The best treatments for acne

If OTC medications are not effective, a healthcare professional may be able to assist with a prescription for stronger medication.

Topical prescription treatments

Examples of topical medications that are available on prescription include tazarotene, adapalene, and tretinoin. They are all derived from vitamin A.

Some topical antibiotics may help to rid the skin of excess bacteria.

It may take a while to find a suitable dosage and combination.

Some people find that a prescription containing benzoyl peroxide combined with an antibiotic can help.

Benzoyl peroxide should be used sparingly, as too much can harm the skin and bleach clothes.

Dapsone gel may help patients with inflammatory acne.

Side effects linked to topical prescription medications include burning, peeling, redness, and stinging. The patient should keep in touch with their doctor to minimize adverse effects.


Share on PinterestAntibiotics are a potential treatment for severe acne.

Oral antibiotics, usually tetracycline, can be used together with a topical treatment for severe acne. Pregnant or breastfeeding mothers should take an erythromycin instead of tetracycline.

Most patients on oral antibiotics should notice improvements after about 6 weeks. A course may last from 4 to 6 months.

Tetracycline cannot be used with birth control pills, and too much direct sunlight exposure should also be avoided.

Antibiotic resistance is a growing problem among patients with pimples.

Doctors will advise tapering off antibiotics as soon as symptoms start to improve, or as soon as it becomes obvious that the drugs are losing their efficacy.

When topical benzoyl peroxide is prescribed together with an oral antibiotic, the risk of antibiotic resistance is lower.


For very severe symptoms, such as deep cysts, antibiotics may not be enough.

Isotretinoin, also known as Accutane or Roaccutane, may be prescribed.

This is a systemic oral treatment, which means it is taken as pills and affects the whole body.

A course lasts 15 to 20 weeks. During this time, the doctor must monitor the patient closely, because there is a risk of serious side effects.

Isotretinoin must not be prescribed to pregnant women or anyone who might become pregnant, due to the risk of fetal abnormalities.

Adverse effects include severely dry and cracking skin, nosebleeds, joint pain, and liver damage.

Depression and suicidal tendencies have been linked to isotretinoin, but a causal relationship has not been confirmed.

Two-thirds of users find that their symptoms disappear long term after treatment.

Birth control

Women with pimples may benefit if they take a combination of norgestimate and ethinyl estradiol.

Birth control pills can slightly increase the risk of hypertension, blood clots, and heart disease.

Laser and light therapy

Laser and light therapy targets Propionibacterium acnes (p. acnes), the bacteria that cause acne inflammation.

This therapy reaches deep into the skin without affecting the surface. By damaging the sebaceous glands, it causes them to produce less sebum, or oil.

Use of this treatment is controversial and its safety and effectiveness have not been proven.

Chemical peels and microdermabrasion

Microdermabrasion is commonly used for skin rejuvenation and to improve the appearance of acne scars.

These cosmetic procedures may be more effective when used alongside other acne treatments.

Dermatologists use special chemical peels that are not available from pharmacies.

Drainage and extraction

Drainage and extraction is used to remove a large cyst, especially if the cyst has not responded to medication.

It reduces the pain and lowers risk of a scar. If the cyst has to be dealt with rapidly, the doctor may inject it with medication.

Anyone who is concerned about the severity of their acne should visit a doctor or dermatologist.

Medications for Acne

Acne is a skin condition caused by dead skin cells sticking together and clogging up pores. Bacteria can play a role, too. A big trigger for the onset of acne is puberty.

Better nutrition and living standards have seen the age of puberty, especially in girls, decrease significantly over the past 40 years. It is now not uncommon for girls as young as 7 to develop acne. Acne is also affecting more adults later in life and doctors are not sure why. A growing number of women have acne in their 30s, 40s, 50s, and beyond.

What Causes Acne?

Our body constantly makes and sheds skin. Normally, dead skin cells rise to the surface of the pore and just flake off our body. At puberty, hormones trigger the production of sebum – an oily substance that helps moisturize our skin.

Sebum sticks dead skin cells together, increasing their chances of becoming trapped inside a pore. Clogged pores become blackheads, whiteheads or pimples. If bacteria are also present, redness and swelling can occur resulting in the progression of the pimple into a cyst or nodule.

Who is More at Risk of Acne?

Unfortunately, some people suffer from acne worse than others. Bad acne tends to run in families – your mother, father, aunt or uncle probably had severe breakouts when they were a teenager.

Some people also have naturally higher hormone levels and make more sebum, so their skin pores are always clogging up.

If you live in an area that gets very humid or have a job which exposes you to moist heat (such as in a food kitchen) or grease or tar (a mechanic or road worker) then you are more likely to get acne.

Chin straps, headbands, and even hair products applied too close to the skin can precipitate a break out as several different medicines – most notably prednisone, phenytoin, and certain hormonal contraceptives that are high in androgens (for example, Microgestin 1.5/30 and the Depo-Provera shot).

What are the Symptoms of Acne?

Acne may appear on the face, forehead, chest, upper back or shoulders. The symptoms and severity of acne vary from person to person but may include:

  • Whiteheads
  • Blackheads
  • Papules (small, red, tender bumps)
  • Pimples (papules with pus at their tips)
  • Nodules (large solid painful lumps beneath the skin surface
  • Cystic lesions (painful pus-filled lumps beneath the skin’s surface).

How is Acne Diagnosed?

If your acne makes you shy or embarrassed, if you have a lot of acne, cysts or nodules on your face or back, or if over the counter products do not seem to work, see your doctor or a dermatologist as soon as you can. They can prescribe stronger topical or oral treatments that are much more effective than products you can buy at a drug store.

Your doctor will look at your skin and ask about the history of your acne. It is a myth that you have to let acne run its course. Treatment helps prevent dark spots and permanent scars from forming as the acne clears.

How is Acne Treated?

The most important thing you can do to reduce the chance of breakouts is to take good care of your skin.

This doesn’t mean scrubbing it raw several times a day with soap. It means gently cleansing it with a mild soap-free wash twice a day, every day. If you play a lot of sport or work in a greasy or humid environment, cleanse your skin as soon as you finish training or right after work.

Be gentle. You aim to cleanse away excess sebum and dead skin cells so they don’t clog up your pores – not to irritate your skin even further.

The first step to clear skin is clean skin. Look for a cleanser that is soap-free and does not contain any harsh detergents such as sodium lauryl or laureth sulfates, which can cause redness, irritation, and inflammation. Avoid pore-clogging ingredients as well, such as algae extract, carrageenan, lanolin, myristyl myristate, octyl palmitate, octyl stearate-5, and oleth-3.

Anti-acne ingredients work by removing dead skin cells, unclogging pores, or reducing bacteria numbers on the skin.

Acne treatments usually contain one of the following ingredients (some of which are only available on prescription):

  • Benzoyl peroxide
  • Salicyclic acid
  • Resorcinol
  • Azelaic acid
  • Dapsone gel
  • Retinoids and retinoid-like creams, gels, and lotions
  • Topical antibiotics
  • Oral antibiotics (eg, tetracyclines,
  • Combined oral contraceptives
  • Oral isotretinoin
  • Spironolactone
  • Lasers and photodynamic therapy
  • Chemical peels
  • Steroid injections.

If you have severe acne you need to be very proactive with skin cleansing and using acne treatment. Seeing a dermatologist early on for prescription products lessens the chances of being left with permanent scars.

How Can I Prevent Acne?

