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If over-the-counter (nonprescription) products haven't cleared up your acne, your doctor can prescribe stronger medications or other therapies. A dermatologist can help you:

• Control your acne
• Avoid scarring or other damage to your skin
• Make scars less noticeable

Acne medications work by reducing oil production, speeding up skin cell turnover, fighting bacterial infection or reducing inflammation — which helps prevent scarring. With most prescription acne drugs, you may not see results for four to eight weeks, and your skin may get worse before it gets better. It can take many months or years for your acne to clear up completely.

The drug your doctor recommends depends on the type and severity of your acne. It might be something you apply to your skin (topical medication) or take by mouth (oral medication). Often, drugs are used in combination. Pregnant women will not be able to use oral prescription medications for acne.

Talk with your doctor about the risks and benefits of medications and other treatments you are considering.

Topical medications

These products work best when applied to clean, dry skin about 15 minutes after washing. You may not see the benefit of this treatment for a few weeks. And you may notice skin irritation at first, such as redness, dryness and peeling.

Your doctor may recommend steps to minimize these side effects, including using a gradually increased dose, washing off the medication after a short application or switching to another medication.

The most common topical prescription medications for acne are:

• Retinoids. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.
• Antibiotics. These work by killing excess skin bacteria and reducing redness. For the first few months of treatment, you may use both a retinoid and an antibiotic, with the antibiotic applied in the morning and the retinoid in the evening. The antibiotics are often combined with benzoyl peroxide to reduce the likelihood of developing antibiotic resistance. Examples include clindamycin with benzoyl peroxide (Benzaclin, Duac, Acanya) and erythromycin with benzoyl peroxide (Benzamycin).
• Dapsone (Aczone). This gel is most effective when combined with a topical retinoid. Skin side effects include redness and dryness.

Oral medications

• Antibiotics. For moderate to severe acne, you may need oral antibiotics to reduce bacteria and fight inflammation. Choices for treating acne include tetracyclines, such as minocycline and doxycycline.

Your doctor likely will recommend tapering off these medications as soon as your symptoms begin to improve or as soon as it becomes clear the drugs aren't helping — usually, within three to four months. Tapering helps prevent antibiotic resistance by minimizing undue exposure to these medications over a long time.

You will likely use topical medications and oral antibiotics together. Studies have found that using topical benzoyl peroxide along with oral antibiotics may reduce the risk of developing antibiotic resistance.

Antibiotics may cause side effects, such as an upset stomach and dizziness. These drugs also increase your skin's sun sensitivity. They can cause discoloration of developing permanent teeth and reduced bone growth in children born to women who took tetracyclines while pregnant.

• Combined oral contraceptives. Combined oral contraceptives are useful in treating acne in women and adolescent girls. The Food and Drug Administration approved three products that combine estrogen and progestin (Ortho Tri-Cyclen, Estrostep and Yaz).

The most common side effects of these drugs are headache, breast tenderness, nausea, weight gain and breakthrough bleeding. A serious potential complication is a slightly increased risk of blood clots.

• Anti-androgen agent. The drug spironolactone (Aldactone) may be considered for women and adolescent girls if oral antibiotics aren't helping. It works by blocking the effect of androgen hormones on the sebaceous glands. Possible side effects include breast tenderness, painful periods and the retention of potassium.
• Isotretinoin. This medicine is reserved for people with the most severe acne. Isotretinoin (Amnesteem, Claravis, Sotret) is a powerful drug for people whose acne doesn't respond to other treatments.

Oral isotretinoin is very effective. But because of its potential side effects, doctors need to closely monitor anyone they treat with this drug. The most serious potential side effects include ulcerative colitis, an increased risk of depression and suicide, and severe birth defects.

In fact, isotretinoin carries such serious risk of side effects that women of reproductive age must participate in a Food and Drug Administration-approved monitoring program to receive a prescription for the drug.

Therapies

These therapies may be suggested in select cases, either alone or in combination with medications.

• Light therapy. A variety of light-based therapies have been tried with success. But further study is needed to determine the ideal method, light source and dose. Light therapy targets the bacteria that cause acne inflammation. Some types of light therapy are done in a doctor's office. Blue-light therapy can be done at home with a hand-held device.

Possible side effects of light therapy include pain, temporary redness and sensitivity to sunlight.

• Chemical peel. This procedure uses repeated applications of a chemical solution, such as salicylic acid. It is most effective when combined with other acne treatments, except oral retinoids. Chemical peels aren't recommended for people taking oral retinoids because together these treatments can significantly irritate the skin.

Chemicals peels may cause temporary, severe redness, scaling and blistering, and long-term discoloration of the skin.

• Extraction of whiteheads and blackheads. Your dermatologist uses special tools to gently remove whiteheads and blackheads (comedos) that haven't cleared up with topical medications. This technique may cause scarring.
• Steroid injection. Nodular and cystic lesions can be treated by injecting a steroid drug directly into them. This improves their appearance without the need for extraction. The side effects of this technique include thinning of the skin, lighter skin and the appearance of small blood vessels on the treated area.

