Treatment for Acne

There are a number of effective treatments for acne. Dermatologists recommend treatments singly or in various combinations, depending on the individual's condition.

Topical Acne Treatments

These lotions, creams, and gels are applied to the surface of the skin. Topical antibiotics (drugs designed to destroy bacteria) can help reduce acne. Types of topical antibiotics include erythromycin, clindamycin, and sulfa drugs. The topical approach is effective because the medication is applied directly to the lesions. Also, because the patient does not swallow the drugs, they do not travel through the body and are less likely to cause side effects. A disadvantage to antibiotic treatment is that bacteria often develop tolerance and resistance to the medication over time, and thus become difficult to eradicate.

Blackheads and whiteheads respond well to treatments with retinoids (Retin A, Avita, Differin, Tazorac, tazarotene [Fabior Foam]), which are chemically similar to vitamin A. Retinoids break up the mixture of oil and dead cells that blocks the follicle and causes the lesion. Once the follicle is unclogged and oil flow is restored, the lesion begins to heal. It may take weeks to see improvement with these treatments. In fact, the acne may get worse before it gets better.

A side effect of retinoids is increased sun sensitivity. Doctors usually recommend covering the skin or using sunscreens to minimize this problem. Sunlight also breaks down retinoids, rendering them less effective. Some researchers have found that mixing yellow pigment with the retinoids reduces this problem.

Benzoyl peroxide is a familiar medication for acne. Over-the-counter and prescription benzoyl peroxide products may be recommended by dermatologists, depending on the severity of the acne.

Benzoyl peroxide kills the bacteria that cause acne. Doctors often use benzoyl peroxide along with topical antibiotics to reduce the likelihood of antibiotic resistance.

A side effect of benzoyl peroxide is local irritation, especially with the higher strengths such as 10 percent gels.

In December 2008, the U.S. Food and Drug Administration (FDA) approved the topical drug combination adapalene and benzoyl peroxide (Epiduo™ Gel) to treat acne in patients 12 years of age and older. This gel is applied to the skin of the face and/or trunk once per day. Patients using this medication should avoid sun exposure if possible, and should be sure to use sunscreen to prevent skin reactions (e.g., redness, stinging, burning).Side effects include scaling (peeling), dryness, and skin irritation.

Mild acid solutions of fruit origin, including salicylic and glycolic acids, can be effective on acne. These solutions encourage the peeling of the top layer of skin and the opening of blocked follicles, which helps reestablish the normal skin-cell replacement cycle.

In June 2014, the FDA warned that OTC topical acne treatments can cause rare but serious allergic reactions or severe irritation. According to the FDA, it's unknown whether these potentially life-threatening reactions are caused by active ingredients—benzoyl peroxide, salicylic acid—, inactive substances in the products, or a combination of both. The topical acne products are marketed under several brand names and store brands. They are available as gels, lotions, face washes and scrubs, solutions, cleansing pads, etc.

Stop using the product and seek emergency medical care if you develop any of the following symptoms while using topical acne treatments.

  • Difficulty breathing
  • Feeling faint or lightheaded
  • Swelling of the eyes, face, lips, or tongue
  • Tightness in the throat

The FDA also cautions consumers to stop using the product immediately if the experience itching or hives. New recommendations involve testing acne products on one or two small areas of affected skin for 3 days prior to using the product as directed. If any discomfort occurs during the test period, the product should not be used. Additional research is ongoing, according to the FDA.

Tea tree oil is a natural oil with antibiotic properties. Research is ongoing to determine whether it can be an effective acne treatment.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 31 Aug 2000

Last Modified: 26 Aug 2015