Non-Hormonal Acne Treatments

Last Editorial Review: 1/30/2005

WebMD Feature

May 15, 2000 -- Many women who have battled acne throughout their lives are familiar with products like Retin-A and tetracycline, which are considered the more "traditional" ways to treat acne. Here's a rundown of those treatments:

Non-Prescription Treatments

  • Cleansers: There are a number of soaps and facial washes that claim to battle acne, but these are usually unnecessary if the acne is otherwise being treated. Cleansers can sometimes irritate the skin.
  • Benzoyl peroxide: Benzoyl peroxide, found in products like Clearasil, destroys the P. acnes bacteria by penetrating the follicle and releasing hydrogen peroxide. (Acne cannot survive in the presence of hydrogen peroxide.) It is an underrated form of treatment, says Guy Webster, MD, PhD, vice chairman of the department of dermatology at Jefferson Medical College in Philadelphia. The problem is that most people don't use benzoyl peroxide products correctly, says Webster. They apply the medicine to existing pimples rather than using it wherever they are likely to get acne, which can prevent it from popping up in the first place. "I would see far fewer acne patients if people knew how to use benzoyl peroxide correctly," he says.
  • Salicylic acid: Available in a number of lotions, creams, and pads (Stridex, for example), salicylic acid helps unclog pores by chemically destroying the plug. You must use salicylic acid treatments continually in order to see results, as pores clog up again once you stop.

Prescription Treatments

Antibiotics: Antibiotics for acne come in two forms, oral and topical. Topical antibiotics like Cleocin T and erythromycin (which is also available in an oral formulation) are limited in their ability to penetrate the skin and clear out some of the more stubborn P. acnes bacteria. Oral antibiotics, such as doxycycline and tetracycline, are often more effective because they circulate throughout the body and go directly to the sebaceous glands.

According to Alan Kling, MD, a clinical assistant professor of dermatology at Mount Sinai School of Medicine in New York, acne cysts (as opposed to blackheads and whiteheads) are better treated with antibiotics. Cysts are large, inflamed lesions that are filled with pus. They occur when the contents of a clogged pore seeps into the skin, thus producing a significant local immune response. Cysts can be painful and leave scars.

  • Topical retinoids: Retinoids (which are derivatives of vitamin A) work to unclog pores. Products such as Retin-A, Differin, and Avita are all retinoids. They're most effective in treating blackheads and whiteheads, says Kling. One of the downsides: Retinoids can dry out the skin and cause irritation.
  • Oral retinoids: Accutane is reserved for patients with severe cystic acne that is unresponsive to other treatments. However, dermatologists must perform a number of blood tests before administering Accutane, and women should not get pregnant while taking it because of the excessive risk of severe birth defects and spontaneous abortion associated with fetal exposure to the drug. Because many women who are prescribed Accutane are of childbearing age, they should not take retinoids unless they've used a reliable contraceptive method for one month prior to therapy, during therapy, and for one month after stopping therapy.

Other dangerous side effects of retinoids may include corneal opacities, decreased night vision, inflammatory bowel disease, and hepatitis.

Cathy Lu is a writer and editor based in San Francisco.

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