ACNE IS EASY TO diagnose. It is the only skin disease in which comedones are present. Other skin diseases, such as rosacea and skin rashes caused by allergies or insect bites, may have red lesions that resemble papules, but there is an absence of comedones. Therefore, the presence of comedones, whether alone or in combination with other skin lesions, indicates the presence of acne.

Once acne is diagnosed, the doctor evaluates the type and severity of a patient’s lesions in order to determine what treatment is best. Acne treatment is individualized. It depends on the type of acne a person has as well as how severely acne lesions are inflamed. For example, treatment for whiteheads and blackheads focuses on removing dead skin cells that clog the follicles, while treatment for pustules is aimed at destroying infection and reducing inflammation. In an effort to achieve these different goals, different medications are needed.

To ensure that each patient receives the most effective treatment for his or her individual problems, doctors employ a special scale known as the acne grading scale. The acne grading scale rates the severity of acne on a scale from zero to eight, with zero indicating very mild acne and eight indicating very severe acne. For example, if a patient has a few comedones, he or she is given a zero rating. The rating increases with the number, size, and severity of a person’s lesions. Therefore, a patient with half of his or her face covered with papules, comedones, and a few pustules receives a four rating, which denotes moderate acne. A rating of eight indicates very severe acne, with the patient having acne lesions of all types, including numerous cysts, covering almost all of his or her face. Once a person’s acne has been rated, doctors match the rating to specific treatment plans recommended by the American Academy of Dermatology, an organization that studies skin diseases. At the same time, the doctor makes adjustments in the recommended treatment for individual differences. For example, these differences may include such factors as how dry or oily the patient’s skin may be, the patient’s gender, whether the patient is allergic to any medications, and whether the patient is pregnant or planning to become pregnant soon.

Because there are many differences in the severity and types of acne lesions, there are a wide variety of acne treatment options. These include over-the-counter medication people can purchase without a doctor’s prescription as well as more powerful, doctor-prescribed medications. Acne medication may be taken orally or applied directly onto the skin in the form of a topical treatment. Often, oral and topical treatments are combined. Once acne outbreaks are eliminated, a special type of surgery known as skin dermabrasion can lessen acne scars.

No matter what form of treatment is used, all acne treatments share a common goal: to control the sequence of events that cause acne outbreaks in order to prevent new outbreaks from occurring. Experts agree that since there are so many different acne treatment options available, most cases of acne outbreaks can be controlled. Edmonton, Canada, dermatologist Don Groot explains: “We’ve got acne by the tail now. If we catch it early, you can do wonders with acne. It’s not a difficult disease to treat anymore.”

Some of the most popular and effective treatment options available for acne are topical treatments. Most commonly used to treat cases of mild to moderate acne, topical treatments come in cream, lotion, or gel form and on specially prepared pads. Those used to treat the mildest cases of acne can be purchased without a doctor’s prescription.

Salicylic acid is a popular topical treatment that can be purchased without a doctor’s prescription. Salicylic acid does not treat infection or inflammation. Therefore, it is mainly used to treat comedones.

When salicylic acid is rubbed onto the skin, it penetrates the pores and gets inside clogged hair follicles. Salicylic acid causes the dead skin cells inside the follicles to dissolve. This allows oil trapped in the follicles to reach the skin. Many patients report that treatment with salicylic acid helps eliminate acne outbreaks. A patient explains: “I have blackheads on my back. I wipe my back with salicylic acid wipes every night. It didn’t help immediately, but after about a month, I noticed a difference. I think it’s helping.”

Benzoyl peroxide is another topical treatment that can be purchased without a doctor’s prescription. In fact, it is the main ingredient in most over-the-counter acne preparations. Used to treat mild inflammatory acne, benzoyl peroxide is available in different strengths. It is often used with products that contain salicylic acid by patients who have both comedones and mildly inflamed pustules.

Benzoyl peroxide is an oxidizing agent, meaning it releases oxygen. The bacteria that cause acne can only exist in an oxygen-free environment, such as a clogged hair follicle. When benzoyl peroxide penetrates hair follicles and releases oxygen, acne-causing bacteria are killed. This not only relieves existing infection but also stops new pustules from forming. A young woman describes her experience with benzoyl peroxide: “After two and a half weeks I was clearer than I had been since before puberty.… Using this benzoyl peroxide… has really changed the way I feel about myself and my ability to take on the world.”

In addition to benzoyl peroxide, there are a number of other antibacterial ointments used to treat mild inflammatory acne. These ointments contain chemicals such as sulfur that kill bacteria. In addition, there are a number of stronger antibiotic creams, gels, and lotions that contain powerful bacteria-killing drugs such as tetracycline and erythromycin, which are used to treat moderately inflamed acne. Although these products do control infection, they have no effect on clogged hair follicles. Therefore, these products are often combined with salicylic acid or a more powerful prescription-strength ointment such as Retin A, a popular retinoid.

Retinoids are derived from vitamin A, which has a potent effect on the skin. Scientists have found that when vitamin A is applied to the skin, it slows the growth of skin cells. This is important in preventing acne because when new skin cells form, old skin cells are shed. Slowing the growth of skin cells keeps dead skin cells from building up inside the hair follicles. This stops new comedones from forming. In addition, for reasons that scientists cannot explain, vitamin A slows down oil production and stimulates the production of collagen. This gives the skin a smoother appearance. Therefore, vitamin A is often used to help smooth out acne scars. According to the American Academy of Dermatology: “Vitamin A products can make a big difference in the appearance of the skin. They speed [collagen] cell turnover and slow down oil production.”

In addition to topical treatments, many people with moderate to severe inflammatory acne take oral medication, either alone or in combination with topical ointments. There are three main types of oral medications used to treat acne. They are antibiotics, hormones, and isotretinoin.

Bacteria-fighting oral antibiotics such as tetracycline, erythromycin, clindamycin, and doxycycline are often prescribed for people whose acne does not respond to topical antibiotic treatment. Oral antibiotics are absorbed through the digestive system, into the bloodstream, and then into the skin and hair follicles. Here they kill acne-causing bacteria and reduce inflammation. This helps stop new acne lesions from forming and gives the skin a healthier appearance by lessening redness. However, most oral antibiotics are absorbed into the bloodstream quickly. Consequently, they are eliminated from the body rapidly. Therefore, in order to maintain a constant level of bacteria-fighting medication in the bloodstream, oral antibiotics must be taken frequently for an extended period of time. Indeed, some people with acne take antibiotics two or three times each day for six months to a year. Moreover, once treatment with oral antibiotics is stopped, unchecked bacteria often cause new acne outbreaks. In an effort to prevent this from occurring, when the skin begins to clear, treatment with oral antibiotics is gradually tapered off, rather than stopped abruptly, and replaced with topical antibiotic treatment. This helps restrain the growth of acne-causing bacteria.

Despite these drawbacks, treatment with oral antibiotics can be quite successful. A patient describes how treatment with tetracycline helped him. “I used benzoyl peroxide and medicated pads, but they didn’t help. My acne was too bad. It took tetracycline to get it under control. It helped a lot, not 100 percent, but a lot. Even with the tetracycline, I still had some little pimples, but not those big old welts. Once the tetracycline kicked in I wasn’t embarrassed about my appearance anymore.”