Acne is a chronic inflammatory skin condition that occurs when hair follicles become plugged with oil and dead skin cells. While it is most frequently associated with the hormonal fluctuations of teenage years, it affects millions of adults worldwide. Leaving acne untreated can lead to deep emotional distress and permanent scarring. Fortunately, we have a range of highly effective treatments designed to clear the skin, prevent future breakouts, and mitigate scarring.
Understanding how to treat acne begins with understanding its root causes. Acne is driven by four primary factors: excess sebum (oil) production, the abnormal shedding of dead skin cells that clog pores, the proliferation of acne-causing bacteria (Cutibacterium acnes), and the resulting inflammation.
Acne treatments are broadly divided into three main categories.
1. Topical Treatments
Topical therapies are creams, gels, lotions, and washes applied directly to the skin. They are most suitable for mild-moderate acne.
- Topical Retinoids: Vitamin A derivatives like tretinoin and adapalene are a cornerstone of acne management. Topical retinoids increase cell turnover preventing pores from becoming blocked and reducing sebum production.
- Benzoyl Peroxide: This is a powerful antimicrobial agent, benzoyl peroxide kills bacteria in the hair follicles. Crucially, bacteria cannot develop a resistance to it.
- Azelaic Acid: This reduces inflammation, fights bacteria, and helps to fade red and dark marks left behind after a spot heals.
- Retinol: For those with very mild breakouts or sensitive skin, over-the-counter offers a gentler alternative to prescription retinoids.
- Winlevi: Winlevi is a new topical anti-androgen that targets hormonal acne directly within the skin's oil glands without systemic side effects.
2. Systemic Treatments
For moderate to severe inflammatory acne, deep cystic acne, or acne covering the chest and back, topical creams alone are unlikely to be effective. In these cases, systemic (oral) medications are prescribed to treat the condition from within.
- Oral Antibiotics: Medications such as lymecycline are used for a limited time (usually 3 to 6 months). Oral antibiotics reduce the bacterial load and provide anti-inflammatory benefits to calm deep, painful cysts.
- Hormonal Therapies: For female patients whose acne flares around their menstrual cycle or jawline, hormonal therapies are highly effective. The combined contraceptive pill regulates oestrogen and progesterone. Alternatively, spironolactone is a medication that directly blocks androgen receptors, reducing oil production.
- Isotretinoin: Reserved for severe or treatment-resistant acne, isotretinoin is an oral retinoid that shrinks sebaceous glands and alters the skin's environment. It offers the closest thing to a permanent "cure" for acne, though it requires strict medical monitoring due to potential side effects.
3. Laser and Light Therapies
Many laser treatments for acne have been tried over the years. In my experience the most effective is the AviClear laser. This uses a specific 1726 nm wavelength of light that selectively targets the sebaceous glands. By shrinking the oil glands with heat, it can give a long term improvement in acne.