No matter how mild or brief acne can be, seeking treatment sooner rather than later is key to getting it under control and limiting the chances of permanent scarring. There’s no telling whether a mild case of acne will progress to a more severe form, continue into adulthood or disappear before you can say goodbye to your teen years.

Acne treatments are aimed at achieving a few things: decrease sebum production, kill acne bacteria (P. acnes), help to normalize skin shedding, and fight inflammation.

Nonprescription Medications (OTC)

For mild acne, you can usually try over-the-counter (OTC) acne treatments first before turning to your doctor for help. They are usually milder than prescription-strength products and are readily accessible. OTC acne treatments can include medicated cleansers and topical creams and gels.

Active ingredients usually include salicylic acid or benzoyl peroxide in various concentrations. Salicylic acid boasts anti-inflammatory and peeling action while benzoyl peroxide is known to cause drying and slight peeling, and it kills bacteria. Benzoyl peroxide-based cleansers and creams are available in concentrations of 5 per cent or less; they are available in higher concentrations (10 per cent) by prescription. Whatever you try, it’s important to stick to the treatment for one to two months before you can see a difference. Visit your doctor if you don’t notice improvement within 6-8 weeks.

What you should know:

• Topical medication should be applied to the entire affected area, not just individual pimples.
  
  
• You should also be aware that applying more won’t work better or faster, so apply a thin layer evenly.
  
  
• Use product as directed on the label and as recommended by your doctor.
  
  
• Products containing benzoyl peroxide can make your skin more sensitive to the sun, so reduce your sun exposure and wear sun protection.
  
  
• Apply your acne medication first and let it dry before applying any make-up.
  
  
• Keep using your treatment even after acne has visibly improved in order to prevent new acne from forming.

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Prescription Medications

Prescription-strength acne treatments can include topical formulations, such as antibiotics and retinoids (vitamin A derivatives). Oral (or systemic) medication can include antibiotics, retinoids, or hormonal agents (i.e. birth control pill).

Topical antibiotics (i.e. erythromycin, clindamycin) can be recommended to help control the inflammation associated with the redness and swelling of acne.

Oral antibiotics (i.e. tetracycline, minocycline) are usually indicated for moderate to severe acne of the chest, back, and shoulders. They work by reducing the presence of P. acnes bacteria.

What you should know:

• Generally, topical antibiotics aren’t recommended for long-term treatment, since there is a tendency for antibiotic resistance to occur with prolonged use —meaning that treatment is no longer effective in killing acne bacteria.
  
  
• Often, your doctor may prescribe a combination product that contains both benzoyl peroxide and a topical antibiotic.

Hormonal agents such as oral contraceptives (OCs) are recommended for moderate to severe acne (e.g. cystic) after other treatments have failed. Often used for acne that begins or worsens in adulthood. Acne that responds well to OCs is the type of acne that flares up in the “premenstrual” part of the cycle and acne that occurs along the jaw line, which is usually hormonal.

What you should know:

• Acne may worsen in the first one to three months of treatment.
  
  
• You shouldn’t take this kind of medication if you are pregnant, since hormonal agents can cause birth defects.
  
  
• Cigarette smoking increases the risk of serious adverse effects on the heart and blood vessels from use of these hormonal agents.
  
  
• Hormonal agents and oral contraceptives are generally not recommended for women over 35.

Retinoids (vitamin A derivatives) are prescribed only to treat severe cases of acne that doe not respond well to other treatment options. They are available in both topical and oral forms. Topical retinoids (i.e. tretinoin, adapalene, tazarotene) help skin cells turn over more efficiently and reduce inflammation. Oral forms (i.e. isotretinoin) are reserved for the most stubborn cases of severe acne.

What you should know:

• Isotretinoin products must not be used during pregnancy due to the risk of severe birth defects and miscarriage when used for any length of time. (Health Canada warns that taking even a single dose can affect a developing fetus.)
  
  
• You must avoid pregnancy or breastfeeding while using isotretinoin products, since they may harm a child.
  
  
• When treating women of childbearing age, doctors must strictly follow the manufacturer's risk management program, including educating the patient about potential risks of this drug; information about birth control options; and having the patient sign a consent form, among other things.
  
  
• Oral isotretinoin products have been linked to depression and even suicide in some people. They can also increase your chances of developing diabetes, liver disease or heart disease in those with a family history.
  
  
• Isotretinoin products may also increase your skin's sensitivity to the sun and cause reduced night vision, which can come on suddenly.
  
  
• Topical retinoids can cause redness and peeling, so you should avoid using them near the eyes, mouth or nose.

Why it is important to stick with treatment

Once your doctor has prescribed a treatment for you, you should use it properly and keep using it for as long as your doctor recommends. Many kinds of acne medication initially cause dryness, visible peeling, flaking, redness, irritation, and/or possibly even acne flare-ups. In some cases, acne can get worse before it gets better. Any of these unwanted effects can lead some patients to stop treatment early and even report to their doctor that it isn’t working. That’s why it’s vital to ask and understand why your doctor prescribed a certain treatment, how to use it, how long to use it, what results to expect and when you can expect to see an improvement in your skin.

Your doctor may suggest easing into a treatment regimen to allow your skin to get used to it. For example, s/he may advise you to apply a topical treatment for 15 minutes at first, then double the time daily until you get to four hours. Your skin should be used to the product by then, so you should be able to apply and leave it on all day or night without any significant irritation. An alternative approach is to alternate the days you use a product, so you would use it one night and skip it the next night until your skin gets used to it. Any skin irritation due to treatment should subside after a few days of use.