Mild acne consists of a few papules/pustules and/or comedones. Moderate acne has an increased number of lesions. Severe acne has numerous comedones, papules, and pustules and may have painful nodules.
Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were.
- Gently cleanse with mild soap or cleansers. (But don't scrub!)
- Resist picking at lesions.
- Avoid irritants (rubbing and other alcohols, abrasive scrubs) and oily creams, cosmetics, hair products, and sunscreens.
- Use products labeled "water-based" or "noncomedogenic."
- Keep hair, hands, and devices such as cell phones off the face.
- Avoid greasy products on the skin and scalp.
All over-the-counter therapies listed below should be used as a preventive therapy, applied in a thin to moderate quantity to entire regions. Acne treatment is not intended for existing individual lesions but is applied consistently over months to prevent new lesions. Expect slow improvement. Develop a skin care regimen that is modified slowly over time, not week to week.
- Benzoyl peroxide (most effective), available in a variety of forms and strengths. Benzoyl peroxides tend to dry the skin. If you have dry skin, use a weaker concentration product; for oily skin, consider higher strengths.
- A combination of a vitamin (nicotinamide) and zinc is available in cream and gel form.
- Exfoliants (or peeling agents) such as salicylic acid, sulfur, resorcinol, alpha-hydroxy acids (glycolic, lactic, pyruvic, and citric acid).
- Aluminum chloride hexahydrate (an antiperspirant available as Xerac-AC™) may be useful but can also be irritating.
- Clinac OC is a copolymer that absorbs oil, helping reduce the look of "greasy skin." It also is produced combined with benzoyl peroxide.
Microdermabrasion performed every 7–10 days ("lunchtime peel") has been a popular (but costly) way to control mild acne. The same type of peeling agents (exfoliants) are available in over-the-counter products, which can be used at home at much less cost.
- Acne can have significant psychological effects. Talk to your doctor about any feelings of depression.
- Changes in diet have no proven effect.
- Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
- Retinoids – vitamin A-derived products such as tretinoin, tazarotene, and adapalene.
- Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
- Hormone therapy with oral contraceptives or spironolactone.
- Isotretinoin, a strong drug with many side effects, for severe acne unresponsive to the above treatments.
- Special "blue light" treatments are being investigated to treat acne but are usually not covered by insurance.
- Several types of laser treatment also help acne and are often used with other treatment methods; however, treatments are expensive, must be repeated for several months, and have variable efficacy. Insurance may not cover laser therapy.
- Laser resurfacing, plastic surgery, and/or dermabrasion may help reduce the prominence of old acne scars.