People of any age can experience acne and most people have acne at some time in their lives. Frequently, acne occurs during puberty and in conjunction with a woman's menstrual cycle due to an increase in hormone production.

The skin contains many tiny hair follicles, or pores. Each pore contains a hair and a multi-lobed gland called a sebaceous gland. Sebaceous glands produce an oily substance called sebum, which normally travels up the pore to lubricate the hair and skin. Acne develops when a pore becomes clogged with excess sebum and dead skin cells. If the pore is partially clogged but the pathway to the skin's surface remains open, the dark surface of the dried sebum is called a blackhead.

However, if the pathway to the skin's surface is blocked, the pore becomes infected and inflamed, resulting in a red, swollen, pus-filled bump called a pimple. The deeper and more serious infections may result in hard nodules under the skin's surface called cysts.

In order to treat acne and prevent successfully it is vital to understand the pathological process behind acne as treatment is tailored according the to stage and grade of the condition.

Procedural treatments. These are used in the treatment of mild to severe acne, depending on the treatment. Procedural therapies are meant to be supportive and used in conjunction with topical and/or systemic treatments.

Comedo extractions - Often performed by therapists during a facial, comedo extractions involve gently coaxing plugs of sebum and cellular debris from the pore. By removing blackheads, milia, and soft closed comedones the overall number of breakouts can be reduced.

Light chemical peels - Despite the name, light chemical peels do not "peel" the skin. Instead, they deeply exfoliate the skin using an alpha-hydroxy, beta-hydroxy, glycolic acids or TCAs. Light chemical peels may greatly improve acne by removing dead skin cells and helping to clear pores of debris. Glycolics (AHA/BHA/PHAs) may be incorporated into a facial for those with mild to moderate acne. We often prescribe glycolic / AHA / PHA creams and a high potency facial wash for home in conjunction with the chemical peels.

Microdermabrasion - This treatment may be performed at a skin spa or your dermatologist's office. A machine is used to rapidly discharge super-fine crystals over the skin's surface, blasting away dead skin cells. It is best for those who have non-inflamed acne, with many blackheads and/or whiteheads.

Phototherapy - Phototherapy is the term used to describe any treatment utilizing laser or light. They work by killing P. acnes, reducing inflammation, or shrinking the sebaceous glands, depending on what therapy is used. There are many different light and laser treatments available including blue light, red light, and photodynamic therapy. Phototherapy can be used to treat all stages of acne, from mild to very severe.

Corticosteroid injections - Cysts are serious lesions that damage skin tissue. Dermatologists can inject a cyst with corticosteroid, reducing inflammation and the chance of scarring. Corticosteroid injections speed healing of the lesion to just a few short days.

Topical treatments available over-the-counter include:

Salicylic acid
Benzoyl peroxide
Sulfur
Resorcinol

Topical treatments available by prescription include:

Azelaic acid
Topical retinoids - adapalene, tazarotene, tretinoin
Topical antibiotics - clindamycin, erythromycin, sulfacetamide
Systemic Acne Treatment Options
Prescription strength benzyl peroxide, antibiotic sets

Systemic treatments work internally.
They may be taken orally, as in pill form, or be injected into the skin. Severe acne and cystic acne must be treated systemically. Systemic treatments may also be used in cases of moderate acne when topical treatments are not enough. Systemic acne treatments are available by prescription only, and are often used in conjunction with topical treatments. Systemic acne treatment medications include:

Oral antibiotics - erythromycin, tetracycline, minocycline, doxycycline Hormonal treatments - birth control pills, spironolactone Isotretinoin - sold under the brand names Amnesteem, Claravis, Sotret (and formerly sold as Accutane)