Some people feel they’ve tried everything in vain, but solutions are available.

Sometimes you might get the impression that you’re bombarded with information about the various types of treatments available for acne – oral, topical, prescription, over-the-counter, medical, natural, scientific, home remedies, etc. Admittedly, it isn’t easy to navigate the different options and find THE treatment that will work for your skin.

 

Acne: a multifactorial problem

All skin and acne specialists know that there isn’t necessarily one single miracle solution. Acne is multifactorial, and a whole set of complementary treatment and lifestyle measures must be taken to optimise the chances of success.

To help you gain a better understanding, here is an overview of some possible strategies and of the range of treatments currently available:  When should you see a dermatologist?  What topical andoral treatments are used for acne? How effective are they, and what are their side effects?

It all depends on the severity of the acne lesions and their impact on quality of life.

  • We know that acne is a normal part of adolescence and that some young people get through it relatively easily, thanks to the use of suitable dermo-cosmetic products and a proper cleansing routine. But it is more difficult to manage for other teenagers, who cannot tolerate their spots and blackheads and thus promptly seek medical advice.
  • As for adults affected by persistent or recurring acne, they tend to see a doctor more quickly for their problems, which can have a significant impact on self-image and self-esteem at this time in life.
  • There is a lot of emphasis on self-image these days, and people with acne tend to rapidly turn to a dermatologist when topical over-the-counter treatments are not working. You shouldn’t hesitate! As a matter of fact, acne is the number one reason for seeing a dermatologist. Only a doctor can objectively evaluate the severity of your acne, according to the official classification of the French Dermatology Society, and prescribe the corresponding treatment. He will also take into account any treatments you may have tried that have failed.
  • Lastly, for young girls and adult women, the choice of an appropriate birth control pill can be decisive in improving their skin. You can discuss this possibility with your gynaecologist, being sure to provide him with any details that will be useful in determining a course of action.
Doctor with patient - Prescription

The 4 main objectives of acne treatments

The various types of acne treatments, whether for topical application (creams, gels, etc.) or oral use (tablets, capsules, etc.), have specific objectives. In some cases, several molecules can be combined to target various components of acne.

Immunity

1. Target Cutibacterium acnes (formerly known as Propionibacterium acnes), the bacterium involved in acne.

Clogged pore

2. Reduce the amount of sebum secreted by the body, thereby minimising its consequences.

Papule

3. Target the inflammation of closed comedones, red spots, cysts, etc.

Blackhead

4. Target comedonal lesions (blackheads or whiteheads) with molecules activating skin cell renewal to generate a keratolytic effect.

Oral acne treatments can only be prescribed by a doctor who has evaluated the severity of the acne.

  • Antibiotics, primarily cyclins and erythromycin, are indicated for inflammatory acne, since they combat the bacteria that have infected the lesions. They are currently being called into question due to their likely effects on the skin microbiome and the microbial flora in general, which may promote the growth of resistant bacteria.

“It should be noted that most treatments are photo-sensitising, i.e. they can cause the skin to react to the sun”.

This means you absolutely must use sun protection when exposed to UV rays. The use of antibiotics for the treatment of acne should be limited to a three-month period.

  • Hormonal treatments combine oestrogen and a progestin and are mainly intended for adult women. They work like the birth control pill and have the same risks and contraindications. They are reserved for certain forms of acne and require close surveillance due to the high risk of thrombosis.
  • Lastly, oral isotretinoin is used for the most severe cases or those resisting other forms of treatment. It is a vitamin A derivative that targets both sebum production and inflammation of the pilosebaceous follicles. It is prescribed under strictly controlled conditions and must be used in conjunction with a method of contraception since this molecule can cause serious foetal abnormalities if taken by pregnant women. It has many possible side effects, including severe dryness of the skin and mucous membranes, but its efficacy is undeniable.
  • Zinc, or rather zinc gluconate, is used to target the inflammatory component of acne.
Woman taking medication

There are many different topical treatments available on the market to treat acne. Some are available over the counter, while others require a medical prescription. Sometimes, the same active ingredients are used but at different concentrations, and the most concentrated formulas are dispensed by prescription only.

