What's the best acne treatment?

Many great answers from above.

In our office, I will personally evaluate the type of acne prior to recommending any customized skin plan. Depending on the severity, I will recommend treatments with lasers and combine with a good skin care home line and re-evaluate on a weekly basis.

In general, for moderate acne our office has had good results with the Obaji Clenziderm line and Clarisonic MD brush with salicylic peels from the office staff. Antibiotics are all right, however, long term use is generally not the best approach.

Good luck!

Acne is a broad term used to describe a wide variety of skin breakouts from mild oily skin with blocked pores to severe painful, inflamed cysts. The treatment of Acne depends on the type of skin (light , dark, sensitive) and the severity of Acne.After Acne evaluation I generally use the following guidelines for long term MANAGEMENT of acne.

• Patient education is essential and helps establish realistic goals, long term compliance and better overall results.
• Acne is a skin condition which results from overproduction of thicker sebum leading to blockage of pores. Subsequent infection leads to painful cysts.
• It is paramount to OPTIMIZE  skin health for long term control of Acne without recurrent and prolonged use of  anti biotics.
• For mild inflammatory acne (oily skin, blocked pores, few painful red pimples), I start with at home skin care (Naila malik MD skin system) and a series of medical microdermabrasion.  These patients generally do very well with the products geared to improve their skin health with high dose antioxidants and botanicals combined with 6 to 8 sessions of Microdermabrasion . Most of my patients in this category have very good control of Acne within 10 to 12 weeks . By this time, the skin is healthier and the breakouts are completely resolved. Furthermore, the pores are shrunken and mild scarring is reuduced without use of topically irritant products.
• For moderate inflammatory acne (moderately oily skin, blocked pores, many painful red cysts, mild scarring) I start with at home skin care (Naila malik MD skin system), series of 6 microdrmabrsion, 2 or 3 chemical peels. I use a customized peel for acne which combines TCA and salacylic acid for excellent improvement. I also use a short course of antibiotics to achieve a quick control on active infection. I limit my antibiotics to 3 to 5 weeks. Most of my patients in this group have healthy, acne free skin and smoother skin texture in 12 to 14 weeks. Long term acne control has been achieved with at home skin care and occasional (once every 4 to 6 week) microdermabrsion.
• Severe cystic Acne presents a challange. Not only it is emotionally scarring, it can be disfiguring due to potential deep pitted acne scars.I urge patients to seek help as soon as possible to avoid permanent scarring. Traditionally Accutane has been used with some success for severe cystic Acne, however due to its potentially serious side effects, I DO NOT   use or reccomend Accutanne to any of my patients. It is important to know, that there are exellent and effective alternetives to Accutane without all the potential side effects.  I start with skin care (Naila malik MdD skin system) to optimize skin health. I also prescribe a brief course of antibiotics (4 to 8 weeks). I persoanlly have had very good success in reducing cystic acne with a combination of PHOTODYNAMIC THERAPY  and a series of CHEMICAL PEELS.  There is no predetermined number of treatments, I evaluate my patients frequently and determine the need for the appropritae treament. Once an adequate control of cystic acne has been established (usually in 4 to 6 months), I have a maintenance program with continued home skin care which is the cornerstone of acne treatment, microdermabrasion (4 to 6 weeks) and occasional chemical peels ( 1 to 4 times a year) depending on individual skin type and response.
• In addition to improving skin health with a good non irritant,  topical skin care system, it is important to take into consideration other factors that contribute to acne. A diet high in simple sugars and fat has been linked to acne exacerbation. Stress, both emotional and physical can lead to exacerbation. Hormonal changes, puberty, switching birth control pills, perimenopausal hormonal changes all contribute to Acne flare ups.
• General healthy lifestyle choices, diet rich in fresh fruits and vegetables, regular exercise, stress reduction, B vitamin suppliments all help achieve better control of acne

As you can see from the many different answers, there is no best treatment for acne. There is no one treatment that works best for every patient. A partnership between an experienced dermatologist and an experienced cosmetic surgeon is often necessary to arrest the acne process and treat the scarring associated with previous outbreaks.

