Over the counter relief
There are a few things to consider when buying and using acne treatments:
- Acne treatments won’t get rid of existing pimples — rather, they help prevent new ones. This means using the treatment even when your skin’s looking good, and spreading it over the entire affected area (not just existing spots).
- Give it time: acne treatments usually take a while to kick in (anything up to six to eight weeks), so if you give up too soon you won’t know if they work.
- What works for your friends may not work for you — and vice versa.
- Your acne may have cleared up of its own accord, not because of the product you’re using (especially if it miraculously clears up the next day). Obviously if the treatment continues to be effective, that’s a different story. .
- If you have a reaction to a particular product, it could be an allergy to one of the ingredients (such as the preservative used), an interaction with something else you’re using or a result of overusing the product.
A ‘topical’ treatment is one you apply directly to the affected area — in this case, areas prone to blackheads and pimples. Topical acne treatments come as creams, gels, ointments and washes. Antiseptics such as benzoyl peroxide stop the growth of bacteria and some, but not all, are designed to clean your skin right down into the pores. You don’t need a prescription to buy them.
- One of the most effective ingredients is benzoyl peroxide. It’s safe for use by adults and children and can be used during pregnancy. However, it can dry and irritate the skin. Products vary in concentration and accompanying ingredients, so you might need to experiment to find one that suits you.
- Sulphur, salicylic acid, resorcinol and azelaic acid help unblock pores. Salicylic acid may dry the skin, but azelaic acid and resorcinol have no notable side effects. Sulphur, an old-fashioned remedy, can be unpleasant to use at higher, more effective concentrations.
- Topical vitamin A, tea tree oil and zinc supplements may help relieve acne. However, there’s no strong evidence that other claimed alternative remedies — such as echinacea, acupuncture, calendula or yoga — have any benefit.
- Triclosan and cetrimide are antiseptics found in some acne treatments (especially washes) but there’s no evidence they work.
If moderate or severe acne doesn’t improve, it’s worth seeing a doctor or a dermatologist. There’s a range of effective oral and topical treatments they can prescribe — sometimes a combination of both may work best.
Topical creams and gels
First choice for many will be topical retinoids: tretinoin, isotretinoin and adapalene. These are widely regarded as the best external medication available to treat whiteheads and blackheads and prevent the formation of new ones. They’re based on vitamin A and cause the skin to peel, unblocking your pores. They may not be safe for pregnant women. Retinoids can irritate the skin and increase its sensitivity to the sun, so you’re usually advised to apply them at night. A sunscreen is also recommended — at least SPF 15+ and containing a physical blocker, such as titanium dioxide — to reduce the risk of UV damage and skin cancer. Gel-based sunscreens are probably best for people with acne, as creams might aggravate it. As well, keep out of the midday sun and avoid sunlamps and tanning beds.
These work by reducing bacteria on the skin and in the pores. They’re useful for mild to moderate inflammatory acne but may not be so effective on blackheads. However, overuse of antibiotics in general has led to the rise of antibiotic-resistant bacteria, causing a rethink on their role in acne treatment. Topical antibiotics include clindamycin and erythromycin. They may cause dry or scaly skin and erythromycin may also give an itching, stinging or burning feeling, but there are no other notable side effects.
These are becoming very popular and work well for moderate acne, especially if you have inflamed and painful pimples. However, they’re not a magic bullet. You should notice a marked decline in the severity of your acne, but it may not disappear altogether. Oral antibiotics include doxycycline, tetracycline and erythromycin. All oral antibiotics can cause stomach upsets, and some aren’t suitable for pregnant women. Doxycycline can make people more sensitive to sunlight and easily sunburnt. Minocycline is also widely used, but it can have side effects including dizziness, light-headedness and vertigo.
Antibiotics can fail, although it may be because they’ve not been taken as directed, rather than problems with the medicine itself. You need to follow the instructions carefully and keep going to the end of the course — even if your symptoms have disappeared, or you think they’re never going to disappear. There’s also the problem of the rise of antibiotic-resistant bacteria. Sometimes a combination of treatments works best. Some studies suggest that combining a topical antiseptic like benzoyl peroxide with an oral antibiotic can give better results than either used alone. Talk to your doctor.
One of the more common treatments for acne in girls and young women is oral contraception. Contraceptive pills decrease the effect of male hormones, which in turn means a decrease in the production of sebum. Effective for reducing acne are DIANE 35 and BRENDA 35, both of which contain cyproterone acetate and oestrogen. The former has an anti-androgenic effect, and is often used to treat problems caused by androgens, such as acne, hirsutism and female-pattern baldness. Other so-called second and third-generation contraceptives are also effective at reducing acne — ask your doctor about them. If you use oral contraceptives to treat acne, your doctor should explain the risk of blood clots — and cyproterone acetate may increase the risk more than some other contraceptive pills.