by your dermatologist.