Acne is a common chronic inflammatory skin condition with a complex pathophysiology involving multiple factors. Effective types of treatment involve both prescription and over-the-counter remedies that may be topical or systemic. While many popular therapies have been available for decades, today’s patients and physicians have more options for acne management. Additionally, new research and novel drugs mean standards of care are continuing to change. Of particular note, the American Academy of Dermatology (AAD) issued new evidence-based guidelines for both adolescents and adults this past year.
These six types of acne treatments — often used in combination — represent the bulk of effective management today.
1. Benzoyl Peroxide
Benzoyl peroxide is a tried-and-true, widely available topical treatment with anti-microbial, anti-comedogenic, anti-keratolytic and anti-inflammatory properties. One advantage of using benzoyl peroxide for managing bacteria compared to antibiotics is that it does not induce resistance. However, benzoyl peroxide is not always a good choice for patients with particularly sensitive skin because dryness and irritation are common side effects.
2. Salicylic Acid
Another popular topical therapy available in both prescription and over-the-counter forms, salicylic acid works by removing the outer layer of skin, treating and preventing clogged pores. However, at high concentrations, salicylic acid is capable of producing chemical burns.
Retinoids include vitamin A and related compounds. While their exact mechanism of action is currently unknown, retinoids have become a mainstay of acne treatment. Topical retinoids are particularly effective in treating comedonal acne and have consequently become the most commonly prescribed topical acne treatment today. In general, topical retinoids produce fewer and less serious side effects compared to oral systemic retinoids, which can cause severe birth defects when taken by pregnant women.
Oral isotretinoin is the most effective method of treatment for severe and nodulocystic acne and is also recommended for use in less severe cases that have not responded to other treatment strategies. While much of its mechanisms are still poorly understood, isotretinoin is able to inhibit sebaceous gland differentiation and sebum production. Approximately 60 percent of patients are permanently cured after five months of treatment. Potential side effects include dry eyes and decreased night vision, which usually resolve after discontinuation of treatment. While some studies have suggested a link between isotretinoin and an increased risk of depression and inflammatory bowel disease, the association remains inconclusive.
4. Hormonal Modulation
Hormonal modulation through androgen blockers and certain estrogen/progesterone oral contraceptives can help to reduce sebum production in acne patients. Unfortunately, hormonal modulation can be associated with severe side effects and is limited to use in female patients.
In particular, spironolactone has become a more frequently prescribed acne treatment. While its use was previously restricted due to the potential side effect of dangerously high blood potassium, a recent retrospective study found no increased risk of hyperkalemia in healthy women. Spironolactone can be used as an alternative to treatment with long-term antibiotics, with studies showing comparable efficacy after six months.
While prolonged use of broad-spectrum antibiotics has long been the standard in acne care, the increasing threat of antibiotic resistance has created a push to reserve their use to less severe forms of acne and for shorter periods of time. However, a wide range of both topical and oral antibiotics have been shown to be effective in acne management.
6. Laser Treatments, Chemical Peels, and Light Therapy
Although popular, there is only limited data suggesting the effectiveness of laser treatments and chemical peels. As such, the AAD does not recommend these strategies for routine acne treatment. However, it does point out that laser treatments and light therapy are still being researched. Additionally, chemical peels, laser treatments and dermabrasion can be used for treating resultant scarring.
For a more detailed look at these treatments, as well as new and emerging prescription products, read our recent white paper What’s New in Acne.