Acne treatments

There is a number of acne treatments available through your doctor or pharmacist that can help treat and prevent acne. The acne treatment recommended for you will depend on the severity of your acne as well as how you feel about your acne – if you have mild acne but it bothers you a lot, your doctor may recommend a different treatment than if your acne is not a concern.

Acne treatments work in several ways – most aim to reduce the oiliness of the skin, unblock pores and/or reduce skin inflammation.

It can take several weeks of treatment to see noticeable improvements, but you should seek further advice from your doctor or pharmacist if your acne has not improved within 4 to 8 weeks.

Most common acne treatments in Australia are applied directly to the skin (called topical treatments) or taken by mouth (oral medicines). Sometimes, a combination of several different acne treatments is recommended to achieve the best results.

Topical preparations usually have to be applied to the whole area of affected skin, not just the acne spots.

Acne may flare up if treatment is stopped, so after the initial treatment period, people often go onto maintenance therapy.

Keratolytics

Keratolytics are peeling agents that can be used to treat acne by unblocking skin pores. Keratolytics used in Australia include salicylic acid preparations (e.g. David Craig Aqueous Cream with Salicylic Acid, Gold Cross Salicylic Acid Ointment).

Topical salicylic acid preparations that are applied to the skin are usually well tolerated. Some people experience mild stinging or skin irritation. Applying salicyclic acid to moist skin increases absorption and can make stinging and irritation worse, so apply salicylic acid preparations to cool, dry skin to reduce these side effects.

Antibiotics and antibacterials for acne

Benzoyl peroxide is a very effective acne treatment if used regularly. It increases the rate of removal of skin cells (helping to unblock pores), reduces inflammation and suppresses the bacteria that contribute to acne.

Benzoyl peroxide treatments include such products as:

  • Benzac AC Gel and Wash;
  • Brevoxyl (Cream);
  • Clean & Clear Continuous Control Acne Cleanser (Cream cleanser);
  • Oxy (Cream);
  • Oxy Vanishing Cream; and
  • PanOxyl Acne Gel.

These products come in varying strengths (2.5 to 10 per cent) but, if too strong (greater than 5 per cent), the skin may become dry or rough. For this reason it is better to start with a lower strength, as stinging and skin redness may occur initially. If applied at night, much of the redness caused by the treatment will have gone by morning.

Azelaic acid (e.g. Azclear Action Medicated Lotion, Finacea Gel) is another acne preparation that has antibacterial, anti-inflammatory and keratolytic (sloughs off dead skin cells) properties. Like benzoyl peroxide, it can cause skin dryness and redness at first.

Topical antibiotic preparations that can be used to control acne include clindamycin – brand names Dalacin T Topical Lotion, ClindaTech (Topical solution) and Zindaclin (Gel).

Topical antibiotics have antibacterial and anti-inflammatory effects, and are the least irritating topical agents commonly used for acne. They are often used in combination with benzoyl peroxide. In fact, combination products containing benzoyl peroxide and clindamycin (e.g. Duac Once Daily Gel) are available.

In more severe cases of acne, your doctor may recommend you take a course of antibiotics by mouth. The most commonly used antibiotics for acne are called tetracyclines and include doxycycline and minocycline. Another type of antibiotic sometimes used is erythromycin.

Hormonal treatments for acne

Hormonal treatments can be an effective treatment for women and teenage girls with moderate to severe acne. They work by blocking the effect of hormones called androgens on the sebaceous glands in the skin, thus reducing the production of sebum (oil).

Formulations of the combined oral contraceptive pill – ‘the pill’ – that contain the synthetic hormone called cyproterone are especially useful in the treatment of acne. Examples include Brenda-35, Diane-35, Estelle-35 and Juliet-35.

Spironolactone is another medicine that works as an anti-androgen and can be used to treat acne in some women.

Retinoids

Retinoids are the most effective treatment for acne, but they can also irritate the skin more than other acne treatments. Retinoids work by unblocking skin pores, reducing the amount of sebum (oil) that is produced by the sebaceous glands in your skin, and reducing inflammation.

Retinoids can cause severe birth defects, so cannot be taken by pregnant women, those planning pregnancy or women who are not using appropriate contraceptive measures.

Retinoid creams and gels

Retinoids are available in topical skin preparations, such as:

  • tretinoin (Stieva-A Cream);
  • adapalene (Differin Topical Cream or Gel); and
  • isotretinoin (Isotrex Gel).

A combination product is available that contains topical retinoid (adapalene) plus benzoyl peroxide (brand name Epiduo Gel).

Topical retinoids should be applied at night and washed off with a mild, soap-free cleanser in the morning. This helps to reduce skin irritation and also reduces problems with sun sensitivity that can be associated with the use of retinoids.

Topical retinoids are usually started gradually to help reduce skin irritation. Your doctor may recommend you apply the medicine every second night for the first 2 weeks before applying every night to the acne-affected area.

