The medications and in-office procedures that dermatologists recommend most for clear skin.
Professional-strength acne treatments and procedures for clear skin
Acne is the most common skin condition in the United States, so if you struggle with breakouts, you’re definitely not alone. Over-the-counter acne treatment products are the first line of defense when you embark on your quest for clear skin. An anti-acne skincare regimen that includes proven dermatologist-recommended ingredients like benzoyl peroxide, salicylic acid and sulfur helps most people get rid of pimples. However, some acne requires extra attention in the form of prescription topical and/or oral medications and in-office treatments.
An acne refresher
Although factors like diet, stress, and hormones can have an impact on acne breakouts, there are three main acne causes. First, the oil glands produce sebum that can then mix with dead skin cells, makeup, and other debris that clogs the pores. Finally, the P. acnes bacteria that causes acne multiplies in the clogged pores and results in redness and inflammation. Acne treatment strives to intervene at each of these points, and different ingredients target each phase of the acne cycle. But it’s important to remember that you need to give any acne treatment routine at least four weeks to work—but six to eight weeks is even better.
3 goals of acne treatment
1. Decrease oil production: An acne cleanser and toner are effective for reducing excess oil on the skin and within the pores—but these topicals don’t actually minimize oil production. However, oral medications like birth control pills and isotretinoin (Accutane) can work within the skin to decrease oil production. Lifestyle factors like stress-relieving activities and getting enough sleep may also help reduce oil production by keeping the body’s cortisol levels to a minimum.
2. Prevent clogged pores: Salicylic acid helps prevent acne by gently exfoliating the skin and removing dead skin cells that can potentially clog pores. Retinoids and chemical peels work similarly. Washing thoroughly to remove sweat, dirt, and makeup can help as well, as can choosing products that are labeled as “non-comedogenic.” Washing your face and body after shampooing and conditioning can also help prevent the clogged pores that lead to acne in areas exposed to these products.
3. Decrease bacteria: Benzoyl peroxide, topical antibiotics, oral antibiotics and light-based treatments are all effective ways to minimize P. acnes bacteria.
Topical prescription-based acne treatments
Dermatologists often prescribe a retinoid (such as tretinoin, adapalene, or tazarotene) to speed cell turnover so acne clears faster. Acne often seems worse after starting these treatments, but this is temporary so follow your dermatologist’s instructions and stick with it. It’s important to gradually increase retinoid use to minimize side effects like redness, dryness, peeling, and sensitivity if it’s your first time using one of these products. It’s best to start with an application every third night before increasing to every other night once it’s obvious your skin can tolerate it. From there, you can expand to nightly use. After your skin tolerates daily retinoid application, your dermatologist may increase the concentration, but you’ll have to start slowly and gradually work up to daily use once again.
In more severe cases, dermatologists may also recommend a prescription-strength benzoyl peroxide that is stronger than products available for purchase at the store. Some dermatologists may also prescribe a topical antibiotic such as clindamycin to help reduce bacteria and inflammation, however these are generally used in conjunction with a retinoid or benzoyl peroxide. (Read on for more about antibiotics for acne.)
Oral prescription-based acne treatments
Since hormones play a role in the skin’s oil production and acne, birth control pills or an oral medication called spironolactone may be recommended by your dermatologist. Oral antibiotics such as doxycycline and erythromycin can be prescribed for limited periods to minimize bacteria and inflammation. Like topical antibiotics, these oral medications are combined with retinol or benzoyl peroxide to avoid antibiotic resistance. You may have heard of Accutane (or isotretinoin) as well. This is a serious drug reserved for severe cases of acne that cause deep, painful cysts and nodules that often lead to scarring. One, four to five month course of isotretinoin provides long-lasting, or even permanent acne clearing. However, this medication can have serious side effects, so it requires careful consideration and thorough discussion with your dermatologist.
In-office acne treatments and procedures
In addition to at-home acne treatment products, your dermatologist may recommend various in-office treatments that help clear acne.