First of all, you should keep in mind the importance of adopting a non-comedogenic cleansing and moisturising routine suitable for acne-prone skin.

“Topical treatments generally have one or more targets, depending on the types of lesions observed, and can combine several types of active ingredients”.

Their effects are usually visible after four to six weeks of treatment.

  • Gels and creams with keratolytic action aim to refine the skin texture by stimulating cell renewal in the epidermis to eliminate comedones beneath the skin. They are mainly intended for cases of comedonal acne characterised primarily by hyperkeratinisation. These products often contain AHAs (alpha hydroxy acids), BHAs (salicylic acid) or benzoyl peroxide, which also has antibacterial action. They are often irritating and require a high level of sun protection.
  • Antibacterial treatments, often using antibiotic molecules, can be associated with anti-inflammatory action. They aim to reduce the activity of the Cutibacterium acnes bacterium which causes inflamed red spots, likely to progress to cysts. This class of treatments includes erythromycin, azelaic acid, clindamycin, etc. Once again, the negative impact on the skin microbiome is currently being studied and the use of benzoyl peroxide is recommended. These treatments can be used in combination with zinc, with anti-inflammatory properties, to increase their efficacy.
  • Retinoids encompass topical treatments containing isotretinoin, tretinoin or adapalene, capable of having both keratolytic action on comedonal acne and antibacterial action on inflammatory acne. They are sometimes used in combination with topical antibiotics or benzoyl peroxide.
Woman applying cream on her face in a bathroom

The side effects of acne treatments

The adverse effects of oral and topical treatments vary significantly depending on the dose, the duration of treatment, and the patient’s personal profile. They can be divided into three main types.

The goal of most treatments is to reduce sebum secretion, so it is logical that they dry out the skin. Over time, there may be irritation and increased sensitivity, sometimes limited to the mucous membranes (lips in particular) and sometimes affecting the entire face.

This is a very common phenomenon with oral isotretinoin. In all cases, it is necessary to counterbalance this dryness through the use of topical moisturising treatments suited to acne-prone skin. They should be non-comedogenic and supply a sufficient amount of fat to nourish the skin without causing new spots.

Your Skin - Woman - Dry Lips

Many acne treatments, especially antibiotics (doxycycline) and isotretinoin, can cause increased sun sensitivity. If taking them in the summer, you must therefore use a non-comedogenic sun protection product.

More broadly, you should be aware that acne treatments dry out the skin and often contribute to thinning of the horny layer. Mechanically, the skin is thus more fragile and more susceptible to sunburn. You are thus advised to apply your treatments in the evening and use a high-protection sun cream as a precautionary measure.

Woman under the sun with a hat

Microbiome and antimicrobial resistance

The use of antibiotics as monotherapy for acne, i.e. not in combination with another molecule, can have negative effects on the skin flora if applied topically and on the bacterial flora in general if taken orally.

Moreover, just like other bacteria, the bacterium responsible for acne can become resistant to treatments. Dermatologists currently know that the balance of the microbiome plays a key role in acne, even though this point remains to be clarified.

The current trend is to limit the use of antibiotics to no more than three months.

 

How long does it take for treatment to work?

Treatment efficacy also depends on several factors, such as compliance (whether or not the patient correctly follows his/her doctor’s advice).

Everyone responds differently, and the suitability of the type of treatment chosen can only be evaluated after a period of three months in general. So be patient! You might see initial results after four weeks, but in most cases, it takes at least two months. 

  • If there is no improvement, your doctor or dermatologist may change strategies, provided he has all the useful and relevant information he needs. Don’t hesitate to tell him which cleansing and moisturising products you use, whether or not you exfoliate your skin, whether you have been exposed to the sun, etc.
  • If your treatment is working, you should continue taking it for several months. You will need to be patient if you want the results to last. Under no circumstances should you stop or reduce your treatment when you start to see improvement!
  • If the side effects are hard to cope with, talk to your doctor about them. He may be able to recommend compensating treatments if necessary.

To maximise the chances of success, there are two rules to follow: do not expose yourself to the sun without solar protection, and most importantly, do not touch your blemishes. Picking and squeezing contribute to inflammation, since your hands are vectors of bacteria and weakened skin is highly subject to scarring.