  • Gently wash your face twice a day and after sweating.
  • Shampoo your hair regularly.
  • Do not pick or squeeze your acne; this increases the risk of scars.
  • Keep your hands off your face. Wash your hands before applying make-up.
  • Be careful what you put on your face, and avoid ingredients that promote acne.
  • Stay out of the sun and off tanning beds; excess tanning can damage your skin.
  • See a dermatologist if you feel shy or products don’t work.



Topical treatments (gels, creams and lotions)

Benzoyl peroxide

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin.

It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.

Benzoyl peroxide is usually available as a cream or gel. It’s used either once or twice a day.

It should be applied 20 minutes after washing to all of the parts of your face affected by acne.

It should be used sparingly, as too much can irritate your skin.

It also makes your face more sensitive to sunlight, so avoid too much sun and sources of ultraviolet (UV) light (such as sunbeds), or wear sun cream.

Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.

Common side effects of benzoyl peroxide include:

  • dry and tense skin
  • a burning, itching or stinging sensation
  • some redness and peeling of the skin

Side effects are usually mild and should pass once the treatment has finished.

Most people need a 6-week course of treatment to clear most or all of their acne.

You may be advised to continue treatment less frequently to prevent acne returning.

Topical retinoids

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating), which helps prevent them building up within hair follicles.

Tretinoin and adapalene are topical retinoids used to treat acne. They’re available in a gel or cream and are usually applied once a day before you go to bed.

Apply to all the parts of your face affected by acne 20 minutes after washing your face.

It’s important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.

Topical retinoids are not suitable for use during pregnancy, as there’s a risk they might cause birth defects.

The most common side effects of topical retinoids are mild irritation and stinging of the skin.

A 6-week course is usually required, but you may be advised to continue using the medicine less frequently after this.

Topical antibiotics

Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They’re available as a lotion or gel that’s applied once or twice a day.

A 6- to 8-week course is usually recommended. After this, treatment is usually stopped, as there’s a risk that the bacteria on your face could become resistant to the antibiotics.

This could make your acne worse and cause additional infections.

Side effects are uncommon, but can include:

  • minor irritation of the skin
  • redness and burning of the skin
  • peeling of the skin

Azelaic acid

Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

Azelaic acid works by getting rid of dead skin and killing bacteria.

It’s available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

The medicine does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.

You’ll usually need to use azelaic acid for a month before your acne improves.

The side effects of azelaic acid are usually mild and include:

  • burning or stinging skin
  • itchiness
  • dry skin
  • redness of the skin

What can clear severe acne?

If you wake up to find a few large pimples on your otherwise clear face, you may consider that severe acne. Likewise, a breakout of whiteheads and blackheads before a first date may seem like severe acne. But that’s not the type of acne we’re talking about here.

What is severe acne?

This 14-year-old boy has acne cysts, which cleared with an antibiotic and prescription medicine that he applied to his acne-prone skin. People who have severe acne tend to have many breakouts, which can cover their face, chest, and back. Severe acne can also appear along the jawline and neck. Sometimes, it develops on the buttocks.

Severe acne causes breakouts that often extend deep into the skin. Called cysts and nodules, these breakouts tend to be painful. When severe acne clears, acne scars often appear.

You may also see many blackheads, whiteheads, or both when acne is severe.

Anyone who has severe acne knows how stubborn it can be. You cannot clear it with acne treatment that you buy at the store. To see clearing, you either have to wait it out or see a dermatologist. Waiting out severe acne can take years.

Benefits of treating severe acne

Living with severe acne can be tough on your psyche. Many studies have found that acne can lead to poor self-esteem, depression, or anxiety. People with acne may stop hanging out with friends and family. Going after a job promotion or trying out for a sport may no longer seem worthwhile.

Acne treatment can help. Many studies show that treatment for severe acne can:

  • Clear acne

  • Prevent new scars

  • Boost a person’s mood and self-esteem

How dermatologists treat severe acne

When a patient has severe acne, a dermatologist often recommends treating it with one of the following.

Antibiotic + medicine you apply to the acne: This is often the first treatment recommended for severe acne. Taking an antibiotic can reduce the redness and swelling of acne. The medicine you apply to your skin works on reducing bacteria and clogged pores.

If this treatment fails to clear your skin, your dermatologist may switch your antibiotic or talk with you about isotretinoin (eye-so-tret-eh-no-in).

Isotretinoin: This is a potent medicine that attacks all four causes of acne—bacteria, clogged pores, excess oil, and inflammation (redness and swelling). About 85% of patients see permanent clearing after one course of isotretinoin.

Due to possible side effects, you will need to carefully consider whether you want to take this medicine. If you decide to take isotretinoin, you must enroll in a monitoring program.

Birth control pill (females only): A birth control pill can be an effective part of an acne treatment plan. When treating severe acne, a birth control pill may be used along with an antibiotic or a medicine called spironolactone (spy-ren-no-lac-tone) to get the acne under control.

Give treatment time

Give your acne treatment time to work. It can take two to three months to see improvement.

If the pill may be an option for you, it’s important to tell your dermatologist about all of your medical conditions, including heart disease. Your dermatologist must weigh the risks of using a birth control pill to treat acne against the benefits.

Spironolactone (females only): This medication can also effectively treat severe acne in women. It reduces excess oil.

If this may be an option for you, be sure to tell your dermatologist about all of your medical conditions.

Acne removal: Your dermatologist can use a few different techniques to remove a large cyst or nodule.

One way your dermatologist can get rid of a painful cyst or nodule is to inject it with a corticosteroid. This helps to quickly reduce the size and pain.

Another procedure is called incision and drainage. It’s used to drain a large, painful acne cyst or nodule that medicine cannot clear. You should not try to drain a cyst or nodule at home. The risk of infection is great when done outside of a medical office.

Dermatologists use a procedure called acne extraction to remove whiteheads and blackheads that fail to clear with acne treatment.

Low-dose prednisone: This is a super-potent corticosteroid. Dermatologists prescribe it to treat a very serious type of severe acne called acne fulminans. It’s also used to treat pityrosporum folliculitis, an itchy, acne-like rash.

Maintenance plan helps keep skin clear

After you see clear (or nearly clear) skin, you still need acne treatment. However, the type of treatment may change. Most people can keep acne away with proper skin care and medicine they apply to their skin. Without this treatment, acne can return quickly.

Skin care plays key role

Even when treating acne, the right skin care is essential. Acne-friendly skin care can make the difference between seeing clearing and an acne flare. You’ll find skin care that dermatologists recommend at, Acne: Tips for managing.

No one needs to live with severe acne

While severe acne can be stubborn, it’s not impossible to get clearing. Thanks to advances in treatment, virtually all acne can clear with a dermatologist’s help.

Severe acne: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Acne along jawline: Image from Thinkstock

Zaenglein AL, Graber EM, et al. “Acne vulgaris and acneiform eruptions.” In: Wolff K. et al. Fitzpatrick’s Dermatology in General Medicine, 7th edition. McGraw-Hill Companies, Inc., USA, 2008:696-700.

Zaenglein AL, Pathy AL, et al. “Guidelines of care for the management of acne vulgaris.” J Am Acad Dermatol. 2016;74:945-73.

Sad but true: Your facial oils, skin-boosting smoothies, and “I totally eat my greens” diet don’t always solve your breakout woes. But there might be a (semi) magic pill that can help. And they’re called supplements. Not just any old drugstore ones, though.