Laser and light-based acne treatments: Most professional treatments use blue and red light (or a combination of both) or infrared light to reduce P. acnes bacteria and inflammation. Photodynamic Therapy involves applying a medication to the skin before exposure to light. Additionally, there is Photoneumatic Therapy, which combines intense pulsed light (IPL) and gentle vacuum suction to help remove excess oil and dead skin cells from the pores. Although most patients see acne clearing after a series of treatments over months, results vary from patient to patient, and light-based treatments are rarely used alone. They are usually combined with over-the-counter and/or prescription-based topicals like retinoids, benzoyl peroxide and/or antibiotics for optimal skin clearing. Once the initial series of light-based treatments is complete, patients often require follow-ups once or twice a year to maintain results.
You may have come across a few at-home light-based devices for treating acne. Though they are not as potent as their in-office counterparts, they are able to boost the results achieved with acne treatment products or help fight bacteria between professional treatments. It’s best to ask your dermatologist before spending your time (or money) on an at-home acne device, as he or she may recommend one in particular.
Chemical peels: Ideal for blackheads and papules, a series of customized chemical peels can help exfoliate the skin and minimize clogged pores. Superficial salicylic acid peels are often used to treat acne because this acid is oil-soluble, which means it can penetrate the pores to dissolve oil. Deeper chemical peels are also effective for improving the appearance of acne scarring. Peels are generally combined with other acne treatments such as over-the-counter and prescription-based topicals, and may have side effects like skin flaking and redness. As an added bonus, chemical peels may help other concerns like fine lines, wrinkles and dark spots as well. However, it’s important to know that those with darker skin tones should consult a dermatologist with extensive experience performing chemical peels on skin of color since they can result in discoloration if used incorrectly.
Kenalog injections: If you’ve ever experienced a deep, painful cyst, you know you want it to go away ASAP. This type of shot uses a steroid such as cortisone to ease the discomfort and inflammation associated with a cyst within 24 hours, and can help prevent scarring. These injections are ideal if you have an acne breakout before a big event, but keep in mind that cortisone shots are not meant to replace your acne treatment products and are not used for mild forms of acne like blackheads and whiteheads. (They can be used for body acne, too.)
Drainage and extraction: In cases of large, painful cysts, your dermatologist can perform what is called “drainage and extraction.” During this procedure, a small incision is made with a needle or scalpel to open the acne blemish and remove what’s inside. This is not the same as popping a pimple, and should never be attempted at home. Dermatologists know the proper technique, and will instruct you about how to care for the treated area after the procedure to minimize the risk of infection and scarring.
Treatments for acne scarring
Acne scars can be very stubborn to treat, but dermatologists have an array of options that can help improve their color and texture. Multiple, shallower depressed scars are often treated with resurfacing procedures like lasers, chemical peels, microdermabrasion and dermabrasion. Microneedling and more invasive treatments like subcision can help elevate just a few deeper depressed scars to meet the surrounding skin as well. Injectable fillers (including hyaluronic acid fillers, longer-lasting fillers and a patient’s own fat) allow dermatologists to improve individual scars, but the product used dictates the longevity of results, which can range from six to 18 months, or permanently. Dermatologists are also using energy-based skin-tightening procedures to improve the appearance of acne scars. As the surrounding skin tightens, scars become less noticeable, and these treatments are safe for all skin tones.
For raised scars, dermatologists may recommend steroid injections, laser treatments or topical scar products like gels, creams or silicone sheets. Discoloration can be improved with topical medications and laser treatments designed to target unwanted pigment. Keep in mind that it’s common to combine multiple scar treatments for optimal results.
The takeaway
Remember, dermatologists are the only doctors who are trained to treat all issues related to the skin (as well as the hair and nails). Acne is the most common skin condition in the United States, and dermatologists have access to a wide range of treatments that can be mixed and matched to create a customized acne treatment plan designed for your skin’s unique needs