If after two months of consistent use of salicylic acid, benzoyl peroxide, and/or Differin (as outlined in the previous post) you’re still dealing with breakouts, it may be time to see a dermatologist. Moderate to severe inflammatory acne (nodules and cysts) will require medical intervention.
A dermatologist may prescribe one or more of the following to treat your acne:
Prescription retinoids come in a cream or gel form. Retin-A and Tazorac are examples of prescription retinoids. They improve skin by changing the way new skin cells get made. Retinoids can work wonders for acneic skin and help rejuvenate aging skin as well. They’re considered the primary therapy for initial acne treatment, but sometimes a retinoid alone is not enough. Read all about retinoids here.
Prescription topical antibiotics control the growth of bacteria and reduce inflammation. Examples of topical antibiotics include clindamycin, erythromycin, sulfacetamide, and dapsone. Some prescription topicals consist of a combination of an antibiotic, retinol, or benzoyl peroxide. Trial and error is often required to determine the most effective topical treatment for an individual.
A chemical peel works best for clearing blackheads and papules (small hard bumps). It gently removes layers of dead skin to reveal fresh, smooth skin. A series of chemical peels is recommended for optimal results. Deep cystic or nodule acne will be less affected by a peel, although the overall quality of the skin will be improved.
The Aerolase laser is highly effective at killing acne bacteria and clearing pores. Consistent treatments are required to maintain clarity.
The Clear + Brilliant laser works best once acne has cleared to lighten post-inflammatory hyperpigmentation (red and brown spots left behind by blemishes). Aerolase and the Clear + Brilliant will NOT produce the side effects commonly associated with laser treatment like redness, blistering, peeling, bruising or hyper or hypopigmentation. They’re two of the safest and most effective lasers for treating breakouts and their aftermath.
Large cysts may be injected with cortisone to eliminate inflammation almost instantly. This can help prevent or reduce scarring. Atrophy of the fatty tissue surrounding the blemish is a possible temporary side effect of having a cyst injected. Cortisone shots are considered symptom management and don’t have any preventative benefit.
Prescription antibiotic medicine kills acne bacteria. Doxycycline and minocycline are the most commonly prescribed oral antibiotics to this end. Antibiotics are ideally used short-term (usually three months maximum) as over time they can promote antibiotic-resistant bacterial strains and cause adverse effects. Stomach issues can occur because beneficial gastrointestinal bacteria are killed off. Fungal infections are another possible side effect, along with permanent tooth discoloration, skin sensitivities, and even sudden acne outbreaks.
Birth control pills
The birth control pill can work wonders for women whose breakouts are due to hormonal imbalance. Estrogen can help offset the effect of androgens. Androgens are responsible for sebaceous gland activity (oil production). It can take three to six months to notice improvement due to oral contraceptives. Different types of pills affect hormones differently so it can take some patience to find the right pill. For some women birth control makes acne worse, so if you’re already on the pill and have bothersome acne, try discontinuing it for a few months to see if the pill could be the culprit.
Spironolactone is a medication that reduces the effects of androgens. It’s only prescribed for acne in women, due to the possibility of feminizing side effects. Spironolactone reduces oil production. Menstrual irregularities are a side effect, and it must not be taken by women who are pregnant or trying to conceive because it causes congenital disabilities. You’ll want to drink plenty of water, as spironolactone is a diuretic and can cause dehydration.
Also known as Accutane, Isotretinoin is an oral retinoid. It’s the most aggressive treatment for acne but can be a miracle for people who are out of alternatives. Isotretinoin can cause serious, sometimes long term side effects, so it’s generally reserved for the most severe cases of acne. It successfully shrinks oil glands, often permanently. After a course of the drug, acne will often not return (or if it does, will be less severe).
Isotretinoin can cause miscarriage and severe congenital disabilities. A program called iPledge requires women who take the drug to be on two forms of birth control for a month before starting until one month following treatment. Monthly pregnancy tests are required throughout treatment as well.
Other possible side effects include dryness and peeling of the skin, muscle pain, nose bleeds, sensitivity to the sun, depression, an increase in triglycerides, liver damage, and pancreatitis. A fifteen to twenty-week course is common.
Some doctors will prescribe low doses of isotretinoin for mild to moderate acne, which is a controversial practice.
Read more about Isotretinoin here:
I sought the help of a dermatologist for my persistent cystic acne. When a retinoid and topical antibiotic alone weren’t enough, I was prescribed oral antibiotics, which made my skin very clear….until one day my acne came back worse than ever. The antibiotics seemed to stop working. It may have been one of those sudden outbreaks they warn about as a possible side effect.
I can no longer take birth control because it gives me migraines, so the dermatologist prescribed spironolactone. The spironolactone, plus clindamycin (topical antibiotic), and Retin-A completely cleared up my skin. This combination has kept me clear for several years now (knock on wood.) I also follow a skincare regimen at home that consists of a gentle face cleanser (usually Neutrogena), Paula’s Choice Resist 2% salicylic acid, followed by clindamycin gel, SkinMedica or Paula’s Choice moisturizer and Retin A. Of course, in the morning I apply sunscreen.
I highly recommend spironolactone for females with hormonal acne, as long as you’re not trying to conceive. The spironolactone made my skin much less oily. A retinoid also works great if you have acne, or you just want to keep your skin looking more vibrant and youthful.
Edited to add: Someone commented that this picture of me was scary. 🤣 I know it’s an odd angle. I hate, HATE photos of myself and rarely take them. This was the only angle I found that I felt was remotely flattering (and i realize it really even isn’t ). In no way do I think this is a glamour shot. I simply wanted to demonstrate that my skin has cleared up. I apologize if it’s odd. 😬. I’m not a selfie, “look at me” type of gal.