“Your body needs a balance of nutrients to stay healthy—and your skin, which is the largest organ in the body, is no different,” says Debbie Palmer, MD, a dermatologist and author of Beyond Beauty. While she recommends trying to get the best nourishment from your diet, Dr. Palmer notes that supplements can deliver your body glow-inducing ingredients you wouldn’t normally eat on the reg (like chlorella or krill oil, for instance).

Think of these skin-friendly pills as a hyper-targeted way to fill the gap between your topical treatments and nourishing foods. “Most of the time, the necessary therapeutic dose of a nutrient that helps with inflammation, hormonal support, or repairing the skin is hard to get on a daily basis,” says Corina Crysler, clinical nutritionist and co-founder of Glisodin Skin Nutrients.

But don’t think you can just pop open a bottle and see immediate results. Whatever your root cause of acne may be, Crysler notes it’s important to be consistent and patient. “Most supplement plans take at least two months to really start working in a noticeable way,” she says. “The skin also needs to go through a few cycles before you see new and healthy .”

Think of these capsules as a treatment that helps your skin to do its thing properly—and, of course, enhance your natural glow. Keep reading for the best supplements for clear skin, based on your acne type.

The problem: Hormonal acne

“This is the acne that typically shows up in areas around the chin and can be more predominate about one week before the menstrual cycle when estrogen starts to plunge and cravings increase,” says Crysler. “Cutting out dairy and sugar can significantly help, in addition to taking these supplements.”

Photo: Vega

The supplement: Maca root

It’s not just a smoothie booster—the herbacious plant helps stabilize your hormones, which is major if your breakouts coincide with your menstrual cycle. “This hormonal regulator works directly with the endocrine system to help establish balance,” says Crysler. “It acts as an adaptogen to help the system deal with stress and adrenal fatigue.” She advises that it can be used daily, but definitely 7-10 days before your menstrual cycle.

Try: Vega Maca Vegicaps

Photo: Sisu

The supplement: Vitamin B6/B12

Have bad cramps with a side of pimples? Consider B complex supplements. “This is a key vitamin for the metabolic system, and is also known to help with stress and PMS,” says Crysler. The combo of both B vitamins results in a super-effective one-two-punch, she adds, as B12 helps with the bioavailability of B6.

Try: Sisu Super B Complex

Photo: Metagenics

The supplement: Zinc

You probably only know zinc as the ingredient to look for in mineral sunscreens, but it can also play a role in getting clear skin. “Zinc reduces the production of dihydrotestosterone (DHT)—which can clog pores and increase pimple-causing inflammation,” she explains. She recommends dividing the daily dosage, since zinc can upset the stomach.

Try: Metagenics Zinc A.G.

Photo: Metagenics

The supplement: Evening primrose oil

If your acne is typically of the painful, cystic type (hello, raging hormones), evening primrose is your ideal aid. “This is a great source of omega-6 and GLA—another fatty acid, which has anti-inflammatory properties and helps sooth and strengthen the skin barrier,” says Crysler. “It also helps with healing lesions and redness.” The oil is also said to help relieve PMS symptoms. Win-win?

Try: Metagenics OmegaGenics Evening Primrose Oil

The problem: Stress acne

Excess stress tends to show up on your face—ever notice those pimples that pop up after a night of last-minute studying or rushing to meet a deadline? “Stress is a major factor in skin health, as it can trigger oxidative stress and start the inflammatory cascade in the body,” says Crysler. “This effects your adrenals, hormones, and your ability to fight off typical free radicals—which can irradiate the skin and cause acne.” Being able to manage stress is crucial—and luckily, some supplements can help your body with that.

Photo: Source Naturals

The supplement: Pycnogenol

Yes, collagen has glowy skin benefits (just ask Jennifer Aniston)—but the collagen your body naturally produces needs to be protected. Enter pycnogenol. “Pycnogenol is a branded pine bark extract, which has great antioxidant properties,” she says. “It protects the collagen matrix from free radicals and increases skin stability during healing, which reduces scarring from acne and can reduce hyperpigmentation.”

Try: Source Naturals Pycnogenol

Photo: GliSODin

The supplement: Antioxidant enzyme

Antioxidants are great (and fight skin damage, for one), but antioxidant enzymes are more powerful because they stay in the body longer, notes Crysler—which gives them time to work their magic on your complexion. “They have the ability to destroy millions of free radicals to reduce oxidative stress, which leads to inflammation,” she says. “And GliSODin helps your body produce more if its own antioxidants.” Basically, acne-causing free radicals don’t stand much of a chance.

Try: GliSODin Skin Brightening Formula

Photo: Sun Potion

The supplement: Ashwagandha

Adaptogens are rockstar herbs for the body—skin included. “Adaptogens are amazing for reducing stress while strengthening our bodies to properly regulate our adrenal system,” notes Crysler. “Ashwagandha is a favorite of mine and can be easily added to a smoothie or taken in capsules.” She points out that it contains withanolides, a natural, antioxidant-filled steroid that limits inflammation in the skin, in addition to helping your hormonal response towards stress.

Try: Sun Potion Ashwaghandha, $37

Photo: NutriStart

The supplement: Omega-3

Healthy fats from fish could result in a glowing complexion—just ask Victoria Beckham. But if you’re not ordering sushi on the reg, opt for a supplement instead. “Krill oil is particularity good for acne because it contains a carotene called astaxanthin, which is also an antioxidant. Krill also has higher phospholipid content, so it’s very beneficial for the skin barrier and hydration, plus it absorbs better than other fish oils,” says Crysler.

Try: NutriStart NutriKrill Superba Krill Oil

The problem: Dietary acne

“Acne on the cheeks and jaw line is a sign that your digestive track can use some help,” says Crysler. “A poor diet can be a leading cause of acne. Fried foods, sugar, dairy, and processed foods can cause inflammation in the body—and also be taxing on the liver.” This is why Crysler advises using liver-cleansing and nutrient-dense supplements to help manage those breakouts—key when you wake up after a wild night to a massive pimple on your chin.

Photo: WelOrganics

The supplement: Milk thistle

It’s not just a tincture your hippie aunt uses—milk thistle works double duty detoxifying your liver and fighting inflammation (multitasking FTW). “Milk thistle contains silymarin, which is both an anti-inflammatory and antioxidant that directly works with cleansing the liver,” says Crysler. It also helps your liver process fat more efficiently—and, of course, healthy fats lead to that coveted glow.

Try: WelOrganics Milk Thistle

Photo: Thorne Research

The supplement: Alpha lipoid acid

Another way to keep your liver clean (which leads to clear skin) is through alpha lipoid acid. “This supplement increases the production of glutathione, an antioxidant enzyme that helps protect your liver,” says Crysler. “It can also help with pulling heavy metals from the body—having too much in your system can show up on your skin.” Basically it works like a magnet for acne-causing buildup.

Try: Thorne Research Liver Tablets

Photo: BioChlorella

The supplement: Chlorella

Not everyone’s eating chlorella on the reg, but the nutrient-rich green—which comes from green algae—can help reduce your body’s stress levels and hormonal imbalances. “Chlorella is rich in magnesium, which diminishes stress and aids in the elimination of toxins as well as reducing inflammation,” says Crysler. There’s nothing like the power of greens.

Try: BioChlorella Chlorella Tablets

Originally posted on January 17, 2017; updated September 12, 2019.

Supplements can also help with your hair—check out the 10 best options for thicker, fuller strands. And these are the mental health-boosting supplements that everyone should take.

