Topical treatments for acne: which option is best?

Acne is an extremely common skin condition, which leaves sufferers feeling self-conscious, embarrassed and ashamed. However, thankfully there are multiple treatment options available on the market nowadays which can relieve the symptoms of acne, leading to improved confidence for acne sufferers. Renowned dermatologist and dermatological surgeon Dr Paul Ferrant examines some of the current treatment options for acne.

What are topical treatments for acne and how do they work?

There are several treatments available which can be applied to the skin to improve acne, referred to as topical treatments.  They work in a number of ways. Treatments such as salicylic acid help remove the top layer of the skin and unblock pores.

Topical antibiotics have the ability to decrease bacterial overgrowth and have an anti-inflammatory effect. Topical retinoids, for example, have a number of different benefits such as affecting cell turnover, unblocking the pores and decreasing the oil produced by the hair follicle oil glands.

Are over-the-counter topical treatments effective for mild acne?

Yes, over-the-counter topical treatments can work well for mild acne. Salicylic acid and Benzoyl peroxide (BPO) are available over the counter and both can be beneficial. BPO has been used by dermatologists for decades and is still an effective and helpful treatment. Serums containing niacinamide, azelaic acid and topical retinol can also be beneficial for mild acne.

What prescription-strength topical treatments are available for acne?

Topical antibiotics, topical retinoids and combinations of these with benzoyl peroxide are all available on prescription. Topical retinoids are considered to be the most effective treatment for acne. They can cause redness and peeling, therefore it is important to start slow and build up gradually.

Whilst all topical treatments are designed for treating the whole spot-prone area, you can experiment initially by applying to the spots alone for the first 1-2 weeks as you get used to them. You can then increase usage over a wider area 2-3 times a week, building to alternate nights or nightly.

How long does it typically take for topical acne treatments to show results?

It can take several months for the benefits of topical treatments to become apparent. In order to be effective, they must be used in combination with a suitable wash and moisturiser for acne prone skin, often marketed as non-comedogenic.

What are oral treatments for acne, and when are they recommended? Which oral medications are commonly prescribed for moderate to severe acne?

Oral treatments refer to any tablet or capsule-based treatment for acne. Examples include antibiotics, hormone-based therapies (certain combined contraceptive pills or spironolactone) and systemic retinoids such as isotretinoin, more commonly known as Roaccutane in the UK.

Oral treatments are recommended for the following cases:

• severe cases of acne
• inflammatory acne where there are numerous pustules, papules or deeper lesions
• cystic acne
• widespread acne involving the chest and back.

How do oral antibiotics work to treat acne, and are there any potential side effects?

Oral antibiotics have an anti-inflammatory action, which combats inflamed acne lesions. They have an effect on all bacteria including bacteria in the gut. They can therefore cause a temporary upset to your bowels, such as loose stools or diarrhoea and nausea. The alteration of the normal bacteria can lead to yeast overgrowth and thrush. Some treatments can make you more sensitive to sunlight.

What is isotretinoin (Roaccutane) and when is it considered as a treatment option for acne?

Isotretinoin is a systemic (capsule-based) treatment for acne. It is highly effective but can be associated with a number of common side effects and therefore is usually restricted to consultant dermatologists to prescribe. These side effects are usually dose-related, largely predictable and can usually be very successfully managed.

Isotretinoin is used in cases of more severe acne, acne that has failed to respond to conventional care or acne that produces significant scarring. It is often used in adults who tend to have more persistent disease that often only partially responds to other treatments. One of the major benefits of Isotretinoin is that even years and decades after a successful treatment course, its effects remain withstanding.

If you are suffering from acne and would like to discuss treatment options with Dr Ferrant, do not hesitate to do so by visiting his Top Doctors profile today.