Acne affects nearly 85% of the U.S. population, making it the most common skin disorder in the United States.  Acne is caused by three major factors:  overproduction of oil by oil glands in the skin; blockage of the hair follicles that release the oil; and a growth of bacteria called Propionibacterium acnes (P. acnes) within the hair follicle.  While there are no cures for acne, there are treatments available to keep it under control.  

 Medications currently used to treat acne include topical retinoids, hydroxy acids, benzoyl peroxide and antibiotics. These medications are the cornerstone of therapy and are helpful both initially and in the long-term maintenance of acne treatment.  In general, mild to moderate acne is treated with topical medications such as retinoids, hydroxy acids, benzoyl peroxide and antibiotics.  These medications work by either unplugging pores or killing bacteria associated with acne flares. For moderate to severe acne, antibiotics taken by mouth are prescribed, such as tetracycline, doxycycline, minocycline or erythromycin, especially when there is significant involvement of acne on the chest and back.  When both topical treatments and oral antibiotics fail to control acne, Accutane can be prescribed.  Accutane must be prescribed with extreme care, because it has been linked to serious side effects such as birth defects.  It has also been linked to depression and suicidal thoughts.  Use of Accutane requires lab monitoring of blood tests while on the medication.

 Doctors sometimes use other procedures in addition to drug therapy to treat acne.  For example, some doctors inject cortisone directly into lesions to help reduce the size and pain of inflamed cysts and nodules.

Newer options available to treat acne include the use of laser and light-based therapies.  New laser and light treatments can specifically target two of the factors that cause acne, oil glands and P. acnes bacteria.  Both of these therapies not only reduce the bacterial count responsible for acne flares, but they also reduce the overproduction of oil by damaging the oil gland, which helps diminish, and in some cases completely remove the acne.  Lasers also promote collagen formation and renewal which regenerates new skin and also can be used to treat scarring.  These treatments are best used after prescription medications have failed to fully control acne and they are a nice alternative to the use of Accutane.  Lasers and light therapy do not replace the need for ongoing acne skin care.  It is important not to think of them as a replacement for other treatments, but rather as an adjunct to treat severe acne and bring it into a more manageable form that will respond to less aggressive treatments.

 One of the most recent devices available for the treatment of acne is called Zeno.  Zeno is the first FDA-cleared medical device for at-home treatment of occasional pimples that occur.  It is a portable handheld device that applies a precisely controlled heat dose directly to the pimple through a special tip.  One treatment lasts 2 ½ minutes.  Two to three treatments spread out over 24 hours clears up most pimples quickly.  Often, only one treatment is needed.  This device is best used in patients that have mild to moderate acne, are on a good skin care treatment plan, yet still have the occasional pimple that occurs.  It is ideal for treating that annoying pimple that needs quick resolution, such as the one the pops up right before an important picture-taking event, such as a wedding or graduation. It is a good treatment option, especially with the rise in bacterial resistance to antibiotics.

One cannot complete the discussion of acne treatment without mentioning other factors that influence the course of acne.  All of the correct medications and treatments can be used and acne still fail to improve if the following two factors are not addressed:  appropriate use of cleansers and cosmetics.  When cleansing the face, it is important to use a non-soap based cleanser.  Most soaps are fat-based and will clog the pores, aggravating acne.  It is also important how the skin is cleansed.  While cleansing, it is important to avoid aggressive scrubbing.  Scrubbing not only pushes bacteria into the pores, but it irritates and makes the pore swell, trapping bacteria inside.  This can lead to an acne flare.   It is also important to avoid popping, picking or squeezing pimples, which can lead to scarring.  Using the correct cosmetic products is also important.  Using cosmetics that say non-comedogenic (meaning they do not block comedones or pores) is also important.  New mineral cosmetics are ideal for patients prone to acne.  Bacteria cannot grow in the mineral base and therefore cannot add to the bacterial count when placed on the skin.  Also, mineral cosmetics do not plug the pores like other cosmetic products can.  As an added bonus, they have reflective properties that distract the eye and camouflage acne lesions.  So it is important to note that, when acne does not respond to all of the appropriate treatments available, a closer look at the cleanser or cosmetic being used may provide the reason why.