Don’t panic, but you’re probably causing your own breakouts. That massive zit wasn’t just manifested into reality – it’s the result of an unwashed makeup brush, an allergic reaction, a dirty pillowcase, the list goes on and on. So to help you cut the pimple-causing factors out of your life, we’ve rounded up all the best, easiest ways to make sure your skin stays clear.

To help us give you the best of the best acne tips, we enlisted Dr. Melissa K. Levin, an NYC-based dermatologist and founder of Entiere Dermatology, to spill the tea on the best acne products that really work.

Before you break out in yet another pimple, read up on all our best recs for how to get clear skin – and fast.

1. Always wash your face before bed. Not washing away the day’s grime? You’re asking for a breakout. Stash cleansing wipes on your nightstand for nights when you’re too tired to move.

You can try fragrance-free cleansing cloths from Cetaphil for around $7 (they’re available at most drugstores).

Gentle Skin Cleansing Cloths Cetaphil $6.99

2. Try an oil-absorbing moisturizer. The point of a moisturizer is to heal your skin, not make it feel greasy. Dr. Levin advises picking a daily lotion that will absorb any excess shine – like Differin Oil Absorbing Moisturizer, the winner for Best Moisturizer in Seventeen’s 2019 Beauty Awards.

“Differin Oil Absorbing Moisturizer contains Micropearl technology to absorb surface oil for a matte finish,” Dr. Levin says.

Oil Absorbing Moisturizer with Sunscreen – Broad-Spectrum UVA/UVB SPF 30 Differin $9.29

3. Don’t skimp on sudsing. Wash your face for 30 to 45 seconds with a dime-size amount of face wash. That’s how long it takes to clear dirt and oil off your face.

And there’s actually a chance that you’re washing your face all wrong. Watch this video from dermatologist Liv Kraemer to learn all the ins and outs of proper face-washing:

4. Wash off ALL your cleanser. Leftover cleanser equals leftover dirt and oil. Rinse with tepid water until skin feels clean and smooth and no longer slippery or soapy. (Hot water dries out your skin and cold water closes your pores.)

If you’re looking for a .

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5. Be gentle. Scrubbing too hard leaves skin rough and red. Don’t fight with your face. Skip harsh scrubs and even washcloths, which can be too rough on your face and can cause irritation. If you use your hands (though I recommend a cleansing brush instead, see number 7), be sure they’re clean, or you’ll transfer acne-causing dirt and oil right back onto your face.

6. Suds up your cleanser in your hands first. It helps activate the ingredients, so they are more effective when applied to your face.

7. Don’t skip your morning wash. Hairstyling products get absorbed by your pillowcase then transfer to your skin — if it’s not cleared away in the am, it’ll clog your pores all day long.

For your before-school wash, try something brightening that’ll help wake up your skin. If you have a hard time getting up in the morning, a cooling face wash can help you really look alive. Test out the Bioré Blemish-Fighting Ice Cleanser. It literally cools your skin as it cleans.

Blemish Fighting Ice Cleanser Bioré $7.99 $5.99 (25% off)

8. Use a cleansing brush. Let’s be real, you just can’t clean inside of teeny tiny pores with your fingers. An exfoliating brush has tiny bristles that can actually get inside to work the grime out of your skin. Trust me, use this thoroughly on your entire face every day and you’ll notice a change in your skin within the week.

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It may be a bit of a splurge, but the Clarisonic Mia is supposed to cleanse six times better than hands alone, reduce appearance of pores, and allow skincare products to absorb better.

Mia Prima Sonic Facial Cleansing Brush clarisonic $99.00

9. Don’t overwash. If your skin still feels oily, instead of washing again (which can make your skin produce even more oil), try an astringent after cleansing.

Blue Astringent Herbal Lotion Kiehl’s $18.00

10. Exfoliate. The trick is to remove the layers of dead skin cells and dirt that are blocking your pores — and your skin’s natural glow. Products with alpha hydroxy and lactic acids exfoliate gently to make you look radiant.

Yosuke Tanaka/Aflo

11. Wash, then exfoliate. When washing, first use a mild face wash to cleanse your skin. Then, lightly massage exfoliator onto your face. This may seem redundant, but before you exfoliate, you want a clean canvas, so that the exfoliant can focus on digging out the stubborn dirt and oil that are stuck deeper inside your pores.

For a great double-duty exfoliator, opt for Peter Thomas Roth’s Acne Face & Body Scrub. It’s an ultra-gentle yet effective acne scrub that cleanses, treats, and exfoliates the face and body with one percent salicylic acid.

12. You need to clean your phone, too. If you’re seeing pimples on your cheeks or anywhere near the area where you hold your phone, they may be from your phone. Since it’s always in your hand, your phone picks up lots of bacteria, which can then get transferred to your face when you make a phone call. Wipe your screen with an anti-bacterial wipe often to get rid of germs.

13. Stop touching your face. You know how you rest your chin on your hand when you’re sitting in class? That might be the reason for those blemishes on your cheek or jaw. You’re constantly touching things that have germs — anything from your phone to your locker — so, putting your hands on your face transfers all of that onto your skin.

14. Change that pillowcase! Not changing your pillowcases enough can also cause your skin to break out. Even if you wash your face every night, your pillowcases carry dirt and sweat from your hair, hands, and build up from the products you use on your face at night. It’s a good idea to change it every few days.

15. Beware of bangs. All that extra hairspray on your bangs could be the cause of those annoying pimples on your forehead and along your hairline. After applying hair products, swipe a cleansing wipe across your face, and try to keep hair products away from your hairline. In addition to your face, hair products can cause bacne, too. Use a mild body wash (or an acne body wash) after washing and rinsing hair to help keep body acne in check.

Body Clear Body Wash for Clean Neutrogena $6.49

16. Try the 3-step solution. If you have acne, dermatologists recommend fighting it with a three-step regimen: a salicylic acid cleanser, a benzoyl peroxide spot treatment, and a daily moisturizer.

Benzoyl peroxide works by fighting the bacteria that causes acne. It causes an exfoliating effect that might cause some slight peeling and can dry out your skin. It’s great for mild cases of acne, and you can get it without a prescription — many drugstore acne washes, creams and gels contain benzoyl peroxide. Prescriptions creams that contain higher doses of benzoyl peroxides such can also be prescribed by a doctor for more severe cases.

Salicylic acid dries out the skin and helps exfoliate it to make dead skin cells fall away faster. It’s good for mild cases of acne, and is available without a prescription. Many drugstore acne creams, washes, and gels contain salicylic acid, but stronger versions are also available in prescription form. It can dry up your skin and cause redness and peeling.

17. Ask your doctor about cortisone injections. If you wake up the day before school starts with a big honking zit, your doc may be able to help. If you can swing it, Dr. Levin says your best bet is to head to the dermatologist for a cortisone injection.

Related Story

It’s quick, with minimal discomfort, and will zap your zit almost immediately. This isn’t an easy or cheap option, obviously, but when it’s an emergency — like, you have a huge whitehead on the tip of your nose the day before senior portraits — it might be worth it.

18. Less is more. Too many products can irritate and too many steps may tempt you to skip. When it comes to your skin, more is definitely NOT more. In other words, trying a bunch of different remedies at once won’t boost your chances of making the zit disappear — more likely, it’ll just wreak havoc on your skin and turn a teeny-tiny pimple into a red, blotchy mess.

19. Seriously, DON’T POP IT. Popping can cause infections, making the situation worse. Instead, dab a sulfur treatment on problem areas morning and night. It brings down swelling until your zit disappears.

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20. Derms are here to help. At-home treatment not working? See a dermatologist. A few appointments to set up a regimen, plus, check-ins every three to six months may get you in the clear.