The first step in the process is to stop acne outbreaks. This is best treated by consultation with a dermatologist. The next step is to erase the painful marks left behind. While no acne treatment can recreate unblemished skin, treatments can improve the texture of the skin.

It can take several treatments over years to get optimal results. In patients with darker skin, the options are more limited and more troublesome. Consultation with an experienced cosmetic surgeon is key to obtaining optimal results.

The four main problems to address in acne care are:

1. Blocked pores - skin debris on the surface can block pores. Acne starts with a blocked pore.
2. Excess oil production - oil gets trapped beneath the surface when skin pores are blocked. Acne-prone skin makes more oil than normal.
3. Inflammation - Acne patients often have red, thickened skin even when no pimples are there.
4. Excess acne-causing bacteria - The bacteria builds up in the areas of inflammation, causing a pimple or nodule.

Acne is treated best when these four major problems are addressed. Treatments to address these problems may include: 

• Microdermabrasion, which decreases surface skin cell debris and unblocks pores
• Chemical peels, especially salicylic acid, which not only decreases surface skin cell debris that blocks pores, but also decreases inflammation
• Photodynamic therapy, which kills off acne bacteria
• Blue Light therapy, which also decreases acne bacteria
• Red Light therapy, which decreases inflammation
• Laser treatment for sebaceous gland hyperplasia, which decreases oil gland size and oil production.

I often combine prescription medications and a home skin care plan with office treatments to maximize results. Which treatments are best for you? Ask an experienced doctor who treats acne regularly for best results!

The face, chest, and back have the highest amount of oil glands, so we normally get acne in these areas. The oil glands are regulated by hormones in the body, so when hormone levels fluctuate, the oil glands produce more oil, thus clogging skin pores, leading to inflammation, and eventually resulting in pus-filled acne lesions. Fast, effective acne treatment requires a series of prescriptions (Rx), as listed below.

Rx 1: Effective treatment of acne requires a thorough evaluation by a Dermatologist who practices scientifically. Success with acne requires the use of a combination of individually-tailored treatments within a holistic framework or regimen.

Rx 2: Prescription-based treatment is extremely important. Most patients find that “over-the-counter” acne medications are not very effective – this makes sense, because treatments sold on television, the internet, or in magazines are often missing key ingredients that are needed to successfully treat acne.

Rx 3: Cosmetic peels, such as the salicylic peel, are a very helpful adjunctive therapy and are often overlooked by most Dermatologists in favor of more expensive treatments. Laser light therapies such as the IPL laser (intense pulsed light) can also be employed as well, as IPL treatments shrink the sebaceous glands and decrease oil production. In short, each acne program must be tailored to each individual patient and the proper combination of therapies must be employed.

Rx 4: For treatment of acne flare-ups, a short course of prescriptive oral antibiotics may be utilized. I use antibiotics only for short periods of time, since patients will eventually become resistant to oral antibiotics. My main approach is to combine all of the best treatments into one effective program.

Rx 5: Some patients find that topical acne treatments irritate their skin – this can be avoided if the right medications are chosen and if your doctor takes the time to educate you on how to use the medications in a way that won’t cause irritation.

Rx 6: Certain contraceptives may worsen acne, and others may improve acne. In short, some contraceptives are far more helpful than others, and the patient who uses contraceptives should consult with a Dermatologist for information on which contraceptives actually improve acne.

Rx 7: Natural supplements can help too. I recommend a multivitamin and a high-potency B complex vitamin to boost the immune system, promote health, and reduce stress levels. Also, it is equally important to exercise regularly and maintain a balanced diet. Foods that are high in fat and sugar may set off a cascade of reactions in the body which promote acne. Environmental factors such as stress, lack of sleep, lack of exercise, nutritional deficiencies, alcohol, and smoking must all be considered. Finally, the astute dermatologist will assess the skin-care products that you are currently using, since many products such as certain cleansers, moisturizers, and make-up may be contributing to your break-outs. It is also important to assess the home and work environment for other exposures that may be aggravating factors. Seeing a Dermatologist who specializes in acne treatment and takes a “big picture” approach is the key. A multi-modal approach will bring about the best results.

