Available Acne treatments

There are a myriad of products sold for the treatment of acne, many of them without any scientifically proven effects. However, a combination of treatments can greatly reduce the amount and severity of acne in many cases. There are four types of acne treatments that have been proven effective:

Killing the bacteria that are harbored in the blocked follicles. This is done either by the intake of antibiotics like tetracyclines, or by treating the affected areas externally with bactericidal substances like benzoyl peroxide or erythromycin. However, reducing the P.acnes bacteria will not, in itself, do anything to reduce the oil secretion and abnormal cell behaviour that is the initial cause of the blocked follicles. Therefore, acne will generally reappear quite soon after the end of treatment—days later in the case of topical applications, and weeks later in the case of oral antibiotics.

Reducing the secretion of oils from the glands. This is done by a great daily oral intake of Vitamin A derivates like isotretinoin over a period of a few months. The product is sold by Roche under the names Accutane in USA and Roaccutane in Europe. Isotretinoin has been shown to be very effective in treating severe acne and is effective in up to 80% of the patients. The drug has a much longer effect than anti-bacterial treatments and will often cure acne for good. The treatment requires close medical examination by a dermatologist since the drug has many known side effects (which can be severe). At the end of the initial acne treatment, about 25% of patients need to take a second treatment for another few months to obtain desired results. The most common side effects are dry skin and nosebleed. It can also permanently damage the liver and, some studies suggest, cause depression. Because of this, the drug is typically used given a last resort after milder treatments have proven insufficient. The drug also causes birth defects if women become pregnant while taking it. For this reason, female patients are required to either use birth control or vow abstinence while on the drug.

Normalizing the follicle cell lifecycle. A group of medications for this are topical retinoids such as Tretinoin (brand name Retin-A), Adapalene (brand name Differin) and Tazarotene. Like Accutane/Roaccutane, they are related to Vitamin A, but they are administered as topicals and generally have much milder side effects. They can give significant irritation of the skin, but are probably rather less nasty than Accutane because less of it circulates in the bloodstream. The retinoids appear to influence the cell creation and death lifecycle of cells in the follicle lining. This helps prevent the hyperkeratinization of these cells that can create a blockage. Retinol, a form of Vitamin A, has similar but milder effects and is used in many over-the-counter moisturizers and other topical products.

Exfoliating the skin. This can be done either mechanically, using an abrasive cloth or a liquid scrub, or chemically. Common chemical exfoliating agents include salicylic acid and glycolic acid, which encourage the peeling of the top layer of skin to prevent a build-up of dead skin cells which combine with skin oil to block pores. It also helps to unblock already clogged pores. Note that the phrase "peeling" is not meant in the visible sense of shedding, but rather as the destruction of the top layer of skin cells at the microscopic level. Depending on the type of exfoliation used, some visible flaking is possible. Moisturizers and anti-acne topicals containing chemical exfoliating agents are commonly available over-the-counter.

Benzoyl peroxide and the topical retinoids may be the best compromise between genuine effectiveness and negative side effects in many cases. The topical retinoids are relatively new and not as widely used as the other acne treatments as of the year 2004. It is highly advisable to ask a dermatologist about the tradeoffs between these treatments for any individual case.

Popping a pimple or any physical acne treatment should not be attempted by anyone but a qualified dermatologist. Pimple popping irritates skin, can spread the infection deeper into the skin and can cause permanent scarring.

Future treatments

Lasers have been in use for some time to reduce the scars left behind by acne, but research is now being done on lasers for prevention of acne formation itself. The laser is used to produce one of the following effects:
to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them

Because acne appears to have a significant hereditary link, there is some expectation that cheap whole-genome DNA sequencing may help isolate the body mechanisms involved in acne more precisely, possibly leading to a more satisfactory treatment. (Crudely put, take the DNA of large samples of people with significant acne and of people without, and let a computer search for statistically strong differences in genes between the two groups). However, as of 2004 DNA sequencing is not yet cheap and all this may still be decades off. It is also possible that gene therapy could be used to alter the skin's DNA.