Skin Care: ACNE: Adult Acne - Adult Acne Treatment

Adult Acne: Acne Treatment

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Adult Acne: Acne Treatment

Contrary to what your mother may have told you, it’s not what you’re eating that causes acne. Acne has a strong genetic component, exacerbated by hormonal changes (most women already know this!); stress associated with school, jobs and starting families, and sometimes-poor skin care regimens. Everyone knows that acne affects teenagers, but most people do not realize that young adults in their 20´s and 30´s are more likely to develop acne than their teen counterparts.


There are different types of acne lesions as well as grades of acne severity. Treatment is based upon these possible combinations.

Types of acneiform lesions

  • Open Comedone (aka the blackhead).

  • Inflamed Papule.

  • Pustule (aka closed comedone).

  • Painful Nodular Cysts.

Dermatologists perform acne grading to help track improvement (or lack thereof) to therapy. Grade 1 is the mildest, with very few lesions. This continues up through grade 4, acne that has the most significant surface coverage.

When a patient presents in my office, I quickly evaluate the overall severity of the acne (the grade) and the types of lesions present. Every dermatologist has their favorite combinations of treatments that have been successful for their patients, so what I am about to share with you are regimens that I tend to favor. I allow 6-8 weeks for any therapy regimen to show significant (I didn’t say miraculous) improvement. If a patient does not demonstrate this, I will often change their medications. If you have been on the same medicines for a year and you are still breaking out, discuss this with your doctor!

Very mild, grade 1 acne, composed of small, superficial lesions, such as blackheads and pustules often responds well to topical therapy. My favorite topical that shows consistent resolutions of blackheads continues to be Retin A .025% cream. Frequently, patients will tell me they have used Retin A in the past and have experienced quite a bit of irritation. Almost everyone can use Retin A if used properly. I tell my patients to wait 30 minutes after washing before applying a pea-size amount of Retin A to the face. I also tell them to apply it only every other night when starting out. This minimizes the dryness. If the patient experiences anything more than some mild white flaking, they should back off to every third, fourth, or fifth nights, etc. until they can tolerate its use. For patients with incredibly oily skin or for those who have innumerable stubborn blackheads, I have been very pleased with the Tazorac Gel that comes in 2 strengths, 0.05 and 0.01%. It is used in the same manner as Retin A or other similar derivatives.

Prescription Therapy For Acne Currently On The U.S. Market*

Used to kill the bacteria P. acnes that causes acne flares as well as act as anti-inflammatory agents, reducing the size of acne lesions and helping prevent outbreaks altogether. Spironolactone works for those women with hormonal influences causing acne. BCPs again work at the hormonal level. Accutane works to correctly form the oil glands whose linings are improperly forming, and is the closest to a “cure” we have for acne.

  • Tetracycline
  • Minocycline
  • Doxycyline
  • Erythromycin
  • Bactrim (Sulfa)
  • Accutane
  • Birth Control Pills (Ortho Tricyclen)
  • Spironolactone

Topical Vitamin A Derivatives
Used to remove blackheads, dry up excess oils and smooth out bumpy acne.

  • Tretinoins (Retin A, Avita)
  • Tazarotene (Tazorac)
  • Adapalene (Differin)
Topical Antibiotics
Used to kill of P. acnes, the bacteria responsible for flaring acne outbreaks.
  • Erythromycin (Erycette, Emgel)
  • Clindamycin (Cleocin T)
  • Azelex
  • Benzoyl Peroxide (BPO)
  • Benzamycin (a combination of BPO and Erythromycin)
  • Clinac BP (a combination of Clinac O.C. and Benzoyl Peroxide)
  • Metronidazole (MetroGel/Lotion/Cream & Noritate))
  • Plexion Lotion & Cleanser (Sulfa based)


The stray cyst can always rapidly be resolved with a small shot of steroid solution known as Kenalog (triamcinolone). The plus side to this is the rapid resolution for those "little emergency" situations like weddings, prom, etc. The draw back is that this is simply not the way to treat widespread recurrent acne. Nor is it pleasant should you experience the atypical "sink" spot where fat atrophy has taken place as a side effect from the shot. Fortunately this is unusual and fills in over several months.


Drying agents help reduce oils and often contain ingredients to help unplug pores otherwise known as keratolytic activity. Many OTC products contain these 2 activities in addition to some antibacterial properties thanks to Benzoyl Peroxide.

  • Sulfur (Sulfacet R)

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