21. Know your options. Benzoyl peroxide products are great at fighting pimples, but can be drying to your skin, so use them once a day at most. If it’s drying out or irritating your skin, switch out your cleanser for a gentle formula. Make sure you keep up your regular acne spot treatment, though. It will clear away dirt and oil without stripping your skin of moisture. Salicylic acid (in creams, gels, astringents, or masks) dries less than benzoyl peroxide, so it can be used with more-drying cleansers.

“If you’re unable to get into a dermatologist for a cortisone injection then I recommend specialized hydrocolloid acne patch called ZitSticka which is a 24 freeze-dried microdarts bandage that self dissolves over two hours to deliver acne-fighting ingredients,” explained Dr. Levin.

KILLA KIT ZitSticka $29.00

“It contains oligopeptide-76, a new anti-inflammatory ingredient that’s like a gentler benzoyl peroxide, salicylic acid, niacinamide (which helps with anti-redness), and moisturizing hyaluronic acid.”

22. Try a prescription. Topical antibiotics are available only with a prescription and work by killing the bacteria on your skin that cause acne, and by reducing inflammation. Some examples of topical antibiotics are erythromycin and clindamycin. Your doctor may prescribe you them in conjunction with another topical treatment such as one containing benzoyl peroxide or a retinoid such as Retin-A.

If you tend to break out on the reg, avoid flare-ups by using a benzoyl peroxide face wash, or by applying a thin layer of a benzoyl peroxide spot treatment to your whole face before bed. Dr. Levin recommends Differin Daily Deep Facial Cleanser for a cleanse that’s soft on skin, but hits acne hard.

Daily Deep Cleanser BPO 5% Differin $12.99

“I love this gentle yet effective benzoyl peroxide facial cleanser (for the face and body),” she told Seventeen. “Benzoyl peroxide effectively treats inflammatory acne because it reduces the factors that can cause inflammation – the overload of P. Acnes bacteria.”

23. Wash those brushes! Make sure to wash your makeup brushes regularly with brush cleanser or baby shampoo. If you use makeup sponges, wash those too. These tools can accumulate bacteria, which can lead to breakouts. Dirty brushes can make the most expensive skincare routines go to waste.

Here’s how to properly wash your face brushes…

24. Be consistent. If you want great skin, care for it each day. Sporadic care won’t do it. And don’t expect any overnight miracles. It takes time for skin-clearing ingredients to kick in. Starting a skincare routine now will give you plenty of time for your skin to adjust by the time you walk through those double doors.

25. Get some sleep. Re-watching The Office until 3 am is not healthy for you or your skin. Not sleeping enough can make your hormones get out of whack and raise your body’s stress levels, which can make you breakout. Aim to get at least eight hours of sleep to look and feel your best.

26. Get your SPF on. Sunscreen isn’t just for summer — your skin needs protection every day, even in winter. There are now sunscreens for every skin type imaginable — even ones that help make your skin less oily, so your face stays matte and pimple-free.

Look for a daily moisturizer with SPF that says it’s “lightweight,” “oil-free,” or “oil-controlling.” For the highest level, look for a PA++ rating, it covers both UVA and UVB rays, so you’re guarded against everything from burns to future wrinkles!

Superscreen Daily Moisturizer Broad Spectrum SPF 40 PA+++ Supergoop! $38.00

If you’re looking for a concealer that does triple duty (offers great coverage, has SPF protection, and treats your acne), Dr. Levin has found the perfect one.

“IT cosmetics Your Skin But Better CC+ Cream great oil-free matte foundation that combines hyaluronic acid and tea tree oil with SPF 40 for sun protection,” she says.

CC+ Cream Oil-Free Matte with SPF 40 IT Cosmetics $39.50

27. Ask your doctor about birth control. Birth control pills that contain both estrogen and progesterone have been shown to lower the amount of androgens in your body (a group of hormones that causes your body to produce sebum; excess sebum triggers acne) and therefore, are sometimes prescribed to help treat hormonal acne.

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It can take a few months to see results and initially your acne may get worse. There are risks associated with taking birth control pills, and some types can actually make your acne worse. Talk to your doctor to see if taking birth control pills will help the kind of acne you have.

Learn all about how birth control can affect your skin here.

28. Carry oil-absorbing sheets in your bag. Use them to blot away any shine that pops up while you’re out and about.

Oil Absorbing Facial Blotting Sheets Clean & Clear $7.96

29. Antibiotics are an option. Oral antibiotics are usually used for moderate to severe acne, especially on the back or chest, and kill bacteria in your skin pores. The ones most commonly used are tetracycline and erythromycin.

Like all antibiotics, they can cause yeast infections as well as more severe side effects and can interfere with the effectiveness of birth control pills. They can also cause increased sun sensitivity, so you’ll need to be extra careful when going outside and use SPF daily.

For more extreme cases, your doctor may suggest Isotretinoin (Accutane), which is used in moderate to severe cases of acne when nothing else works, but can have more extreme side effects.

30. Pat skin dry. It seems like such a tiny thing, but skin is very delicate. Gently pat dry instead of harshly rubbing.

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Kristin Koch Executive Director Kristin Koch is the Executive Director of Seventeen, overseeing the content and editorial operations for all of Seventeen’s digital and print efforts.

Back acne: How to see clearer skin

Dermatologists recommend wearing sweat-wicking clothes when working out. If you have acne on your back—or “bacne” as some people call it—you don’t have to wait for it to clear on its own. Treatment and the right skin care can help you see clearer skin more quickly.

You may even be able to clear your back on your own.

Who can treat back acne at home?

You may see clearer skin from treating it yourself if you:

  • Have a few blemishes on your back (mild acne)

  • Developed back acne recently

  • Have a mix of whiteheads, blackheads, and pimples on your back, but nothing that’s painful or goes deep into the skin (moderate acne)

Anyone who has deep, painful acne on their back (or anywhere else) will need a dermatologist’s help.

OTC treatment for back acne that works

OTC stands for over-the-counter. It’s medical jargon that means any treatment that you can buy without a prescription.

Studies show that the following OTC acne products can help clear mild (or moderate) back acne when used along with acne-friendly skin care:

Benzoyl peroxide (emollient foam wash): This helps to kill the bacteria that cause acne. Used daily, it can help control back acne and reduce flares.

Benzoyl peroxide needs time to work

Studies show that benzoyl peroxide works best if left on the back for two to five minutes.

Letting the benzoyl peroxide sit on your skin for a few minutes has two advantages.

  1. This approach helps the medicine penetrate your skin. Skin is thicker on the back than on the face.

  2. Rinsing it off prevents bleached clothes, sheets, and towels. Benzoyl peroxide is known to bleach fabrics.

You’ll find OTC benzoyl peroxide foaming washes in different strengths. Using a product that contains 5.3% benzoyl peroxide is less likely to cause irritated skin, dryness, or peeling.

If you feel that you need stronger medicine, you can start with a foaming wash that contains 10% benzoyl peroxide. That’s the strongest concentration of benzoyl peroxide that you can buy without a prescription.

Retinoid (adapalene 0.1% gel): Using this along with benzoyl peroxide can improve your results. This OTC retinoid can help unclog pores, which will help the benzoyl peroxide work better.

Dermatologists recommend applying adapalene after you shower or before going to bed. Again, you want to apply it daily.

How to apply medicine to your back

For treatment to work, you must get it on your back. Investing in a lotion applicator for the back can help you apply the medicine where you want it.