Retinoid capsules and tablets

Retinoids (isotretinoin) are also available as oral medicine (capsules). Oral retinoids are usually recommended for the treatment of severe acne, cystic acne, acne that is not responding to other treatments or acne that is causing emotional distress.

Your doctor may need to refer you to a skin specialist (dermatologist) for treatment with oral retinoid medicines.

Isotretinoin brand names include:

  • APO-Isotretinoin;
  • Dermatane;
  • Isotretinoin AN;
  • Isotretinoin SCP;
  • Isotretinoin-PS;
  • Oratane;
  • Roaccutane; and
  • Rocta.

People taking retinoids may need non-oily moisturisers for their lips and face, as well as eye lubricant drops, as they can cause dry skin and eyes.

Skin care while using acne treatments

The active ingredients in many acne treatments reduce oiliness and build-up of dead skin cells in the pores, which are known to be factors that contribute to acne lesions. A side-effect of this is that many acne treatments, both topical (surface) and oral medicines, can cause dryness, redness and irritation of the skin. It is important to know that dryness is expected, and usually means that the treatments are working.

In addition to your acne treatment, your skin care regimen should include:

  • cleansing;
  • moisturising; and
  • sun protection.

1. Cleansing

  • Choose a soap-free cleanser for sensitive skin types (not one for acne, unless specifically advised by your doctor).
  • Cleanse your face twice a day, using your cleanser to also remove make-up.
  • Don’t wash your face directly under the shower head (this can lead to excessive dryness and redness).
  • Avoid cleansers with added herbs, fragrances, vitamins, fruity acids, etc.
  • Don’t use exfoliants, Buf-Pufs, alcohol or acne wipes, toners, scrubs, granules, masks, peels, steams or have facials (check with your doctor first if in doubt).
  • Don't squeeze or pick at pimples or blackheads.

2. Moisturising

  • It is important to moisturise whenever necessary, even if you have acne, because otherwise your skin may not be able to cope with the treatments that have been suggested to you.
  • Try to moisturise twice a day, with extra ‘top ups’ during the day if necessary.
  • It’s best to moisturise immediately after washing your face, before any treatments or sunscreens are applied.
  • Use oil-free, non-comedogenic lotions i.e. those less likely to clog the pores of the skin.
  • Again, try to avoid products with additives.

3. Sun protection

  • Many acne treatments will leave your skin sensitive to the sun (this is temporary).
  • Wear a broad-brimmed hat, stay out of the full sun, especially between 10am and 2pm (11am and 3pm summer time) and use a sunscreen.
  • Sunscreens should ideally be SPF 30+ or higher, broad spectrum and applied every 2 hours when outdoors.
  • Some sunscreens can aggravate acne, so trial and error may be required.
  • It’s best to choose oil-free formulations.

Other treatments for acne

If you have severe or cystic acne that is not responding to other treatments, your doctor or dermatologist may recommend specialist treatment.

Treatments that may help improve acne include the following.

  • Corticosteroid injections, which can be used speed up the healing time associated with inflammatory acne lesions such as nodules and cysts. Injections are only occasionally recommended for lesions that are particularly troublesome.
  • Extraction (removal) of blackheads and whiteheads with a special instrument.
  • Chemical peels, which involve having a chemical solution applied to the skin that may help unblock skin pores and improve the appearance of acne-prone skin.
  • Light therapy, which may help reduce sebum production in the skin and reduce inflammation. Several different types of light therapy have been tried, and further research is needed to confirm its effectiveness. Kleresca is one form of light therapy - it uses a photoconverter gel applied to the skin area, which is then illuminated by a high-intensity light.

These treatments are associated with side effects, including local skin irritation. Your skin specialist will be able to discuss the risks and benefits of these treatments with you, and whether they are suitable for your type of acne.

Acne scar treatments

Sometimes severe, untreated acne results in acne scars, including ice-pick scars, boxcar scars and rolling scars. There are treatments available that can help improve the appearance of acne scarring, including:

  • dermabrasion or dermaplaning, where a special instrument is used to remove the top layer of skin in people with severe acne scarring;
  • laser therapy, including laser resurfacing to remove the top layer of skin and non-ablative laser treatment (fractional laser, e.g. Fraxel) that promotes skin healing through the growth of new collagen in specific areas;
  • chemical peels that remove the top layer of skin to help reduce scarring; and
  • cosmetic or plastic surgery, including fillers.
Last Reviewed: 30 November 2016
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References

1. Acne (published November 2015). In: eTG complete. Melbourne: Therapeutic Guidelines Limited; 2016 Jul. http://online.tg.org.au/complete/ (accessed Nov 2016).
2. Mayo Clinic. Acne (updated 23 Jul 2015). http://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-treatments/art-20045892?pg=1 (accessed Nov 2016).
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