Treating acne scars

Procedures used to diminish scars left by acne include the following:

• Soft tissue fillers. Injecting soft tissue fillers, such as collagen or fat, under the skin and into indented scars can fill out or stretch the skin. This makes the scars less noticeable. Results are temporary, so you would need to repeat the injections periodically. Side effects include temporary swelling, redness and bruising.
• Chemical peels. High-potency acid is applied to your skin to remove the top layer and minimize deeper scars.
• Dermabrasion. This procedure is usually reserved for more severe scarring. It involves sanding (planing) the surface layer of skin with a rotating brush. This helps blend acne scars into the surrounding skin.
• Laser resurfacing. This is a skin resurfacing procedure that uses a laser to improve the appearance of your skin.
• Light therapy. Certain lasers, pulsed light sources and radiofrequency devices that don't injure the epidermis can be used to treat scars. These treatments heat the dermis and cause new skin to form. After several treatments, acne scars may appear less noticeable. This treatment has shorter recovery times than some other methods. But you may need to repeat the procedure more often and results are subtle.
• Skin surgery. Using a minor procedure called punch excision, your doctor cuts out individual acne scars and repairs the hole at the scar site with stitches or a skin graft.

Treating children

Most studies of acne drugs have involved people 12 years of age or older. Increasingly, younger children are getting acne as well. In one study of 365 girls ages 9 to 10, 78 percent of them had acne lesions. If your child has acne, you may want to consult a pediatric dermatologist. Ask about drugs to avoid in children, appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.

Treatment of children with acne is often complicated by their family situation. For example, if a child moves between two homes due to divorced parents, it may help to use two sets of medications, one in each home.

You can try to avoid or control mild acne with nonprescription products, good basic skin care and other self-care techniques:

• Wash problem areas with a gentle cleanser. Twice a day, use your hands to wash your face with a mild soap and warm water. If you tend to develop acne around your hairline, shampoo your hair every day.

Avoid certain products, such as facial scrubs, astringents and masks, because they tend to irritate skin, which can worsen acne. Excessive washing and scrubbing also can irritate skin. And be gentle while shaving affected skin.

• Try over-the-counter acne products to dry excess oil and promote peeling. Look for products containing benzoyl peroxide as the active ingredient. You might also try products containing sulfur, resorcinol or salicylic acid. Nonprescription acne medications may cause initial side effects — such as redness, dryness and scaling — that often improve after the first month of using them.

The Food and Drug Administration warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a rare but serious reaction.

• Avoid irritants. You may want to avoid oily or greasy cosmetics, sunscreens, hairstyling products or acne concealers. Use products labeled water-based or noncomedogenic, which means they are less likely to cause acne.
• Use an oil-free moisturizer with sunscreen. For some people, the sun worsens acne. And some acne medications make you more susceptible to the sun's rays. Check with your doctor to see if your medication is one of these. If it is, stay out of the sun as much as possible. Regularly use a nonoily (noncomedogenic) moisturizer that includes a sunscreen.
• Watch what touches your skin. Keep your hair clean and off your face. Also avoid resting your hands or objects, such as telephone receivers, on your face. Tight clothing or hats also can pose a problem, especially if you're sweating. Sweat and oils can contribute to acne.
• Don't pick or squeeze blemishes. Doing so can cause infection or scarring.

Some studies suggest that using the following supplements may help treat acne. More research is needed to establish the potential effectiveness and long-term safety of these and other natural acne treatments, traditional Chinese medicine, and ayurvedic herbs.

Talk with your doctor about the pros and cons of specific treatments before you try them.

• Tea tree oil. Gels containing 5 percent tea tree oil may be as effective as are lotions containing 5 percent benzoyl peroxide, although tea tree oil might work more slowly. Possible side effects include contact dermatitis and, if you have rosacea, a worsening of those symptoms. One study reported that a young boy experienced breast development after using a combination lavender and tea tree oil hair product. Tea tree oil should be used only topically.
• Alpha hydroxy acid. This natural acid is found in citrus fruit and other foods. When applied to your skin, it helps remove dead skin cells and unclog pores. It may also improve the appearance of acne scars. Side effects include increased sensitivity to the sun, redness, mild stinging and skin irritation.
• Azelaic acid. This natural acid is found in whole-grain cereals and animal products. It has antibacterial properties. A 20 percent azelaic acid cream seems to be as effective as many other conventional acne treatments when used twice a day for at least four weeks. It is even more effective when used in combination with erythromycin. Prescription azelaic acid (Azelex, Finacea) is an option during pregnancy and while breastfeeding.
• Bovine cartilage. Creams containing 5 percent bovine cartilage, applied to the affected skin twice a day, may be effective in reducing acne.
• Zinc. Zinc in lotions and creams may reduce acne breakouts.
• Green tea extract. A lotion of 2 percent green tea extract helped reduce acne in two studies of adolescents and young adults with mild to moderate acne.
• Aloe vera. A 50 percent aloe vera gel was combined with a conventional acne drug (tretinoin) and tested for 8 weeks on 60 people with moderate acne. The combination approach was significantly more effective than tretinoin alone.
• Brewer's yeast. A specific strain of brewer's yeast, called CBS 5926, seems to help decrease acne. Brewer's yeast is the only item in this list that's taken orally. It may cause flatulence.

Acne and the scars it can cause may affect your social relationships and self-esteem. Sometimes it can help to talk with your family, a support group or a counselor.