If you’re not sure where to find one of these, just search online for a “lotion applicator for the back.”

Acne friendly skin care essential

To get the results you expect from treatment, you’ll also need acne-friendly skin care. Without it, your acne can flare, even when you’re treating it.

To help their patients with back acne get the best results, dermatologists recommend the following:

1. Develop these habits when working out or getting sweaty.

  • Wear loose-fitting workout clothes made of cotton or sweat-wicking fabric.

  • Wash workout clothes after each use.

  • Shower and change clothes ASAP after working out (or doing anything that causes you to sweat).

If you cannot shower immediately, use an oil-free cleansing wipe to gently wipe off your sweaty skin. You’ll also want to change out of sweaty clothes.

2. Cleanse your skin gently.

Scrubbing skin with acne may seem best, but this actually worsens acne. When washing your back and applying acne treatment, you want to be gentle.

3. Stop irritating your skin with harsh skin care products.

Antibacterial soaps, astringents, and abrasive scrubs can worsen acne. Ditto for loofahs, back brushes, and buff puffs. For best results, you’ll want to use gentle, fragrance-free skin-care products.

4. Use oil-free skin care products and cosmetics.

The packaging may read “non-comedogenic,” “non-acnegenic,” “won’t clog pores,” or “oil-free.”

5. Avoid using anything that rubs against your back, such as a backpack.

Anything that rubs against your back can irritate your skin, causing back acne to flare. Swap a backpack for a handheld bag. If you carry a purse on your shoulder, place the strap on your arm.

6. Resist the temptation to pick and pop acne, even on your back.

This will only worsen acne.

Choose the right sunscreen

Buy non-comedogenic, SPF 30, broad-spectrum, and water resistant sunscreen.

7. Protect your skin from the sun.

People often believe that the sun’s rays will help clear acne, but the sun can actually worsen acne. The sun’s rays tend to darken acne and cause it to last longer.

You can help clear acne by always wearing oil-free sunscreen when outdoors. You’ll want to apply sunscreen to all skin that clothes won’t cover.

8. Change your sheets and pillowcases weekly.

Clean sheets and pillowcases are essential for clearing back acne. You may want to change pillowcases twice a week. By the end of a week, sheets and pillowcases are swarming with dead skin cells and bacteria.

When washing sheets and pillowcases, be sure to use fragrance-free detergent. If you like fabric softener, it, too, should be fragrance-free.

When to see a dermatologist

It can take time to see results from treatment. If treatment works, you may start to see results in six to eight weeks. Complete clearing can take three or four months.

If you don’t see any difference in six to eight weeks, you may need a dermatologist’s help. With a dermatologist’s help, virtually every type of acne can be successfully treated.

Bikowski J. “A review of the safety and efficacy of benzoyl peroxide (5.3%) emollient foam in the management of truncal acne vulgaris.” J Clin Aesthet Dermatol. 2010;3(11):26-9.

Brand B, Gilbert R, et al. “Cumulative irritancy comparison of adapalene gel 0.1% versus other retinoid products when applied in combination with topical antimicrobial agents.” J Am Acad Dermatol. 2003;49(3 Suppl):S227-32.

Del Rosso JQ. “Management of truncal acne vulgaris: current perspectives on treatment.” Cutis. 2006 May;77(5):285-9.

Eichenfield LF, Andrew C. Krakowski AC, et al. “Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne.” Pediatrics. 2013;131 Suppl 3:S163-86.

Leyden JJ, Del Rosso JQ. “The effect of benzoyl peroxide 9.8% emollient foam on reduction of Propionibacterium acnes on the back using a short contact therapy approach.” J Drugs Dermatol. 2012;11(7):830-3.

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University Rutgers University

Physicians are scaling back on prescribing antibiotics for long-term acne treatment in favor of a combinations of therapies, report researchers.

For a new paper, which appears in Dermatologic Clinics, researchers surveyed studies on acute and long-term acne treatments over the past decade to identify trends.

“People are more conscious about the global health concern posed by the overuse of antibiotics and that acne is an inflammatory, not infectious, condition,” says Hilary Baldwin, clinical associate professor of dermatology at Rutgers Robert Wood Johnson Medical School.

“Overuse of antibiotics also can promote the growth of resistant bacteria, which can make treating acne more challenging.”

Prolonged use of antibiotics can affect the microbiome (the trillions of bacteria, viruses, and fungi that inhabit our bodies) in areas other than the skin, resulting in disease.

People who use topical and oral antibiotics were three times as likely to show an increase of bacteria in the back of their throat and tonsils compared with non-users, according to the study. Long-term use of antibiotics in acne treatment also links to an increase in upper respiratory infections and skin bacteria and may affect a user’s blood-sugar level.

Hormone imbalance

Doctors are increasingly exploring combinations of therapies instead of antibiotics for long-term treatment. Baldwin points to renewed interest in the antibacterial medication benzoyl peroxide that often combines with topical retinoids—medicines derived from vitamin A.

Benzoyl peroxide, which kills the acne-causing bacteria, helps the skin shed more effectively, reduces clogged pores, and doesn’t promote resistant acne-inducing bacteria strains.

Although acne is common in teens, it can continue into adulthood, affecting mainly women. The report notes that about 50 percent of women in their 20s, one-third in their 30s, and one-quarter in their 40s still have acne.

The oral medication spironolactone is particularly effective in women. Although this medication, typically prescribed for high blood pressure, heart failure, and swelling, is not FDA-approved for acne treatment, it is commonly used for disorders related to androgens, a group of sex steroid hormones.

Since hormone imbalance can trigger acne, doctors are looking to hormonal therapies, which target androgens in the development of acne and have been shown to be effective, safe, and require little continual monitoring.

Diet’s role

Laser and light therapies and regulating diet also show promise as non-antibiotic alternatives, but more research is needed, the researchers say.

“Our patients often ask about the role diet plays in acne development, but that remains unclear,” Baldwin says. “However, there is some evidence that casein and whey in dairy may promote clogged pores and that low levels of omega-3 polyunsaturated fatty acids in foods such as fish contribute to inflammation that can lead to acne.”

In severe acne, early intervention with the retinoid isotretinoin is effective without antibiotics. “This oral medication is unique among acne therapies in that it has the potential to not just treat acne but to eradicate it. It is 80 percent effective if a complete course is taken,” says coauthor Justin Marson, a medical student at Rutgers Robert Wood Johnson Medical School.

“Studies also have disproven internet theories that the medication increases the risk of depression, ulcerative colitis, and Crohn’s disease.”

Antibiotics remain highly effective for moderate to severe cases of inflammatory acne and are approved by the FDA as a supplement to other treatments such as benzoyl peroxide or a topical retinoid, the researchers say.

“Numerous studies have shown that these combinations are fast, effective and help reduce the development of resistant strains of bacteria that causes acne, but the Centers for Disease Control and Prevention recommend that antibiotics be used for a maximum of six months,” Baldwin says.

Source: Rutgers University

Patient Stories 5/10/17

Acne & Antibiotics: Why I Regret Not Speaking with my Doctor

by: Samantha Relich for Choosing Wisely Canada

Years after being on long-term antibiotics for her acne, a patient regrets not having a conversation with her doctor earlier.

For a long time, when Lauren looked in the mirror all she wanted was her acne gone. By the time she was in the 11th grade she had exhausted all her options for topical over-the-counter treatments.

