If you have acne but have had no success with over-the-counter products then it is probably time for you to visit your doctor. In general, most treatments take two to four months to produce their maximum effect.
Acne treatments fall into the following categories:
- Topical treatments, i.e. those that are applied directly to the skin
- Oral antibiotics, i.e. tablets taken by mouth
These are usually the first choice for those with mild to moderate acne. There are a variety of active anti-acne agents, such as benzoyl peroxide, antibiotics (e.g. erythromycin, tetracycline and clindamycin), retinoids (e.g. tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide. They should be applied to the entire affected area of the skin (e.g. all of the face) and not just to individual spots, usually every night or twice daily depending on the treatment. Some topical treatments can be irritating to the skin, so it may be advised that the treatment is initially used on a small area of affected skin for a few applications before being applied to the entire affected area. It may then be recommended to gradually increase the use of the treatment, for example using it once or twice weekly, gradually building to regular daily use. Consult your doctor if the treatment causes irritation of the skin.
Oral antibiotic treatment
Your doctor may recommend a course of antibiotic tablets, usually erythromycin or a type of tetracycline, which is sometimes taken in combination with a suitable topical treatment.
Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement, for at least six months. Some should not be taken at the same time as food, so read the instructions carefully.
Oral contraceptive treatments
Some types of oral contraceptive pills help females who have acne. The most effective contain a hormone blocker (for example, cyproterone) which reduces the amount of oil the skin produces. It usually takes at least three to four months for the benefits to show. Although they may not be taken for this reason, the pills also help to prevent conception. As they prevent ovulation, they may be less suitable in young teenage girls where ovulation is not well established. These tablets increase the risk of blood clots which can be dangerous. This is a greater risk for people who smoke, are overweight or have others in the family who have had blood clots.
This is a powerful and highly effective treatment for acne which continues to benefit most patients for up to two years after a course of treatment. However, it has the potential to cause a number of serious side effects and can be prescribed only under the supervision of a consultant dermatologist. Isotretinoin can harm an unborn child. The government medicine safety agency (MHRA) has strict rules for doctors prescribing this medicine. Women enrol in a pregnancy prevention programme and need to have a negative pregnancy test prior to starting treatment. Pregnancy tests will be repeated every month during treatment and five weeks after completing the course of treatment. Effective contraception must be used for at least four weeks before treatment, whilst on treatment, and for at least four weeks afterwards.
There are concerns that isotretinoin may cause depression and suicidal feelings. Acne itself often makes people feel depressed so this can be complicated. Details about any personal and family history of depression or other mental illness should be discussed with your own doctor and dermatologist prior to considering treatment with isotretinoin.
Most courses of isotretinoin last for four months during which time the skin usually becomes dry, particularly around the lips. Regular application of a lip moisturiser is usually helpful. Often, acne becomes a little worse for a few weeks before improvement occurs. The improvement is progressive throughout the course of treatment, so do not be disappointed if progress seems slow.
It should be emphasised that many thousands of people have benefited from treatment with isotretinoin without serious side effects.