Acne treatments and medications for adults

Why treatment needs to match the acne

Acne develops when hair follicles become blocked with excess oil and dead skin cells. Bacteria can grow inside the blockage and cause inflammation and pus. Whiteheads and blackheads are different from deep, painful nodules and cysts, and you can have several types together. Hormone changes, certain medicines, and greasy skin or hair products can contribute.23

How do acne treatments and medications compare?

For a few mild spots, a pharmacist can help you choose a topical treatment such as benzoyl peroxide or salicylic acid. Deep, painful lumps, scarring or unsuccessful self treatment call for medical assessment rather than another shop purchase. Prescription topical medicines usually come as creams, gels or lotions; oral medicines are swallowed.23

Which treatments work together?

Combining different topical treatment types can improve results. Antibiotics should be used alongside benzoyl peroxide to reduce the development of antibiotic resistance, which makes bacteria harder to treat. Oral antibiotics should not become an indefinite treatment. A dermatologist can also consider a corticosteroid injection for faster relief of inflammation and pain in a larger acne bump.1

How strong should treatment be, and how long does it take?

One studied combination gel contains adapalene 0.1% and benzoyl peroxide 2.5%. Applied once daily for 12 weeks, it reduced both inflamed spots and blocked pore spots in people with moderate acne. That is a schedule for this particular combination, not a universal schedule for every retinoid or acne product. The combination also has a role in maintenance treatment, which means continuing treatment to help keep acne controlled.5

What skincare belongs alongside treatment?

Choose skincare and makeup labelled noncomedogenic, meaning designed not to clog pores, which is a more useful job description than 'miracle'. Wash with a gentle cleanser twice a day. Avoid scrubbing, which can irritate skin and worsen acne, and do not pick or squeeze spots because that can cause scars.23

Remove makeup at the end of the day, even when the makeup has already completed its working hours. For body acne, wear loose, breathable clothing, especially during exercise or sweating.23

What should you know before taking isotretinoin?

Isotretinoin treats deep, painful cysts and nodules. A course usually takes about six months, although it can be shorter or longer. Some people have worsening acne for 1 to 2 months at the start; tell your dermatologist if this happens.4

Dry skin, chapped lips, irritated eyes and nosebleeds are common. Apply an oil free moisturizer to damp skin after cleansing and whenever skin feels dry. Petroleum jelly helps dry lips indoors; outdoors, use lip balm with SPF 30 or higher. Artificial tears or saline eye drops can help dry eyes. Skin can become more sun sensitive: use shade, protective clothing and water resistant, broad spectrum SPF 30 or higher sunscreen. Reapply at least every two hours and after swimming or sweating.4

Isotretinoin must not be taken during pregnancy because it can cause severe birth defects and pregnancy loss. In the United States, all patients must enrol in iPLEDGE REMS. Patients who can become pregnant need two pregnancy tests before the first prescription and testing every 30 days for refills. Pregnancy prevention requirements include two forms of birth control or abstinence for one month before treatment, throughout treatment and at least one month afterwards.4

Immediately tell your dermatologist about mood changes while taking isotretinoin. The relationship between isotretinoin and mood disorders remains uncertain. Trouble seeing at night, thinning hair, and muscle or joint pain are other possible effects.4

What do reviews say about acne treatments and medications?

Across six clinical studies, adapalene 0.1% with benzoyl peroxide 2.5% produced better treatment success and satisfaction than the same gel base without the medicines. More people stopped the combination because of side effects. The combination was more useful for treating moderate acne than severe acne, although it could help maintain control after treatment of severe acne.5

Treatment satisfaction includes more than whether spots improve. How often treatment is used, how long it lasts, its format, cost and side effects all matter. When comparing experiences, separate the benefit from the practical burden of using the treatment.6

Are procedures, diets or supplements better alternatives?

Evidence is insufficient to recommend chemical peels, laser or light devices, microneedling, dietary changes, vitamins or plant based therapies as acne treatments. Established medicines have clearer support than these alternatives.1

When should you see a doctor?

Seek medical help if self treatment is not working, you have many spots, or spots are deep, painful or leaving scars. Hot, swollen and red skin can indicate infection; redness can be harder to see on brown and black skin. Acne affecting your mental health is also a reason to seek help.3

Acne care should include mental health and wellbeing alongside decisions about topical medicines, oral medicines and specialist treatment.7