A little desperate, she visited her family doctor who prescribed her Minocycline, an antibiotic. “I was already on birth control, so the antibiotic was the first thing that my doctor went to,” says Lauren. Her doctor told her that her acne looked like it might be cystic and advised her that an antibiotic was likely the only treatment that would give her clear skin.

Lauren jumped at the chance. The first six-month prescription worked so well, that Lauren stayed on the antibiotic for five years. “I just kept taking it,” Lauren says. “You know how it is when you’re in high school and you’re a little vain – once your acne’s gone, you just want it to stay gone.”

In all likelihood, the antibiotic was the solution most likely to clear up Lauren’s acne. However, now off the antibiotic, Lauren worries about the possible long-term side effects of being on an antibiotic so long. She also wishes she had been able to dialogue better with her doctor.

“I just went with it,” she says. As a teenager, it never crossed Lauren’s mind to ask her doctor about the risks associated with long-term antibiotic use. After the initial prescription, renewals became her default response. “It was easy to forget to bring it up when I did see her,” says Lauren.

Lauren took the daily prescription throughout her four years of university. A few times she stopped taking the pill for a month or so, hoping that her skin improved. Each time she stopped taking the pills her acne came back. She finally stopped taking the prescription in 2014.

“I started to realize that being on antibiotics for years couldn’t be good for me,” she says. However, more than that, she was tired of a solution that masked the physical symptoms of the problem but didn’t actually solve it.

“I wanted to figure out the real reason I was getting acne, whether it was hormonal or a food allergy,” Lauren says. She laughs, “I still haven’t really figured it out.” Her skin has improved, though; she has mostly cut out dairy and gluten and describes her new diet as “more on the vegan side.”

“I still really struggled when I came off the antibiotic,” she says. “My skin was the worst it had ever been.” In addition to the dietary changes, Lauren now uses a topical treatment. She explains she wishes she had asked her doctor about alternatives before committing to using the antibiotic for so long. “I probably would have tried lifestyle changes first, if I had known to ask,” she says.

The next time she visits her family doctor, Lauren wants to talk about the possible long-term effects. “I know she gave me the best advice at the time. But I want inquire about the effects that could have come from it,” she says.

Her advice to her high school self is simple she says, “If you’re at the point where you’re being prescribed a pill or another drug, do your research and ask your doctor as many questions as you feel like you need to ask.”

New low-dose antibiotics, topicals offer options for acne

LAS VEGAS – New acne treatment strategies that address the issue of antibiotic resistance include subantimicrobial dosing; new, narrower-spectrum antibiotics; and topical use of tetracycline-family antibiotics, according to Dr. Linda Stein Gold, a dermatologist at Henry Ford Hospital, Detroit.

Oral antibiotics have long been a mainstay of acne treatment, but long-term use of low-dose antibiotics may be contributing to the global crisis of antibiotic resistance. At least 2 million people become infected with resistant bacteria yearly in the United States alone, and at least 23,000 people die yearly from these infections, she noted.

Dr. Linda Stein Gold

“In dermatology we use antibiotics quite a bit, and we want to make sure when we’re utilizing drugs, we’re utilizing them in the best possible way,” Dr. Stein Gold said at the Skin Disease Education Foundation’s annual Las Vegas dermatology seminar. Finding the right antibiotic dose for effective treatment of acne can be a challenge, she noted. “Is more better? Is too little bad?”

In a review of new treatment strategies that address these concerns without compromising efficacy, Dr. Stein Gold said that the rationale for using subantimicrobial antibiotic dosing comes from the anti-inflammatory effect seen with many antibiotics, even with doses lower than needed for antimicrobial action.

For example, a study of a subantimicrobial-dose of doxycycline found that when adults with moderate acne were treated with the antibiotic (20 mg, twice daily) for 6 months, their acne significantly improved. The number of comedones, inflammatory lesions, and noninflammatory lesions improved significantly compared with those on placebo (Arch Dermatol. 2003 Apr; 139:459-64).

In another head-to-head trial that compared low-dose modified-release doxycycline with placebo or 100 mg of doxycycline, the lower dose outperformed both placebo and full-strength antibiotics. No resistant organisms were found among skin flora in the subjects, and the microbiota of the patients’ skin did not change significantly during the study period, she said.

Dr. Stein Gold’s work also suggests that systemic antibiotics may not be necessary for all patients with acne: In a study, after 12 weeks of treatment, adapalene plus benzoyl peroxide, in combination with doxycycline, resulted in significantly more patients with clear or almost-clear skin than with vehicle alone plus doxycycline. “Antibiotics are not always the golden nugget in the treatment of acne,” she commented.

Another tactic is to treat with antibiotics for a period of 3-6 months along with potent topicals, to get skin clear or almost clear, then discontinue the antibiotic and continue topical treatment. Many patients will be able to maintain clear skin on this regime, she noted.

A new tetracycline-family antibiotic, sarecycline, is in phase III trials for acne vulgaris and in phase II trials for acne rosacea. Sarecycline, “compared with existing tetracycline antibiotics, showed improved anti-inflammatory properties and a narrower spectrum of activity,” Dr. Stein Gold said.

A topical minocycline in a foam formulation shows promising results for tolerability and efficacy in phase II trials for moderate and severe acne, she added. Dapsone as a 7.5% topical gel formulation is in phase III clinical trials as well.

Another antibiotic with a long history of systemic use for acne, clindamycin, is also showing promising results in combination with benzoyl peroxide (1.2%/3.75% gel). A 12-week double-blind study of the combination, compared with vehicle alone for individuals with moderate or severe acne, showed significant improvement in comedonal and inflammatory lesions, as well as overall global improvement in severity, for the treatment arm, she said (J Drugs Dermatol. 2014 Sep;13:1083-9).

Dr. Stein Gold reports being a consultant and investigator for Galderma, Stiefel Laboratories, and Allergan; a consultant and speaker for Valeant; a speaker for Ranbaxy Laboratories, Promius Pharma, and Actavis; and a medical/legal consultant for Roche.

SDEF and this news organization are owned by the same parent company.

[email protected]

On Twitter @karioakes

Acne can be stubborn and frustrating to treat, and if you’ve been to the dermatologist, you may have heard of (or even been prescribed) doxycycline as part of a skincare regimen. Doxycycline is a popular treatment option, so let’s talk about what you should know while taking it.

What is doxycycline?

Doxycycline is an antibiotic, meaning it is a drug used to kill bacteria. It belongs to a group (sometimes called a “class”) of antibiotics known astetracyclines. Two other drugs in this class are tetracycline (yes it has the same name as the group!) and minocycline.

We don’t know for sure yet if any one of these three work better than the others, but your doctor will work with you to find the best treatment. Minocycline and doxycycline usually cause fewer side effects (like an upset stomach) and don’t have to be taken as often, so they are prescribed more commonly than tetracycline.

Brand names for doxycycline include Vibra-Tab, Doryx, and Oracea, among others. Generic versions includedoxycycline hyclate and doxycycline monohydrate.

How does doxycycline help my acne?

Bacteria live on everyone’s skin. In fact, there are around1,000 types of bacteria that call your skin home. One of them, called P. acnes, lives in the oil-producing glands of your skin. When you reach puberty, your testosterone levels will rise, causing those glands to make more oil. All that extra oil results in P. acnes multiplying and causing inflammation. Inflammation is one cause of acne.

Doxycycline treats acne by killing off these P. acnes bacteria, so they can’t cause inflammation, and also by reducing the inflammation that is already there.

How long does it take to start working?