I agree with Dr. Goldberg that laser treatment for acne is an excellent treatment option. There is usually no downtime associated with these treatments, they are safe for all skin types, and they also help with acne scarring. Another alternative is the use of AminoLevulonic Acid with Photodynamic Therapy (ALA with PDT). Both of these modalities provide a good option to long-term antibiotics or Accutane. Finding the right practitioner is key - do your research, ask questions, understand what the treatments and expected outcomes are.

It is my opinion that there is no “4-step solution” for acne, especially since there are so many different skin types, and what works for one person may not work for another.

I do think it is important to use products which have ingredients targeted for acne (benzoyl peroxide, salicylic acid) but also ingredients which balance, protect, soothe, and prevent the spread of infections (hyaluronic acid, MSM, copper).

Blue light therapy is a treatment that uses light to kill the acne causing bacteria. Perfect for those allergic to topical and oral antibiotics.

Acne needs to be treated two ways:

- Unclog the pores

- Kill the bacteria that causes the inflammation.

Ideally it should be treated with both modalities. Blue light is just half the answer. Cooltouch is a laser light source that shrinks the oil gland and results in decreased bacteria counts as well.

Patients do best when also using a retinoid ( Retin-A, Differin, Tazorac) because these products act to prevent the clogs in the pores, as well as are anti-inflammatory.

The most complete product to treat acne is still Accutane. If properly prescribed, it decreases bacteria because of its action on the sebaceous glad, unclogs the pores and is anti-inflammatory as well.

Visit a Dermatologist or go to a licensed esthetician. Chemical peels are key to bring down inflammation and dry up acne breakouts.

1. Utilize atopical antibiotic in the morning and alternate a retinoid with a benzoyl peroxide derived at night.
2. Blue light/red light combination LEDs are helpful to diminish acne causing bacteria and diminishing inflammation.

Adult acne is very common and there are several ways adults can handle this issue.

First, patients can take pills such as antibiotics and/or Accutane to eliminate or reduce acne breakouts.

A second option is laser treatment. This approach can be highly effective without the pill-associated internal complications. Most patients require approximately five to seven monthly treatments to see the desired improvement, with periodic re-treatments required as acne flares. An added benefit is that laser acne treatments can reduce the need for antibiotics and pills.

As always, patients should work with their doctor on a treatment regimen.

Choose an anti-acne system that not only treats the blemishes but also nurtures your skin, sealing in moisture and providing antioxidants to heal skin that has been exposed to the elements. Look for a system that you can use daily.

I am NOT a fan of systems that seek to “dry out” the pimple—think of what these types of treatments are doing to your face! Dried out skin looks weathered and aged. This is not a look that people should strive to achieve.

Also, look for systems that can address more than one of your specific skin care needs, e.g. acne and aging, sensitive skin, dry skin, etc.

Once you find a system that works for you, stay with it!! If you stop using it, your acne might return.

In general, I would recommend the following:

1. Use gentle but powerful formulations to lift away debris and kill bacteria instantly—by using the maximum amount of ingredients allowed by the FDA (e.g. 10% benzoyl peroxide), but use a wash, not a leave-on product, as leave-on products are drying
2. Use anti-inflammatory herbals to not only calm angry skin, but also take away the redness of the pimple. Make sure it’s pharmaceutical grade herbals that are scientifically measured to deliver the maximum effect that you can count on.

Salicylic Acid gel (I like Neutrogena Clear Pore) will dry blemishes and diminish appearance of pores.

Waxing can cause irritation and breakouts. Besides a bath gel and pumice gloves, also use a blemish lotion (Tu’eL Clear-It) on backs, chests, and faces as these are all normal break out body parts. This will dry out the blemish without drying the healthy skin, which you do not want to do.