Like other acne treatments, doxycycline needs some time to start working. Your acne might start improving within 2 weeks, but it can take up to 12 weeks (or 3 months) to see the full benefit of the treatment. You’ll know doxycycline is working for you when you see less acne forming and your skin starts to look clearer. Many treatments can make your skin look worse when you first start them, but this is generally not an issue with doxycycline.

How long do I need to take doxycycline?

If you’re still taking doxycycline at 3 months, you and your provider can decide whether or not you should continue taking it at that point. Doctors often limit doxycycline treatment to 3 months to prevent P. acnes from becomingresistant to doxycycline (meaning the medication no longer kills them). However, everyone is different, and your doctor might want you to stay on it longer.

Doctors also usually prescribe doxycycline with other treatments, primarily topical treatments like retinoid creams or benzoyl peroxide. This is so that:

  • After you stop taking doxycycline, you still have treatment and your acne won’t come back
  • You only need to take doxycycline for a short time (which reduces the chance that P. acnes will become resistant to doxycycline)

If your doctor prescribed doxycycline and another drug for you to use at the same time, it’s important to follow their instructions to get the best results.

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What’s the best way to take doxycycline?

Doxycycline comes in a tablet or a capsule you take by mouth with a full glass of water. For acne, the typical dosing for doxycycline is 50 mg or 100 mg twice daily or 100 mg once daily. But some forms of doxycycline are taken as 20 mg twice daily or 40 mg once daily.

Doxycycline can cause an upset stomach, so if you experience this side effect, taking it with food can help. Keep in mind though some forms of doxycycline, like Oracea (doxycycline 40 mg), should be taken only on an empty stomach so your body can fully absorb it. Check with your doctor or pharmacist before starting treatment to find out how you should take it.

Dairy products and other foods as well as supplements high in calcium or iron can also prevent absorption. The key is to plan ahead. Don’t consume dairy products or take calcium or iron supplements within 1 hour before or 2 hours after taking doxycycline. Remember, too, that many multivitamins have iron and calcium in them that could interfere with your doxycycline treatment.

What are common side effects of doxycycline?

Most people do well on doxycycline, but all medications can cause side effects. The most common side effects of doxycycline are:

  • Sun sensitivity (getting burned more easily in the sun). Be sure to protect yourself in the sun while taking doxycycline. If you’re planning to be outside, remember to wear sunscreen, find shady spots, and wear protective clothing, a hat, and sunglasses.
  • Nausea, vomiting, or diarrhea. Depending on the type of doxycycline you have, your provider may recommend that you take it with food or switch to a different medication to avoid these side effects. Once you stop taking doxycycline, your stomach will likely feel better within a few days.
  • Inflammation of your esophagus (the tube that connects your mouth to your stomach). This condition is known as esophagitis; it can feel like heartburn and might cause pain when you swallow. You can prevent esophagitis by not lying down for at least 30 minutes after taking doxycycline.

Rare side effects of doxycycline include:

  • Permanent yellow staining of teeth. If children or pregnant women take doxycycline, it can permanently stain the children’s (or unborn child’s) teeth. Because of this, children and pregnant women shouldn’t take doxycycline for acne, though they may be able to take it for certain infections.
  • Stevens-Johnson Syndrome (SJS) or toxic epidermal necrolysis (TEN). Both of these are very rare but serious immune reactions, usually caused by a medication. Symptoms start appearing 1 to 3 weeks after starting the medication and can include a rash, usually on the face, neck, or upper torso; fever; headache; and coughing. If you think you might be having these symptoms, call 9-1-1 or go to the nearest emergency room immediately. While SJS and TEN may be scary, keep in mind they are very rare. In fact, looking at all people (regardless of whether they’re taking a medication), it’s estimated that SJS happens in as few as 1 in 1 million people, and TEN happens in as few as 1 in 2 million people.

Always consult your provider if you have questions or concerns about side effects.

Can doxycycline interact with any other medications?

The following over-the-counter medications may make doxycycline less effective by blocking how much of it you absorb from your gut:

  • Calcium-containing antacids (Tums)
  • Iron supplements
  • Bismuth subsalicylate (Pepto-Bismol, Kaopectate)
  • Aluminum- and magnesium-containing products, like Milk of Magnesia, Maalox, and some multivitamins

These prescription medications can also interact with doxycycline:

  • Warfarin. Warfarin is a popular blood thinner (a drug that keeps your blood from clotting). When taken with doxycycline, doxycycline can increase the effects of warfarin, leading to severe bleeding when your blood can’t clot properly. If you are taking warfarin, your provider will likely be monitoring your INR level, a measure of how much the warfarin is thinning your blood. This will be even more important if you start taking doxycycline.
  • Seizure medications. Some seizure medications (phenytoin and phenobarbital, for example) might make your doxycycline less effective.

Note that this is not a complete list of all the medications and supplements that can interact with doxycycline. Make sure your doctor and pharmacist are aware of all the medications you are taking, including over-the-counter and herbal medications. That way they can check if doxycycline is safe for you.

How much does doxycycline cost?

Doxycycline hyclate and doxycycline monohydrate, the generic versions of doxycycline, are two forms that have similar effects and are prescribed at about the same rate.

However, the average retail price of doxycycline monohydrate is about half that of doxycycline hydrate. The average retail price for 20 capsules of 100 mg of doxycycline monohydrate is about $44, while the average retail price for the same prescription of doxycycline hydrate is about $87.

To save on doxycycline, check with your insurance plan first. Most Medicare plans and private insurance plans cover both doxycycline monohydrate and doxycycline hydrate. You can also save by usinga GoodRx coupon or a mail order pharmacy. Currently, the lowest GoodRx price for a prescription of twenty 100 mg tablets of either medication is just $12.

Regardless of whether your provider prescribes doxycycline hydrate or monohydrate to you, you can ask your pharmacist to swap your prescription for the other if you find that that price is better. They might just want to call your provider first to confirm it’s okay.

What are some alternatives to doxycycline?

Doxycycline is a popular acne medication, but it’s not for everyone. When it comes to antibiotics for acne, the American Academy of Dermatology also recommends these:

  • Minocycline
  • Tetracycline
  • Azithromycin
  • Erythromycin
  • Sulfamethoxazole/trimethoprim

With all of the treatment recommendations out there for acne, don’t forget that your healthcare providers are there for you. Whether it’s sorting out side effects or figuring out your insurance coverage, work with your provider to find out which medication, if any, is right for you.

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  • Is low-dose doxycycline effective to treat acne?

    Low-dose doxycycline is a treatment that is gaining some momentum. When this antibiotic is at doses much lower than those traditionally considered to be therapeutic, it seems to have at least some effect on the growth of the bacteria. In addition, at these lower doses, there does not seem to be the same adverse side effects or bacterial resistance. The low-dose formulation works not by killing off the bacteria, as it would at the higher doses, but by affecting the ability of the bacteria to cause problems in the skin. In the studies done so far, at the end of 6 months, when the low-dose oral antibiotic was used alone, without any other adjunctive treatment, there was a 50% reduction in inflammatory lesions and a 53% reduction in comedones. There was no decrease in the number of Propionibacterium acnes in the skin, nor was the resistance profile affected. The bacteria that were present were simply inactivated. Side effects were minimal to none.
    Although the drug’s side-effect profile is definitely a plus, 6 months does, however, seem like a long time to wait for improvement of the acne. The acne was improved, but not completely resolved. The clearance may improve more quickly if combined with topical benzoyl peroxide or retinoids. It remains to be determined how useful this drug will be in the long term for the treatment of acne.

    Does antibiotics clear acne

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